Jefferson County EMS Protocols Exam
With Practice Questions And Correct
Answers (Verified
1. A patient with severe sepsis is being transported under Jefferson County EMS
protocol. The protocol mandates a 30 mL/kg crystalloid bolus for hypotension, but the
patient has a documented history of heart failure with reduced ejection fraction
(HFrEF). Which of the following best describes the protocol's recommended
modification?
A. Administer the full 30 mL/kg bolus rapidly, then initiate norepinephrine if
hypotension persists.
B. Reduce the bolus to 10 mL/kg and reassess after each 250 mL for signs of pulmonary
edema.
C. Withhold all IV fluids and administer push-dose epinephrine for permissive
hypotension.
D. Give 500 mL wide open and place the patient in Trendelenburg position to improve
preload.
Answer: B. Reduce the bolus to 10 mL/kg and reassess after each 250 mL for signs of
pulmonary edema.
Rationale: Jefferson County EMS sepsis protocol for HFrEF patients recommends a
reduced initial bolus (10 mL/kg) with frequent reassessment for fluid overload. Full bolus
(A) risks pulmonary edema; withholding fluids (C) contradicts sepsis guidelines;
Trendelenburg (D) is not recommended and can worsen respiratory status.
Page 1 of 78
,2. During a mass-casualty incident, a paramedic is assigned to the treatment area.
According to Jefferson County EMS triage protocol, which patient should be
prioritized for immediate transport when resources are limited?
A. A patient with a Glasgow Coma Scale of 6 and agonal respirations.
B. A patient with a penetrating chest wound and absent radial pulses but palpable carotid.
C. A patient with bilateral femur fractures and a blood pressure of 90/60 mmHg.
D. A patient with a superficial laceration and a history of asthma.
Answer: B. A patient with a penetrating chest wound and absent radial pulses but
palpable carotid.
Rationale: Under the county's SALT triage, patients with life-threatening but survivable
injuries (e.g., tension pneumothorax, hemorrhagic shock) are prioritized as 'Immediate'
(Red). Agonal respirations (A) are 'Expectant' (Black); bilateral femur fractures (C) are
'Delayed' (Yellow); minor laceration (D) is 'Minor' (Green).
Page 2 of 78
,3. A patient with refractory ventricular fibrillation has received three defibrillation
attempts, epinephrine, and amiodarone per Jefferson County EMS protocol. Which of
the following is the next recommended antiarrhythmic according to the current county
protocol?
A. Lidocaine 1.5 mg/kg IV/IO
B. Magnesium sulfate 2 g IV/IO
C. Sodium bicarbonate 1 mEq/kg IV/IO
D. Procainamide 20 mg/min IV/IO
Answer: A. Lidocaine 1.5 mg/kg IV/IO
Rationale: The Jefferson County EMS protocol follows ACLS guidelines where lidocaine is
the second-line antiarrhythmic after amiodarone for VF/pVT. Magnesium (B) is for
torsades de pointes; sodium bicarbonate (C) is for hyperkalemia or TCA overdose;
procainamide (D) is for stable monomorphic VT, not cardiac arrest.
4. A patient with suspected cervical spine injury requires endotracheal intubation.
According to Jefferson County EMS protocol, which technique is preferred to
minimize cervical movement during laryngoscopy?
A. Manual in-line stabilization with video laryngoscopy.
B. Cervical collar removal and direct laryngoscopy.
C. Traction applied to the head while using a Macintosh blade.
D. Awake fiberoptic intubation without stabilization.
Answer: A. Manual in-line stabilization with video laryngoscopy.
Rationale: Jefferson County EMS protocol mandates manual in-line stabilization combined
with video laryngoscopy to reduce cervical spine motion. Removing the collar (B) increases
risk; traction (C) is contraindicated; awake fiberoptic (D) is not a prehospital protocol.
Page 3 of 78
, 5. A patient with severe asthma exacerbation is unresponsive to albuterol and
ipratropium. The Jefferson County EMS protocol recommends which adjunctive
therapy for impending respiratory failure?
A. Magnesium sulfate 2 g IV over 20 minutes.
B. Methylprednisolone 125 mg IV push.
C. Epinephrine 1 mg IV push.
D. Heliox 70:30 via non-rebreather.
Answer: A. Magnesium sulfate 2 g IV over 20 minutes.
Rationale: The county protocol includes magnesium sulfate as a bronchodilator for severe
asthma not responding to first-line therapy. Methylprednisolone (B) is anti-inflammatory
but not immediate; IV epinephrine (C) is not recommended due to arrhythmia risk; heliox
(D) is not in the protocol.
6. A patient with a suspected opioid overdose presents with respiratory depression.
After administering naloxone per Jefferson County EMS protocol, the patient
becomes combative and diaphoretic. Which of the following is the most appropriate
next action?
A. Administer a second dose of naloxone to fully reverse symptoms.
B. Apply physical restraints and transport immediately.
C. Provide supportive care and monitor for re-sedation.
D. Administer flumazenil to counteract benzodiazepine co-ingestion.
Answer: C. Provide supportive care and monitor for re-sedation.
Rationale: The goal of naloxone is to restore adequate ventilation, not full alertness;
agitation is a sign of over-reversal. Supportive care and monitoring (C) are correct.
Additional naloxone (A) worsens withdrawal; restraints (B) may be needed but not first;
flumazenil (D) is contraindicated in mixed overdoses.
Page 4 of 78
With Practice Questions And Correct
Answers (Verified
1. A patient with severe sepsis is being transported under Jefferson County EMS
protocol. The protocol mandates a 30 mL/kg crystalloid bolus for hypotension, but the
patient has a documented history of heart failure with reduced ejection fraction
(HFrEF). Which of the following best describes the protocol's recommended
modification?
A. Administer the full 30 mL/kg bolus rapidly, then initiate norepinephrine if
hypotension persists.
B. Reduce the bolus to 10 mL/kg and reassess after each 250 mL for signs of pulmonary
edema.
C. Withhold all IV fluids and administer push-dose epinephrine for permissive
hypotension.
D. Give 500 mL wide open and place the patient in Trendelenburg position to improve
preload.
Answer: B. Reduce the bolus to 10 mL/kg and reassess after each 250 mL for signs of
pulmonary edema.
Rationale: Jefferson County EMS sepsis protocol for HFrEF patients recommends a
reduced initial bolus (10 mL/kg) with frequent reassessment for fluid overload. Full bolus
(A) risks pulmonary edema; withholding fluids (C) contradicts sepsis guidelines;
Trendelenburg (D) is not recommended and can worsen respiratory status.
Page 1 of 78
,2. During a mass-casualty incident, a paramedic is assigned to the treatment area.
According to Jefferson County EMS triage protocol, which patient should be
prioritized for immediate transport when resources are limited?
A. A patient with a Glasgow Coma Scale of 6 and agonal respirations.
B. A patient with a penetrating chest wound and absent radial pulses but palpable carotid.
C. A patient with bilateral femur fractures and a blood pressure of 90/60 mmHg.
D. A patient with a superficial laceration and a history of asthma.
Answer: B. A patient with a penetrating chest wound and absent radial pulses but
palpable carotid.
Rationale: Under the county's SALT triage, patients with life-threatening but survivable
injuries (e.g., tension pneumothorax, hemorrhagic shock) are prioritized as 'Immediate'
(Red). Agonal respirations (A) are 'Expectant' (Black); bilateral femur fractures (C) are
'Delayed' (Yellow); minor laceration (D) is 'Minor' (Green).
Page 2 of 78
,3. A patient with refractory ventricular fibrillation has received three defibrillation
attempts, epinephrine, and amiodarone per Jefferson County EMS protocol. Which of
the following is the next recommended antiarrhythmic according to the current county
protocol?
A. Lidocaine 1.5 mg/kg IV/IO
B. Magnesium sulfate 2 g IV/IO
C. Sodium bicarbonate 1 mEq/kg IV/IO
D. Procainamide 20 mg/min IV/IO
Answer: A. Lidocaine 1.5 mg/kg IV/IO
Rationale: The Jefferson County EMS protocol follows ACLS guidelines where lidocaine is
the second-line antiarrhythmic after amiodarone for VF/pVT. Magnesium (B) is for
torsades de pointes; sodium bicarbonate (C) is for hyperkalemia or TCA overdose;
procainamide (D) is for stable monomorphic VT, not cardiac arrest.
4. A patient with suspected cervical spine injury requires endotracheal intubation.
According to Jefferson County EMS protocol, which technique is preferred to
minimize cervical movement during laryngoscopy?
A. Manual in-line stabilization with video laryngoscopy.
B. Cervical collar removal and direct laryngoscopy.
C. Traction applied to the head while using a Macintosh blade.
D. Awake fiberoptic intubation without stabilization.
Answer: A. Manual in-line stabilization with video laryngoscopy.
Rationale: Jefferson County EMS protocol mandates manual in-line stabilization combined
with video laryngoscopy to reduce cervical spine motion. Removing the collar (B) increases
risk; traction (C) is contraindicated; awake fiberoptic (D) is not a prehospital protocol.
Page 3 of 78
, 5. A patient with severe asthma exacerbation is unresponsive to albuterol and
ipratropium. The Jefferson County EMS protocol recommends which adjunctive
therapy for impending respiratory failure?
A. Magnesium sulfate 2 g IV over 20 minutes.
B. Methylprednisolone 125 mg IV push.
C. Epinephrine 1 mg IV push.
D. Heliox 70:30 via non-rebreather.
Answer: A. Magnesium sulfate 2 g IV over 20 minutes.
Rationale: The county protocol includes magnesium sulfate as a bronchodilator for severe
asthma not responding to first-line therapy. Methylprednisolone (B) is anti-inflammatory
but not immediate; IV epinephrine (C) is not recommended due to arrhythmia risk; heliox
(D) is not in the protocol.
6. A patient with a suspected opioid overdose presents with respiratory depression.
After administering naloxone per Jefferson County EMS protocol, the patient
becomes combative and diaphoretic. Which of the following is the most appropriate
next action?
A. Administer a second dose of naloxone to fully reverse symptoms.
B. Apply physical restraints and transport immediately.
C. Provide supportive care and monitor for re-sedation.
D. Administer flumazenil to counteract benzodiazepine co-ingestion.
Answer: C. Provide supportive care and monitor for re-sedation.
Rationale: The goal of naloxone is to restore adequate ventilation, not full alertness;
agitation is a sign of over-reversal. Supportive care and monitoring (C) are correct.
Additional naloxone (A) worsens withdrawal; restraints (B) may be needed but not first;
flumazenil (D) is contraindicated in mixed overdoses.
Page 4 of 78
