EMS Delaware Protocols 2025| 100 QUESTIONS| WITH COMPLETE SOLUTIONS
Course
EMS Protocols
Question 1
According to Delaware BLS protocols, when should you assist a patient with nitroglycerin
(NTG) for chest pain? What precautions or contraindications must you check first?
Answer / Explanation
You may assist with NTG if:
The patient is prescribed NTG,
Their systolic blood pressure is above the safe threshold (≥ 90 mmHg, depending on local
policy),
They have not taken phosphodiesterase-5 inhibitors (e.g. for erectile dysfunction) in the
past 48 hours,
They are not suspected to have a right ventricular infarct, or other contraindications.
Precautions:
Always re-check blood pressure prior to each dose (to ensure it didn't drop too low).
Limit the number of doses (often 3–5) as per Delaware protocol.
If any contraindications exist, contact medical control before administering.
(Delaware BLS protocol mentions nitrates under cardiac / chest pain section. )
Question 2
In the Delaware ALS protocol, what is the maximum duration (in seconds) that a paramedic’s
radio/telephone report to medical control should take? Why is there such a limit?
Answer / Explanation
The paramedic report to medical control should not exceed 30 seconds in duration.
Reasoning / Rationale:
The limit ensures brevity and clarity, avoiding unnecessary delay in communication.
It helps medical control receive essential information quickly, so guidance and orders can
be given without excessive radio time.
, Overlong reports risk losing critical details or confusing communication channels in
emergency operations.
Question 3
Delaware classifies patient priority levels (Priority I, II, III). Define each priority, and give one
example scenario for Priority II.
Answer / Explanation
Definitions:
Priority I: A patient with an immediate life- or limb-threatening injury or illness.
Priority II: A patient whose injury or illness, if left untreated, could potentially threaten
life or limb.
Priority III: A patient who requires medical attention but whose condition is not life- or
limb-threatening.
Example for Priority II:
A patient with moderate chest pain and stable vital signs but showing signs of cardiac ischemia
(e.g., ECG changes), or a patient with a fracture with neurovascular compromise but not yet in
critical condition.
Question 4
Under Delaware protocols, how long do you have to complete the Patient Care Report (PCR)
after concluding patient transfer? What is the exception?
Answer / Explanation
You must complete the PCR within 4 hours of patient delivery (or prior to leaving the receiving
facility).
Exception: Some calls categorized as “service calls” or “public assist” may not require a full
PCR in the same timeframe (depending on local policy).
Question 5
A 12-year-old child presents with acute wheezing, retractions, and tachypnea. According to
Delaware EMS protocols (pediatric respiratory distress), what are the initial steps you should
follow? Name at least 4.
Answer / Explanation
Initial steps for pediatric acute respiratory distress in Delaware:
, 1. Perform a pediatric triangle assessment (appearance, work of breathing, circulation to
skin).
2. Keep the child warm (prevent heat loss).
3. Provide supplemental oxygen to maintain adequate saturation.
4. Use nebulized bronchodilators (e.g., albuterol) if indicated and within protocol.
5. Assess for foreign body obstruction (if suspicion).
6. Consider lower airway disease (e.g. asthma) or other causes.
Question 6
Under the Delaware ALS protocols, list three indications or triggers that require contacting
medical control (OLMC) before or during care.
Answer / Explanation
Three triggers to contact medical control include:
1. When administering IV medications (all require OLMC).
2. In cases of hypertensive crisis (to consider IV labetalol).
3. When the patient’s condition deteriorates or is unstable, or when orders are unclear.
Other triggers:
Requests for unusual therapies (e.g. blood products),
Do-not-resuscitate (DNR) or advance directives questions,
Refusal of transport in certain conditions (if abnormal vitals, altered mental status,
intoxication).
Question 7
What are the criteria under Delaware protocol for terminating resuscitation efforts (i.e.
declaring “Dead on Paramedic Arrival” or DOPA)? Provide at least 4 conditions.
Answer / Explanation
Criteria (some or all must be met based on protocol and medical control) include:
Effective CPR has been ongoing for at least 20 minutes without ROSC (return of
spontaneous circulation).
Advanced airway is in place, with end-tidal CO₂ (EtCO₂) less than 10 mmHg.
Course
EMS Protocols
Question 1
According to Delaware BLS protocols, when should you assist a patient with nitroglycerin
(NTG) for chest pain? What precautions or contraindications must you check first?
Answer / Explanation
You may assist with NTG if:
The patient is prescribed NTG,
Their systolic blood pressure is above the safe threshold (≥ 90 mmHg, depending on local
policy),
They have not taken phosphodiesterase-5 inhibitors (e.g. for erectile dysfunction) in the
past 48 hours,
They are not suspected to have a right ventricular infarct, or other contraindications.
Precautions:
Always re-check blood pressure prior to each dose (to ensure it didn't drop too low).
Limit the number of doses (often 3–5) as per Delaware protocol.
If any contraindications exist, contact medical control before administering.
(Delaware BLS protocol mentions nitrates under cardiac / chest pain section. )
Question 2
In the Delaware ALS protocol, what is the maximum duration (in seconds) that a paramedic’s
radio/telephone report to medical control should take? Why is there such a limit?
Answer / Explanation
The paramedic report to medical control should not exceed 30 seconds in duration.
Reasoning / Rationale:
The limit ensures brevity and clarity, avoiding unnecessary delay in communication.
It helps medical control receive essential information quickly, so guidance and orders can
be given without excessive radio time.
, Overlong reports risk losing critical details or confusing communication channels in
emergency operations.
Question 3
Delaware classifies patient priority levels (Priority I, II, III). Define each priority, and give one
example scenario for Priority II.
Answer / Explanation
Definitions:
Priority I: A patient with an immediate life- or limb-threatening injury or illness.
Priority II: A patient whose injury or illness, if left untreated, could potentially threaten
life or limb.
Priority III: A patient who requires medical attention but whose condition is not life- or
limb-threatening.
Example for Priority II:
A patient with moderate chest pain and stable vital signs but showing signs of cardiac ischemia
(e.g., ECG changes), or a patient with a fracture with neurovascular compromise but not yet in
critical condition.
Question 4
Under Delaware protocols, how long do you have to complete the Patient Care Report (PCR)
after concluding patient transfer? What is the exception?
Answer / Explanation
You must complete the PCR within 4 hours of patient delivery (or prior to leaving the receiving
facility).
Exception: Some calls categorized as “service calls” or “public assist” may not require a full
PCR in the same timeframe (depending on local policy).
Question 5
A 12-year-old child presents with acute wheezing, retractions, and tachypnea. According to
Delaware EMS protocols (pediatric respiratory distress), what are the initial steps you should
follow? Name at least 4.
Answer / Explanation
Initial steps for pediatric acute respiratory distress in Delaware:
, 1. Perform a pediatric triangle assessment (appearance, work of breathing, circulation to
skin).
2. Keep the child warm (prevent heat loss).
3. Provide supplemental oxygen to maintain adequate saturation.
4. Use nebulized bronchodilators (e.g., albuterol) if indicated and within protocol.
5. Assess for foreign body obstruction (if suspicion).
6. Consider lower airway disease (e.g. asthma) or other causes.
Question 6
Under the Delaware ALS protocols, list three indications or triggers that require contacting
medical control (OLMC) before or during care.
Answer / Explanation
Three triggers to contact medical control include:
1. When administering IV medications (all require OLMC).
2. In cases of hypertensive crisis (to consider IV labetalol).
3. When the patient’s condition deteriorates or is unstable, or when orders are unclear.
Other triggers:
Requests for unusual therapies (e.g. blood products),
Do-not-resuscitate (DNR) or advance directives questions,
Refusal of transport in certain conditions (if abnormal vitals, altered mental status,
intoxication).
Question 7
What are the criteria under Delaware protocol for terminating resuscitation efforts (i.e.
declaring “Dead on Paramedic Arrival” or DOPA)? Provide at least 4 conditions.
Answer / Explanation
Criteria (some or all must be met based on protocol and medical control) include:
Effective CPR has been ongoing for at least 20 minutes without ROSC (return of
spontaneous circulation).
Advanced airway is in place, with end-tidal CO₂ (EtCO₂) less than 10 mmHg.
