Grays Harbor County EMS Protocols
Exam With Practice Questions And
Correct Answers (Verif
1. A patient with suspected opioid overdose presents with agonal respirations and a
suspected fentanyl analog exposure. According to Grays Harbor County EMS
protocols, which intervention sequence is most appropriate after ensuring scene safety
and PPE?
A. Administer naloxone 4 mg intranasally, provide bag-valve-mask ventilations, and
transport immediately.
B. Administer naloxone 0.4 mg intramuscularly, establish IV access, and administer 2 L
saline bolus.
C. Provide high-flow oxygen, initiate CPAP, and withhold naloxone until hospital arrival.
D. Administer naloxone 2 mg intranasally, observe for 5 minutes, and repeat if no
improvement before ventilating.
Answer: A. Administer naloxone 4 mg intranasally, provide bag-valve-mask
ventilations, and transport immediately.
Rationale: Current county protocols prioritize intranasal naloxone at higher doses (4 mg)
due to potent synthetic opioids, combined with immediate BVM ventilation for agonal
respirations. Option D delays ventilation, which is critical; Option B uses an outdated low
IM dose and unnecessary fluid bolus; Option C withholds an indicated antidote.
Page 1 of 79
,2. A 12-lead ECG shows a regular narrow-complex tachycardia at 180 bpm with no
visible P waves, and the patient is hemodynamically stable but symptomatic. Per
Grays Harbor County protocols, which intervention is indicated FIRST?
A. Synchronized cardioversion at 100 J
B. Adenosine 6 mg rapid IV push followed by saline flush
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers and observation
Answer: D. Vagal maneuvers and observation
Rationale: For stable, symptomatic SVT, protocols recommend starting with vagal
maneuvers (e.g., Valsalva) before pharmacological intervention. Adenosine is subsequent if
vagal maneuvers fail; cardioversion is reserved for instability; amiodarone is not first-line
for stable SVT.
Page 2 of 79
,3. During a mass-casualty incident with a hazardous material spill, which triage
system does Grays Harbor County EMS utilize, and what is the correct initial action
for a patient with respiratory rate 32, radial pulse absent, and unable to follow
commands?
A. START triage; immediate (red) category
B. JumpSTART triage; delayed (yellow) category
C. SALT triage; expectant (black) category
D. START triage; minor (green) category
Answer: A. START triage; immediate (red) category
Rationale: Grays Harbor County uses START triage for adult mass-casualty incidents. A
respiratory rate >30, absent radial pulse, and altered mental status meet immediate (red)
criteria. JumpSTART is pediatric; SALT is an alternative but not county standard; green
indicates minor injuries.
4. A patient with severe asthma exacerbation has received albuterol via nebulizer with
minimal improvement. According to Grays Harbor County protocols, which adjunct
medication is indicated next, and what is the correct dose?
A. Epinephrine 1:1000, 0.3 mg IM
B. Ipratropium bromide 0.5 mg nebulized
C. Methylprednisolone 125 mg IV
D. Magnesium sulfate 2 g IV over 20 minutes
Answer: B. Ipratropium bromide 0.5 mg nebulized
Rationale: Protocols recommend adding ipratropium bromide to albuterol for severe
asthma not responding to beta-agonists alone. Epinephrine is reserved for anaphylaxis or
impending respiratory failure; steroids and magnesium are later considerations or
hospital-based.
Page 3 of 79
, 5. Which statement accurately reflects Grays Harbor County EMS protocols
regarding termination of resuscitation (TOR) in the field for a medical cardiac arrest?
A. TOR is permissible after 20 minutes of ACLS with asystole and no reversible causes.
B. TOR requires online medical control approval in all cases.
C. TOR is contraindicated if the arrest was witnessed by EMS.
D. TOR may be considered after 30 minutes of ACLS, including 3 rounds of
epinephrine, with asystole and no ROSC.
Answer: D. TOR may be considered after 30 minutes of ACLS, including 3 rounds of
epinephrine, with asystole and no ROSC.
Rationale: County protocols allow TOR after 30 minutes of ACLS, including at least 3
rounds of epinephrine, persistent asystole, and no reversible causes. Option A is too short;
Option B is not universally required; Option C is incorrect as witnessed arrest does not
preclude TOR.
6. A patient with suspected cervical spine injury requires airway management. Per
Grays Harbor County protocols, which technique is preferred for endotracheal
intubation while maintaining spinal motion restriction?
A. Orotracheal intubation with manual in-line stabilization
B. Nasotracheal intubation with head tilt
C. Surgical cricothyrotomy as first-line
D. Supraglottic airway placement without stabilization
Answer: A. Orotracheal intubation with manual in-line stabilization
Rationale: Manual in-line stabilization during orotracheal intubation is the standard to
minimize cervical movement. Nasotracheal intubation with head tilt is contraindicated;
cricothyrotomy is a rescue technique; supraglottic airways do not require stabilization but
are not preferred for definitive airway.
Page 4 of 79
Exam With Practice Questions And
Correct Answers (Verif
1. A patient with suspected opioid overdose presents with agonal respirations and a
suspected fentanyl analog exposure. According to Grays Harbor County EMS
protocols, which intervention sequence is most appropriate after ensuring scene safety
and PPE?
A. Administer naloxone 4 mg intranasally, provide bag-valve-mask ventilations, and
transport immediately.
B. Administer naloxone 0.4 mg intramuscularly, establish IV access, and administer 2 L
saline bolus.
C. Provide high-flow oxygen, initiate CPAP, and withhold naloxone until hospital arrival.
D. Administer naloxone 2 mg intranasally, observe for 5 minutes, and repeat if no
improvement before ventilating.
Answer: A. Administer naloxone 4 mg intranasally, provide bag-valve-mask
ventilations, and transport immediately.
Rationale: Current county protocols prioritize intranasal naloxone at higher doses (4 mg)
due to potent synthetic opioids, combined with immediate BVM ventilation for agonal
respirations. Option D delays ventilation, which is critical; Option B uses an outdated low
IM dose and unnecessary fluid bolus; Option C withholds an indicated antidote.
Page 1 of 79
,2. A 12-lead ECG shows a regular narrow-complex tachycardia at 180 bpm with no
visible P waves, and the patient is hemodynamically stable but symptomatic. Per
Grays Harbor County protocols, which intervention is indicated FIRST?
A. Synchronized cardioversion at 100 J
B. Adenosine 6 mg rapid IV push followed by saline flush
C. Amiodarone 150 mg IV over 10 minutes
D. Vagal maneuvers and observation
Answer: D. Vagal maneuvers and observation
Rationale: For stable, symptomatic SVT, protocols recommend starting with vagal
maneuvers (e.g., Valsalva) before pharmacological intervention. Adenosine is subsequent if
vagal maneuvers fail; cardioversion is reserved for instability; amiodarone is not first-line
for stable SVT.
Page 2 of 79
,3. During a mass-casualty incident with a hazardous material spill, which triage
system does Grays Harbor County EMS utilize, and what is the correct initial action
for a patient with respiratory rate 32, radial pulse absent, and unable to follow
commands?
A. START triage; immediate (red) category
B. JumpSTART triage; delayed (yellow) category
C. SALT triage; expectant (black) category
D. START triage; minor (green) category
Answer: A. START triage; immediate (red) category
Rationale: Grays Harbor County uses START triage for adult mass-casualty incidents. A
respiratory rate >30, absent radial pulse, and altered mental status meet immediate (red)
criteria. JumpSTART is pediatric; SALT is an alternative but not county standard; green
indicates minor injuries.
4. A patient with severe asthma exacerbation has received albuterol via nebulizer with
minimal improvement. According to Grays Harbor County protocols, which adjunct
medication is indicated next, and what is the correct dose?
A. Epinephrine 1:1000, 0.3 mg IM
B. Ipratropium bromide 0.5 mg nebulized
C. Methylprednisolone 125 mg IV
D. Magnesium sulfate 2 g IV over 20 minutes
Answer: B. Ipratropium bromide 0.5 mg nebulized
Rationale: Protocols recommend adding ipratropium bromide to albuterol for severe
asthma not responding to beta-agonists alone. Epinephrine is reserved for anaphylaxis or
impending respiratory failure; steroids and magnesium are later considerations or
hospital-based.
Page 3 of 79
, 5. Which statement accurately reflects Grays Harbor County EMS protocols
regarding termination of resuscitation (TOR) in the field for a medical cardiac arrest?
A. TOR is permissible after 20 minutes of ACLS with asystole and no reversible causes.
B. TOR requires online medical control approval in all cases.
C. TOR is contraindicated if the arrest was witnessed by EMS.
D. TOR may be considered after 30 minutes of ACLS, including 3 rounds of
epinephrine, with asystole and no ROSC.
Answer: D. TOR may be considered after 30 minutes of ACLS, including 3 rounds of
epinephrine, with asystole and no ROSC.
Rationale: County protocols allow TOR after 30 minutes of ACLS, including at least 3
rounds of epinephrine, persistent asystole, and no reversible causes. Option A is too short;
Option B is not universally required; Option C is incorrect as witnessed arrest does not
preclude TOR.
6. A patient with suspected cervical spine injury requires airway management. Per
Grays Harbor County protocols, which technique is preferred for endotracheal
intubation while maintaining spinal motion restriction?
A. Orotracheal intubation with manual in-line stabilization
B. Nasotracheal intubation with head tilt
C. Surgical cricothyrotomy as first-line
D. Supraglottic airway placement without stabilization
Answer: A. Orotracheal intubation with manual in-line stabilization
Rationale: Manual in-line stabilization during orotracheal intubation is the standard to
minimize cervical movement. Nasotracheal intubation with head tilt is contraindicated;
cricothyrotomy is a rescue technique; supraglottic airways do not require stabilization but
are not preferred for definitive airway.
Page 4 of 79
