1. The National Highway Traffic Safety Administration (NHTSA) has identified 15 essential components of an EMS system. Which component is responsible for establishing policies and procedures for equipment maintenance, ambulance cleanliness, and infection control?

2. What is the primary role of a medical director in an EMS system?

3. Which of the following BEST describes the purpose of a designated trauma center within an EMS system?

4. An EMT administers aspirin to a patient with chest pain based on standing orders. The patient subsequently develops an allergic reaction. Under the doctrine of expressed consent, the EMT is protected from liability because:

5. A community implements a comprehensive 911 public access system that includes text-to-911 capability and automatic location detection for cellular calls. Which benefit does this system improvement primarily provide?

6. You are treating a 72-year-old female with severe respiratory distress. Her oxygen saturation is 84% on room air. Your protocols indicate high-flow oxygen for saturation below 90%. You apply a non-rebreather mask at 15 L/min, but her saturation only improves to 88%. You consider positive pressure ventilation with a BVM. This intervention exceeds your standing orders for this situation. What is your MOST appropriate action?

7. An EMS agency serves a region with three hospitals: a Level I trauma center 25 minutes away, a community hospital 8 minutes away, and a specialized burn center 35 minutes away. You are dispatched to a construction site where a worker has suffered significant burns to both legs and his torso from a chemical splash. The patient is conscious with partial-thickness burns. Which transport decision demonstrates appropriate use of the EMS system’s designated specialty centers?

8. During your ambulance shift, you respond to a call where the patient’s family member, who identifies herself as a physician, demands that you administer a specific medication that is not in your protocols. She states, “I’m ordering you to give this medication.” What is your MOST appropriate response?

9. A rural county’s EMS system has experienced significant challenges: average response times exceed 15 minutes, volunteer EMT availability is inconsistent, the nearest hospital is 30 minutes away, and the county lacks a dedicated medical director, relying instead on a neighboring county’s physician who is rarely available for online consultation. The county commissioners ask you to recommend the single MOST critical improvement to address multiple system weaknesses. Which recommendation would have the broadest positive impact?

10. You are the lead EMT for a call involving a 45-year-old male with suspected sepsis. Your standing orders include IV access and fluid bolus for hypotension, but the patient’s blood pressure is 100/60 mmHg – technically within normal range. The patient has a fever, altered mental status, and mottled skin. You recognize signs of early septic shock and believe early fluid resuscitation could be beneficial. However, your protocols don’t specifically authorize fluids for this blood pressure. You have a 45-minute transport time. Analyze this situation and determine the BEST course of action.

11. Which type of consent is obtained when an EMT explains a procedure to a conscious, alert patient and the patient agrees to the treatment?

12. Which patient is legally considered competent to provide consent for emergency medical treatment?

13. What is the MOST important action an EMT must take when a competent adult patient refuses transport to the hospital?

14. An EMT responds to a call for an unconscious diabetic patient. The patient cannot respond to questions or provide consent for treatment. Which legal principle allows the EMT to provide emergency care without obtaining expressed consent?

15. An EMT responds to a 45-year-old male complaining of chest pain. The patient is alert, oriented, and understands he may be having a heart attack. Despite the EMT’s explanation of the risks, the patient refuses transport because he cannot afford the hospital bill. Which statement best describes the EMT’s appropriate response?

16. You are treating a 17-year-old female who was involved in a minor motor vehicle collision. She has a small laceration on her forehead but refuses transport. Her parents cannot be reached by phone. She states she is emancipated and shows you an apartment lease in her name. What is the MOST appropriate course of action?

17. A 52-year-old male called 911 for severe abdominal pain. Upon your arrival, he is alert and oriented. After your assessment, you recommend transport due to the severity of his pain. He states, “I’m not going to the hospital. They’ll just give me pills that don’t work.” Which element is MOST critical to include in your documentation of this refusal?

18. You arrive at the scene of a motor vehicle collision. The driver, a 35-year-old male, is unconscious with visible head trauma. A bystander tells you the patient is a Jehovah’s Witness and would not want a blood transfusion. There is no family member present. The patient is bleeding heavily from a leg wound. What is the MOST appropriate action?

19. You respond to a call for a 67-year-old male with difficulty breathing. Upon arrival, you find the patient sitting upright, using accessory muscles to breathe, with audible wheezing. His SpO2 is 88% on room air. He has a history of COPD. The patient is alert and oriented but states, “I’ve been through this before. Just give me oxygen and I’ll be fine. I’m not going to the hospital.” His wife is present and begging him to go. After 15 minutes of oxygen therapy, his SpO2 improves to 94%, but he still refuses transport. Which of the following represents the MOST appropriate comprehensive approach to this situation?

20. You are called to a residence for a 22-year-old female who has ingested an unknown quantity of pills in a suicide attempt. Upon arrival, her roommate tells you the patient took the pills about 30 minutes ago after an argument with her boyfriend. The patient is conscious, alert, and oriented. She states she took some ibuprofen “to teach him a lesson” but refuses to tell you how many. She adamantly refuses transport, saying, “I’m fine. I just want to sleep.” You observe an empty 200-count bottle of ibuprofen on the table. Which of the following is the MOST appropriate action?

21. A 45-year-old male with severe chest pain refuses transport despite your explanation of the risks. He is alert, oriented to person, place, and time, and understands your concerns. What is the MOST appropriate action?

22. You are documenting a patient encounter. Which of the following is the MOST appropriate way to document the patient’s description of pain?

23. You are using START triage at a mass casualty incident. You encounter an adult patient who is apneic. What should you do FIRST?

24. You are the first unit on scene of a large motor vehicle collision with multiple vehicles and approximately 10 patients. What should you do FIRST?

25. You respond to an industrial accident and see an overturned tanker truck with a placard showing the number 3 in a red diamond. Several workers appear ill. What should you do?

26. You are providing a radio report to the receiving hospital. Which format is MOST appropriate for organizing your report?

27. You are called to care for a patient with active tuberculosis who is coughing. What PPE is MOST appropriate?

28. A 17-year-old female requires emergency care. Her parents are not present to provide consent. What should you do?

29. While responding with lights and sirens to a call, you approach an intersection with a red light. What should you do?

30. What is the primary purpose of a quality improvement (QI) program in EMS?

31. During a mass casualty incident, you encounter a patient with the following: RR 24, capillary refill 3 seconds, follows commands. Using START triage, what tag should be applied?

32. Which of the following is the MOST important element to document when a patient refuses transport?

33. Under the Incident Command System (ICS), which position is responsible for overall management of the incident?

34. A 67-year-old female with advanced dementia requires wound care but cannot understand the procedure. Her family is unavailable to consent. Under what principle can you provide care?

35. What does a placard with a skull and crossbones indicate?

36. When using the SBAR communication format, which element would include the patient’s vital signs?

37. You are called to care for a patient with significant bleeding from a leg wound. What PPE should you don before making patient contact?

38. When is it appropriate to exceed the posted speed limit while operating an emergency vehicle?

39. A patient tells you he has a Do Not Resuscitate (DNR) order but cannot produce the document. The patient is now unresponsive and in cardiac arrest. What should you do?

40. After a difficult cardiac arrest call, your partner makes a medication error that is discovered during the call. What is the MOST appropriate action?

41. Using the JumpSTART pediatric triage system, you encounter a 5-year-old child who is not breathing. What should you do FIRST?

42. In the Incident Command System, which section is responsible for providing resources, facilities, and services to support incident objectives?

43. Which of the following abbreviations is approved for use in patient care documentation?

44. Which of the following situations is an example of abandonment?

45. You respond to a scene where you smell a strong chemical odor and see a green placard with a number 2 on a container. What should you do?

46. When providing a patient report via radio to the receiving hospital, which information should be communicated FIRST?

47. After caring for a patient with known hepatitis C, you notice blood on your forearm where your glove ended. What should you do?

48. While driving with lights and sirens, another vehicle does not yield the right of way. What should you do?

49. An EMT is caring for a prominent community member. What is the MOST appropriate action regarding patient confidentiality?

50. After responding to a pediatric cardiac arrest where the child did not survive, you are having difficulty sleeping and feel emotionally drained. What is the MOST appropriate action?