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SNHD Paramedic Protocol Exam | Southern Nevada
Health District | Paramedic Protocols, Emergency
Medical Services, Prehospital Care, Patient
Assessment | Open-Ended Q&A with Rationales
Exam Structure:
Subject: Paramedic Protocols / Emergency Medical Services / SNHD
Source: SNHD Paramedic Protocol Exam – 2026
Format: Open-ended questions with Correct Answers and rationales
1. Identify the Parkland Burn Formula for Fluid Replacement.
Correct Answer: 4 mL × (body weight in kg) × (% BSA burned) = total
fluids for 24 hours. Give 1/2 in the first 8 hours; give remainder over next
16 hours.
Rationale:
1. The Parkland formula calculates fluid resuscitation for burn patients.
2. Lactated Ringer's is the recommended fluid.
3. Half of the total volume is given in the first 8 hours from the time of burn.
4. The remaining half is given over the next 16 hours.
2. For children, a fall greater than ______ requires transport to a Level 1
or 2 trauma center.
Correct Answer: 10 feet or two times the height of the child
Rationale:
1. Falls from significant height indicate high mechanism of injury.
2. Children have different body proportions and injury patterns than adults.
3. Two times the child's height accounts for the relative impact force.
3. What is the dose of Naloxone (Narcan) in the setting of a suspected
overdose?
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Correct Answer: 2.0 mg IN/IM/IV; may be repeated to a max dose of 10 mg
Rationale:
1. Naloxone reverses opioid-induced respiratory depression.
2. Higher initial doses (2 mg) may be needed for synthetic opioids like
fentanyl.
3. Total maximum dose is 10 mg.
4. For a traumatic cardiac arrest, what interventions must be
performed prior to considering terminating resuscitation efforts?
Correct Answer: Provide effective ventilation with 100% oxygenation for
two (2) minutes; Open airway with basic life support measures; Perform
bilateral needle thoracentesis if tension pneumothorax suspected
Rationale:
1. Airway patency is the first priority in any resuscitation.
2. Two minutes of effective ventilation with 100% oxygen addresses reversible
causes of hypoxia.
3. Tension pneumothorax is a reversible cause of traumatic arrest requiring
immediate decompression.
5. For a patient in Pulmonary Edema/CHF who is hypertensive with a
diastolic blood pressure greater than 100 mmHg, what is the dose of
Nitroglycerin?
Correct Answer: 1.6 mg SL
Rationale:
1. Hypertensive pulmonary edema requires higher doses of nitroglycerin for
afterload reduction.
2. Sublingual nitroglycerin is typically 0.4 mg per dose.
3. 1.6 mg represents four 0.4 mg tablets.
6. Which patient(s) can be taken to a hospital that has been placed on
internal disaster?
Correct Answer: A patient in which an airway cannot be established; A
patient in cardiac arrest
Rationale:
1. Hospitals on internal disaster have limited resources and may divert stable
patients.
2. Patients without an established airway or in cardiac arrest have immediate
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life threats.
3. These patients cannot tolerate transport to a more distant facility.
7. A patient who was ejected from a motor vehicle requires transport
to a Level 1 and 2 trauma center only.
Correct Answer: False (Level 1, 2 or 3)
Rationale:
1. Ejection from a motor vehicle is a high-risk mechanism meeting trauma
center criteria.
2. Such patients should be transported to a Level 1, 2, OR 3 trauma center
depending on regional system.
3. The statement is false because Level 3 trauma centers also qualify for these
patients.
8. When should radio contact be established to a receiving facility?
Correct Answer: All trauma patients; Emergency (code 3) returns; Need
for telemetry physician; Per protocol
Rationale:
1. Radio contact ensures receiving facility notification and medical direction.
2. Trauma patients require preparation of the trauma team.
3. Code 3 (lights and sirens) returns require notification for traffic control
and ED preparation.
9. How often can additional Diazepam (Valium) doses be administered
to a pregnant patient who is refractory to Magnesium Sulfate?
Correct Answer: Every 5 minutes
Rationale:
1. Diazepam is used for seizure control in eclampsia when magnesium sulfate
is ineffective.
2. Doses may be repeated every 5 minutes as needed.
3. Airway management is essential due to respiratory depression risk.
10. For non-trauma patients, telemetry reports should include at a
minimum which of the following?
Correct Answer: Attendant/vehicle identification; Nature of call
(INFORMATION ONLY or REQUEST FOR PHYSICIAN ORDERS); Patient
information (number, age, sex); Patient condition (stable, full arrest);
SNHD Paramedic Protocol Exam | Southern Nevada
Health District | Paramedic Protocols, Emergency
Medical Services, Prehospital Care, Patient
Assessment | Open-Ended Q&A with Rationales
Exam Structure:
Subject: Paramedic Protocols / Emergency Medical Services / SNHD
Source: SNHD Paramedic Protocol Exam – 2026
Format: Open-ended questions with Correct Answers and rationales
1. Identify the Parkland Burn Formula for Fluid Replacement.
Correct Answer: 4 mL × (body weight in kg) × (% BSA burned) = total
fluids for 24 hours. Give 1/2 in the first 8 hours; give remainder over next
16 hours.
Rationale:
1. The Parkland formula calculates fluid resuscitation for burn patients.
2. Lactated Ringer's is the recommended fluid.
3. Half of the total volume is given in the first 8 hours from the time of burn.
4. The remaining half is given over the next 16 hours.
2. For children, a fall greater than ______ requires transport to a Level 1
or 2 trauma center.
Correct Answer: 10 feet or two times the height of the child
Rationale:
1. Falls from significant height indicate high mechanism of injury.
2. Children have different body proportions and injury patterns than adults.
3. Two times the child's height accounts for the relative impact force.
3. What is the dose of Naloxone (Narcan) in the setting of a suspected
overdose?
, 2|Page
Correct Answer: 2.0 mg IN/IM/IV; may be repeated to a max dose of 10 mg
Rationale:
1. Naloxone reverses opioid-induced respiratory depression.
2. Higher initial doses (2 mg) may be needed for synthetic opioids like
fentanyl.
3. Total maximum dose is 10 mg.
4. For a traumatic cardiac arrest, what interventions must be
performed prior to considering terminating resuscitation efforts?
Correct Answer: Provide effective ventilation with 100% oxygenation for
two (2) minutes; Open airway with basic life support measures; Perform
bilateral needle thoracentesis if tension pneumothorax suspected
Rationale:
1. Airway patency is the first priority in any resuscitation.
2. Two minutes of effective ventilation with 100% oxygen addresses reversible
causes of hypoxia.
3. Tension pneumothorax is a reversible cause of traumatic arrest requiring
immediate decompression.
5. For a patient in Pulmonary Edema/CHF who is hypertensive with a
diastolic blood pressure greater than 100 mmHg, what is the dose of
Nitroglycerin?
Correct Answer: 1.6 mg SL
Rationale:
1. Hypertensive pulmonary edema requires higher doses of nitroglycerin for
afterload reduction.
2. Sublingual nitroglycerin is typically 0.4 mg per dose.
3. 1.6 mg represents four 0.4 mg tablets.
6. Which patient(s) can be taken to a hospital that has been placed on
internal disaster?
Correct Answer: A patient in which an airway cannot be established; A
patient in cardiac arrest
Rationale:
1. Hospitals on internal disaster have limited resources and may divert stable
patients.
2. Patients without an established airway or in cardiac arrest have immediate
, 3|Page
life threats.
3. These patients cannot tolerate transport to a more distant facility.
7. A patient who was ejected from a motor vehicle requires transport
to a Level 1 and 2 trauma center only.
Correct Answer: False (Level 1, 2 or 3)
Rationale:
1. Ejection from a motor vehicle is a high-risk mechanism meeting trauma
center criteria.
2. Such patients should be transported to a Level 1, 2, OR 3 trauma center
depending on regional system.
3. The statement is false because Level 3 trauma centers also qualify for these
patients.
8. When should radio contact be established to a receiving facility?
Correct Answer: All trauma patients; Emergency (code 3) returns; Need
for telemetry physician; Per protocol
Rationale:
1. Radio contact ensures receiving facility notification and medical direction.
2. Trauma patients require preparation of the trauma team.
3. Code 3 (lights and sirens) returns require notification for traffic control
and ED preparation.
9. How often can additional Diazepam (Valium) doses be administered
to a pregnant patient who is refractory to Magnesium Sulfate?
Correct Answer: Every 5 minutes
Rationale:
1. Diazepam is used for seizure control in eclampsia when magnesium sulfate
is ineffective.
2. Doses may be repeated every 5 minutes as needed.
3. Airway management is essential due to respiratory depression risk.
10. For non-trauma patients, telemetry reports should include at a
minimum which of the following?
Correct Answer: Attendant/vehicle identification; Nature of call
(INFORMATION ONLY or REQUEST FOR PHYSICIAN ORDERS); Patient
information (number, age, sex); Patient condition (stable, full arrest);
