Kitsap County EMS Protocols Exam With
Practice Questions And Correct Answers
(Verified An
1. A patient presents with suspected opioid overdose and inadequate respiration.
According to Kitsap County EMS protocols, which intervention is prioritized after
initial airway management?
A. Administer naloxone 0.4 mg IV/IO, repeat every 2 minutes as needed.
B. Administer naloxone 2 mg intranasal, repeat every 3 minutes as needed.
C. Administer naloxone 0.4 mg IM, repeat every 5 minutes as needed.
D. Administer naloxone 0.8 mg IV/IO, repeat every 5 minutes as needed.
Answer: B. Administer naloxone 2 mg intranasal, repeat every 3 minutes as needed.
Rationale: Kitsap County EMS protocols prioritize intranasal naloxone at 2 mg due to ease
of administration and rapid onset in prehospital settings. IV/IO routes are reserved for
cases with established access, and doses of 0.4 mg are outdated. IM administration has
slower onset and is not first-line.
2. During a mass casualty incident, which triage system does Kitsap County EMS
utilize for prioritizing patients?
A. START triage
B. JumpSTART triage
C. SALT triage
D. ESI triage
Answer: C. SALT triage
Rationale: Kitsap County EMS has adopted SALT (Sort, Assess, Lifesaving Interventions,
Treatment/Transport) triage for mass casualty incidents, aligning with current national
standards. START and JumpSTART are older systems, and ESI is for emergency
department triage, not prehospital MCI.
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,3. A patient with severe asthma exacerbation is unresponsive to initial albuterol
treatments. According to Kitsap County EMS protocols, which medication is indicated
next?
A. Epinephrine 1:1000, 0.3 mg IM
B. Magnesium sulfate 2 g IV over 10 minutes
C. Methylprednisolone 125 mg IV
D. Ipratropium bromide 0.5 mg nebulized
Answer: B. Magnesium sulfate 2 g IV over 10 minutes
Rationale: Kitsap County EMS protocols recommend magnesium sulfate for severe asthma
exacerbations refractory to beta-agonists due to its bronchodilatory effects. Epinephrine is
reserved for anaphylaxis, steroids have delayed onset, and ipratropium is typically
combined with albuterol initially.
4. A patient with suspected STEMI on 12-lead ECG is being transported. Which
destination protocol does Kitsap County EMS mandate?
A. Nearest emergency department regardless of PCI capability
B. Nearest PCI-capable hospital within 90 minutes transport time
C. Nearest hospital with cardiac catheterization lab, even if >90 minutes
D. Transport to a trauma center for stabilization first
Answer: B. Nearest PCI-capable hospital within 90 minutes transport time
Rationale: Kitsap County EMS protocols require transport to a PCI-capable facility if
transport time is within 90 minutes, to ensure timely reperfusion. Transporting to the
nearest ED may delay definitive care, and exceeding 90 minutes is not recommended unless
no PCI center is accessible.
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,5. Which of the following best describes the Kitsap County EMS protocol for
prehospital termination of resuscitation in traumatic cardiac arrest?
A. Termination is permitted after 20 minutes of ACLS with asystole.
B. Termination is permitted after 30 minutes of ACLS with no ROSC.
C. Termination is not permitted; transport is mandatory.
D. Termination is permitted if the patient has no bystander CPR and initial rhythm is
asystole.
Answer: D. Termination is permitted if the patient has no bystander CPR and initial
rhythm is asystole.
Rationale: Kitsap County EMS protocols allow termination of resuscitation in traumatic
arrest when there is no bystander CPR and the initial rhythm is asystole, as survival is
negligible. Other options do not reflect the specific criteria or are overly restrictive.
6. A patient with suspected cervical spine injury requires immobilization. Which
device does Kitsap County EMS protocol prefer for transport?
A. Rigid cervical collar alone
B. Cervical collar with long spine board
C. Cervical collar with vacuum mattress
D. Manual stabilization only
Answer: C. Cervical collar with vacuum mattress
Rationale: Kitsap County EMS protocols favor a cervical collar combined with a vacuum
mattress for superior immobilization and patient comfort, reducing pressure ulcers. Long
spine boards are discouraged for prolonged transport due to complications, and manual
stabilization is only temporary.
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, 7. In pediatric patients with symptomatic bradycardia, what is the Kitsap County
EMS protocol for atropine administration?
A. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
B. 0.01 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
C. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 1 mg
D. 0.01 mg/kg IV/IO, minimum dose 0.1 mg, maximum 1 mg
Answer: A. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
Rationale: Kitsap County EMS protocols specify atropine 0.02 mg/kg for pediatric
bradycardia, with a minimum dose of 0.1 mg to avoid paradoxical bradycardia, and a
maximum single dose of 0.5 mg. Other doses are either subtherapeutic or exceed safety
limits.
8. Which of the following is a contraindication to administering nitroglycerin in a
patient with chest pain per Kitsap County EMS protocols?
A. Heart rate 110 bpm
B. Systolic blood pressure 90 mm Hg
C. History of erectile dysfunction
D. Recent use of sildenafil within 24 hours
Answer: D. Recent use of sildenafil within 24 hours
Rationale: Kitsap County EMS protocols contraindicate nitroglycerin if the patient has
taken sildenafil (Viagra) within 24 hours due to risk of severe hypotension. Systolic BP
<100 mm Hg is also a contraindication, but 90 mm Hg is borderline; heart rate >100 is
not absolute, and ED history alone is not contraindicated.
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Practice Questions And Correct Answers
(Verified An
1. A patient presents with suspected opioid overdose and inadequate respiration.
According to Kitsap County EMS protocols, which intervention is prioritized after
initial airway management?
A. Administer naloxone 0.4 mg IV/IO, repeat every 2 minutes as needed.
B. Administer naloxone 2 mg intranasal, repeat every 3 minutes as needed.
C. Administer naloxone 0.4 mg IM, repeat every 5 minutes as needed.
D. Administer naloxone 0.8 mg IV/IO, repeat every 5 minutes as needed.
Answer: B. Administer naloxone 2 mg intranasal, repeat every 3 minutes as needed.
Rationale: Kitsap County EMS protocols prioritize intranasal naloxone at 2 mg due to ease
of administration and rapid onset in prehospital settings. IV/IO routes are reserved for
cases with established access, and doses of 0.4 mg are outdated. IM administration has
slower onset and is not first-line.
2. During a mass casualty incident, which triage system does Kitsap County EMS
utilize for prioritizing patients?
A. START triage
B. JumpSTART triage
C. SALT triage
D. ESI triage
Answer: C. SALT triage
Rationale: Kitsap County EMS has adopted SALT (Sort, Assess, Lifesaving Interventions,
Treatment/Transport) triage for mass casualty incidents, aligning with current national
standards. START and JumpSTART are older systems, and ESI is for emergency
department triage, not prehospital MCI.
Page 1 of 79
,3. A patient with severe asthma exacerbation is unresponsive to initial albuterol
treatments. According to Kitsap County EMS protocols, which medication is indicated
next?
A. Epinephrine 1:1000, 0.3 mg IM
B. Magnesium sulfate 2 g IV over 10 minutes
C. Methylprednisolone 125 mg IV
D. Ipratropium bromide 0.5 mg nebulized
Answer: B. Magnesium sulfate 2 g IV over 10 minutes
Rationale: Kitsap County EMS protocols recommend magnesium sulfate for severe asthma
exacerbations refractory to beta-agonists due to its bronchodilatory effects. Epinephrine is
reserved for anaphylaxis, steroids have delayed onset, and ipratropium is typically
combined with albuterol initially.
4. A patient with suspected STEMI on 12-lead ECG is being transported. Which
destination protocol does Kitsap County EMS mandate?
A. Nearest emergency department regardless of PCI capability
B. Nearest PCI-capable hospital within 90 minutes transport time
C. Nearest hospital with cardiac catheterization lab, even if >90 minutes
D. Transport to a trauma center for stabilization first
Answer: B. Nearest PCI-capable hospital within 90 minutes transport time
Rationale: Kitsap County EMS protocols require transport to a PCI-capable facility if
transport time is within 90 minutes, to ensure timely reperfusion. Transporting to the
nearest ED may delay definitive care, and exceeding 90 minutes is not recommended unless
no PCI center is accessible.
Page 2 of 79
,5. Which of the following best describes the Kitsap County EMS protocol for
prehospital termination of resuscitation in traumatic cardiac arrest?
A. Termination is permitted after 20 minutes of ACLS with asystole.
B. Termination is permitted after 30 minutes of ACLS with no ROSC.
C. Termination is not permitted; transport is mandatory.
D. Termination is permitted if the patient has no bystander CPR and initial rhythm is
asystole.
Answer: D. Termination is permitted if the patient has no bystander CPR and initial
rhythm is asystole.
Rationale: Kitsap County EMS protocols allow termination of resuscitation in traumatic
arrest when there is no bystander CPR and the initial rhythm is asystole, as survival is
negligible. Other options do not reflect the specific criteria or are overly restrictive.
6. A patient with suspected cervical spine injury requires immobilization. Which
device does Kitsap County EMS protocol prefer for transport?
A. Rigid cervical collar alone
B. Cervical collar with long spine board
C. Cervical collar with vacuum mattress
D. Manual stabilization only
Answer: C. Cervical collar with vacuum mattress
Rationale: Kitsap County EMS protocols favor a cervical collar combined with a vacuum
mattress for superior immobilization and patient comfort, reducing pressure ulcers. Long
spine boards are discouraged for prolonged transport due to complications, and manual
stabilization is only temporary.
Page 3 of 79
, 7. In pediatric patients with symptomatic bradycardia, what is the Kitsap County
EMS protocol for atropine administration?
A. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
B. 0.01 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
C. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 1 mg
D. 0.01 mg/kg IV/IO, minimum dose 0.1 mg, maximum 1 mg
Answer: A. 0.02 mg/kg IV/IO, minimum dose 0.1 mg, maximum 0.5 mg
Rationale: Kitsap County EMS protocols specify atropine 0.02 mg/kg for pediatric
bradycardia, with a minimum dose of 0.1 mg to avoid paradoxical bradycardia, and a
maximum single dose of 0.5 mg. Other doses are either subtherapeutic or exceed safety
limits.
8. Which of the following is a contraindication to administering nitroglycerin in a
patient with chest pain per Kitsap County EMS protocols?
A. Heart rate 110 bpm
B. Systolic blood pressure 90 mm Hg
C. History of erectile dysfunction
D. Recent use of sildenafil within 24 hours
Answer: D. Recent use of sildenafil within 24 hours
Rationale: Kitsap County EMS protocols contraindicate nitroglycerin if the patient has
taken sildenafil (Viagra) within 24 hours due to risk of severe hypotension. Systolic BP
<100 mm Hg is also a contraindication, but 90 mm Hg is borderline; heart rate >100 is
not absolute, and ED history alone is not contraindicated.
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