Massachusetts State Protocols EMT

You are treating an 8-year-old child [60lbs] suffering from stridor, tachycardia, and edema to lips, following apparent peanut exposure. What medication intervention would be MOST appropriate?

a)Epinephrine 1:1000 0.3mg SC

b)Diphenhydramine 25mg IV/IO/IN

c)Epinephrine 0.3mg via auto-injector

d)Epinephrine 0.15mg via auto-injector

c) Epinephrine 0.3mg via auto-injector

Protocol 2.2A

When managing a 56-year-old male presenting with confusion, tachycardia, and cool/clammy skin. He has a medical alert bracelet indicating "IDDM," But you do not have a glucometer available. You do not suspect a stroke. What treatment would be MOST appropriate?

a)Oral Glucose 1 tube PO

b)Glucagon 1mg IV/IO/IM/IN

c)Monitoring and transport to emergency department

d)Insulin, in accordance with patient's prescriptions

c) Monitoring and transport to emergency department

Protocol 2.3A

You may assist a patient with suspected Acute Coronary Syndrome with their own nitroglycerin if the patients systolic blood pressure is greater than:

a)90mmHg

b)100mmHg

c)110mmHg

d)120mmHg

d) 120mmHg

Protocol 3.1

There are times EMT's must deviate from STPs in those cases, the "Exception Principle" in 1.0 Routine Patient Care defines the proper procedure. The action must (1) be within the provider scope of practice, (2) providers must be fully trained in the procedure, (3) not be used to circumvent the protocols, and (4):

a)Receive approval from medical control

b)Be within a neighboring state's protocols

c)Recently featured in peer-reviewed EMS research studies

d) Can be done without medical control approval

a) Receive approval from medical control

Protocol 1.0

Which of the following individuals could possible refuse medical care and ambulance transport on behalf of a patient without the capacity to do so themselves?

a)Health care agent listed on proxy form, on scene and presenting proper Health Care Proxy paperwork

b)Patient's family member with no paperwork

c)Patient's neighbor

d)Nursing Assistant in healthcare facility

a) Health care agent listed on proxy form, on scene and presenting proper Health Care Proxy paperwork

Protocol 7.5

Where should the initial assessment and care of a patient begin?

a)After the patient is extricated to the ambulance

b)At the side of the patient, upon initial contact

c)In the emergency department

d)Always in building lobby

b) At the side of the patient, upon initial contact

Protocol 1.0

Which treatments should be provided to a conscious patient who overdosed on a psychiatric medication ten minutes before EMS arrival? (Choose all that apply)

a)Charcoal 1g/kg PO with Medical Control order

b)Ipecac 15-30mL PO

c)Naloxone 2.5mg IV

d)None of the above

d) None of the above

Protocol 2.14

You are treating an unconscious 3-year-old with a heart rate of 30 and hypoperfusion that persists despite assisted ventilation with 100% oxygen. You should:

a)Obtain 12-lead ECG

b)Give the child some warm water to drink

c)Consider initiating chest compressions/CPR

d)Massage the neck to stimulate Vagus nerve

c) Consider initiating chest compressions/CPR

Protocol 3.3P

If diazepam rectal gel (Diastat) has been prescribed for a seizure patient, all levels of EMS personnel may assist a family member or caregiver with the administration in accordance with the physician's instructions.

a)True

b)False

b) False

Protocol 2.15A/P

What medication should be considered when treating a patient who is unresponsive with depressed breathing, and suspected of overdosing on pain medications?

a)Charcoal 12.5g Oral

b)Naloxone 2-4mg Intranasal

c)Fentanyl 1mcg/kg

d)Thiamine 100mg

b) Naloxone 2-4mg Intranasal

Protocol 2.14

You are caring for a 70-year-old male restrained driver in a 35 mile per hour rear-end collision. He is conscious and alert, complaining only of neck pain, and has not been ambulatory on the scene following the accident. Your assessment reveals no life threats. Which of the following procedures would be the MOST appropriate:

a)Stabilization with KED/Seated Immobilization device and transfer to Long Spine Board for transport.

b)Self-extricate and struggle into ambulance, then secured supine on cot.

c)C-collar sized and applied in car, stand/pivot to stretcher, secured to cot with head elevated at 25 degrees and transport.

d)Suggest patient sign and refusal and see a chiropractor next week.

c) C-collar sized and applied in car, stand/pivot to stretcher, secured to cot with head elevated at 25 degrees and transport.

Protocol 4.8

You are transporting a patient who exhibited signs of a stroke less than five hours ago. The patient has 2 positive signs on the FAST-ED scale. With these findings you should:

a)Administer glucagon

b)Lay the patient flat

c)Notify receiving facility of a "Stroke Alert" and consider completing checklist to leave with patient

d)Administer patient's own aspirin

c) Notify receiving facility of a "Stroke Alert" and consider completing checklist to leave with patient

Protocol 2.18

What does a bear icon within a protocol indicate?

a)Provide 1 stuffed teddy bear to patient

b)Pediatric specific order within adult protocol

c)Adult-specific order with pediatric protocol

d)Medication to be administered

b) Pediatric-specific order with adult protocol

Protocol Table of Contents

What icon indicates medical control orders?

a) Radio

b) Hospital

c) Bear

d) Telephone

d) Telephone

Protocol Table of Contents

You are called to a nursing home to transfer a 90-year-old male with difficulty breathing. While receiving the report, the nurse hands you the patient's MOLST form. MOLST stands for:

a) Multi Order Life Support Treatment

b) Manually Operated Lift Support Technique

c) Medical Orders for Life Sustaining Treatment

d) Medicare Ordered Life Sustaining Treatment

c) Medical Orders for Life Sustaining Treatment

Protocol 7.3 1.0

You are dispatched for a male party having chest pain at the Dunkin Donuts. Upon arrival you find a 70yo M experiencing mid-sternum chest pain with an extensive cardiac history. The patient has taken one nitroglycerin tablet sublingually prior to your arrival [PTA] without relief. How many additional nitroglycerin tablets can you assist this patient per protocol?

a) One

b) Two

c) Three

d) Four

b) Two

Protocol 3.1

You are dispatched to the local YMCA for shortness of breath. Upon your arrival, you are led to the basketball court by staff and find an 18yo F with severe shortness of breath. As you perform your medical assessment and obtain SAMPLE/OPQRST you determine that the patient has a medical history of exercise-induced asthma. She states that she has her own prescribed metered-dose inhaler. Upon confirming the Five Patient Rights, you determine that you can assist the patient with her inhaler providing that it is not contraindicated. Which of the following is NOT a contraindication of this protocol?

a) The maximum dose has been prescribed prior to your arrival

b) The patient has taken Viagra within the last 48 hours

c) The patient can not physically use the device properly

d) The device has not specifically been prescribed for this patient

b) The patient has taken Viagra within the last 48 hours

Protocol 2.6A

Newborn infants are prone to hypothermia which may lead to hypoglycemia, hypoxia, and lethargy. Aggressive warming techniques include all of the following with the exception of?

a) Swaddling

b) Heat Packs

c) Drying

d) Warm blankets covering the body and head

b) Heat Packs

Protocol 2.11

You are dispatched to the basement of a single-family home for an unresponsive 34yo M. As you approach the patient you see drug paraphernalia. Your assessment you determine that the patient is in cardiac arrest. What should be administered to the patient in addition to good effective CPR and the application of the AED?

a) Oral Instant Glucose

b) Nitroglycerin

c) Naloxone

d) Metered Dose Inhaler to stimulate breathing

c) Naloxone

Protocol 3.4

You are dispatched for a motor vehicle vs pedestrian. As you assess your patient you find an angulated fracture of the left lower extremity. Further assessment of the injury determines that the patient has no distal pulse in the affected extremity. How should you go about treating this patient?

a) Apply a traction splint

b) Apply gentle traction along the axis of the extremity distal to the injury until the pulse is palpable and immobilize.

c) Apply an air splint in the position found

d) Wrap in a trauma dressing and package for transport

b) Apply gentle traction along the axis of the extremity distal to the injury until the pulse is palpable and immobilize.

Protocol 4.6

You are dispatched for a 56yo F complaining of shortness of breath. Upon gathering the patient's past medical history, it is determined that she has a history of cardiac disease. Can this patient be administered a small volume nebulizer of albuterol?

a) Yes

b) No

b) No

Protocol 6.1

You are dispatched for a flash fire involving a propane grill. Upon your arrival, you find a 37 yo M with second degree burns to his face, chest, and circumferential burns to his upper extremities. Does this patient meet the conditions for Air Medical Transport?

a) Yes

b) No

a) Yes

Protocol 7.1

You encounter a patient within the Bridge to Transplant Program from the local hospital who has an LVAD. The LVAD malfunctions, thus the reason for your call to their residence. The patient appears to be in cardiac arrest. Should this patient receive chest compressions?

a) Yes

b) No

a) Yes

Protocol 7.8

Which of the following is the second component of a valid patient refusal of care?

a) Informed Refusal

b) The Patient's Signature

c) Capacity

d) Implied Refusal

c) Capacity

Protocol 7.5

When providing care to a patient experiencing a CVA/TIA, we should avoid hyperoxygenation. Oxygen administration should be titrated to patient condition, and withheld unless evidence of hypoxemia, dyspnea, or an SPO2 of less than %.

a) 94

b) 99

c) 96

d) 98

a) 94

Protocol 2.18

You respond for a 3yo F who has fallen out of the third story window of an apartment complex who has a controlled airway and is not in cardiac arrest. According to the state's Trauma Point of Entry Plan which receiving facility should this patient be transported to?

a) The closest appropriate Trauma Center which is Level III Trauma Center that is 10 minutes away.

b) By pass the Level III Trauma Center to go to a Level 1 Trauma Center that is 25 minutes away.

c) Transport to the nearest receiving facility which is not a Trauma Center

d) Transport to a certified Stroke Center as the patient will need a CT Scan

a) The closest appropriate Trauma Center which is Level III Trauma Center that is 10 minutes away.

Protocol A4

The Amtrak's Downeaster is approaching the Sutton Street Crossing and derails. The train is carrying 78 passengers. What level of a Multiple Casualty Incident would this be?

a) Level 1

b) Level 2

c) Level 3

d) Level 4

d) Level 4

Protocol 8.2

The local police department deploys their electronic control weapons to apprehend a suspect. During the deployment, the electronic control weapon is embedded in the posterior region of the neck. How should this patient be treated?

a) Have law enforcement remove it.

b) EMS are authorized to remove it.

c) Leave it in place and treat it as an impaled object.

d) Let the patient remove it.

c) Leave it in place and treat it as an impaled object.

Protocol 7.2

Which of the following is not an Exception to the Initiation of Resuscitation?

a) Evident complete destruction of heart or brain

b) Transection of the torso

c) Decapitation

d) Amputation of the arm at the shoulder

d) Amputation of the arm at the shoulder

Protocol 7.7

What does the second A stand for in APGAR?

a) Appearance

b) Activity

c) Ability

d) Absence

a) Appearance

Protocol 2.11

You are dispatched for a patient experiencing a chemical burn. Per protocol, you should wash with copious amounts of clean water and/or sterile normal saline for how long?

a) 2-3 minutes

b) 5-10 minutes

c) 10-15 minutes

d) 30 minutes

c) 10-15 minutes

Protocol 4.1

During Rehab Operations, what is the preferred level of staffing by EMS providers in the rehab operation?

a) EMT

b) First Responder

c) Doctor

d) Paramedic

d) Paramedic

Protocol 8.1

According to the State of Massachusetts Point of Entry Plans an unstable patient is one whose vital signs have significantly changed (either upwards or downwards) from normal ranges, in the absence of interventions.

a) True

b) False

a) True

Protocol A4 1.0

In the care of the New Born, what is the minimum number of inches of the umbilical cord that should be left before cutting

a) 6 inches

b) 2 inches

c) 4 inches

d) 10 inches

a) 6 inches

Protocol 2.11

What is the proper dose of albuterol via a small volume nebulizer to treat bronchospasm in a known asthmatic who is 1.5 yo?

a) Albuterol 1.25mg in 3ml Normal Saline, via nebulizer, x1 dose

b) Albuterol 2.5-3mg in 3ml Normal Saline, via nebulizer, x1 dose

c) Albuterol 3.5mg in 3ml Normal Saline, via nebulizer, x1 dose

d) Albuterol 4mg in 3 ml Normal Saline, via nebulizer, x 1 dose

a) Albuterol 1.25mg in 3ml Normal Saline, via nebulizer, x1 dose

Protocol 6.1

In the patient with an obstructed tracheostomy tube, in whom no effective ventilation/oxygenation is possible; can the EMT remove the tracheostomy tube?

a) True

b) False

a) True

Protocol 5.3

In a patient who is experiencing a flail chest segment and is in respiratory distress the EMT should do which of the following:

a) Splint the chest with a bulky trauma dressing

b) Assist with positive pressure ventilations

c) Apply an occlusive dressing

d) Insert a chest tube

b) Assist with positive pressure ventilations

Protocol 4.9

In a patient who has experienced a closed head injury, at what degree should the patient's head be elevated?

a) 10 - 20 degrees

b) 20 - 30 degrees

c) 30 - 40 degrees

d) 45 degree

b) 20 - 30 degrees

Protocol 4.4

You and your partner are dispatched for an EMS standby of a potential Nerve Agent release. How should all antidotes be administered?

a) IN

b) SQ

c) IM

d) PO

c) IM

Protocol 2.9

According to the question above regarding Nerve Agents, potential signs/symptoms experienced by a patient exhibiting a cough, weakness, eye pain, wheezing, and shortness of breath would be categorized as the severity of the exposure as?

a) Mild

b) Moderate

c) Severe

d) Life Threatening

b) Moderate

Protocol 2.9

A newborn should be transported with the mother on the stretcher to keep warm and promote bonding?

a) True

b) False

a) False

Protocol 7.4

You and your partner are dispatched to a witnessed drowning (approximately 12 minutes) at the local swimming hole where the water temperature is 65 degrees. As you arrive you are directed to where the fire department has identified where the body is and has gone in to execute the rescue. When should you bring resuscitative measures?

a) Once the patient has been removed from the water and CPR has been initiated.

b) While removing the patient from the water.

c) Once the AED has analyzed the patient.

d) Do not begin resuscitative effort

b) While removing the patient from the water.

Protocol 4.2

A severely injured patient requiring immediate care and transport during a multiple casualty incident should be prioritized as?

a) Black

b) Red

c) Yellow

d) Green

b) Red

Protocol 8.2

When determining the hemodynamic status of a hypothermic patient, the rescuer should assess the pulse and respiratory status for a period of how many seconds?

a) 25

b) 30

c) 45

d) 60

d) 60

Protocol 2.8

Who should be notified by local EMS in cases where EMTs have withheld or ceased resuscitative efforts in accordance with the Statewide Treatment Protocol when the patient is left in the field?

a) The patient's primary care provider

b) The next of kin

c) Police

d) Patient's Life Insurance Carrier

c) Police

Protocol 7.7

Under the Scope of Practice of an EMT who has completed the ALS Assist Training Program, can an EMT assist the paramedic in the use of CPAP?

a) Yes

b) No

b) No

Protocol A3

Failure to control an active bleed using direct pressure, pressure bandages, tourniquets, or a hemostatic bandage could potentially lead to what kind of shock in a pediatric patient?

a) Cardiogenic

b) Distributive

c) Hypovolemic

d) Obstructive

c) Hypovolemic

Protocol 2.16

When assisting a patient with Oral Glucose who has a blood sugar below 70 mg/dl, what would be the appropriate dose of Oral Glucose?

a) One Tube

b) Two Tubes

c) Three Tubes

d) Four Tubes

a) One Tube [37.5g]

Protocol 2.3A

Can a traction splint be applied for an isolated adult open mid-shaft femur fracture?

a) Yes

b) No

b) No

Protocol 4.6

When moving a patient on the ambulance stretcher, the EMT's should adjust the height of the ambulance stretcher from the load position to the?

a) Mid Position

b) Ground position

c) Highest position

d) Load Position

a) Mid Position

Protocol 1.0