Elite Universal Test Bank:
New York
EMS/Paramedic State
Protocol v25.1 Mastery
PART 0: THE NAVIGATOR
● PART I: THE PRIMER: Core structural intelligence, v25.1 protocol synthesis, and critical
axiom matrices.
● PART II: THE ELITE TEST BANK:
○ Tier 1 (Questions 1–28) - Foundational Syntax & Application: Protocol
hardlines, procedural memorization, and v25.1 baseline directives.
○ Tier 2 (Questions 29–58) - Complex Application & Simulation: Variable-driven
clinical scenarios assessing single-pivot critical thinking, updated medication
dosing, and triage logic.
○ Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-system
emergencies requiring the flawless simultaneous integration of pharmacology,
operations, and physiology.
PART I: THE PRIMER
Mastering the New York State EMS Collaborative Protocols (v25.1) transcends rote
memorization; it demands algorithmic, instinctual execution under extreme physiological
pressure. This document forges practitioners into elite clinical operators, translating complex
state mandates directly into decisive, high-stakes prehospital intervention.
The v25.1 Protocol Evolution (Effective July 2025)
The most recent iterations of the NYS Collaborative Protocols (Policies 25-01 and 25-04)
radically optimize prehospital resuscitation by restricting ineffective interventions and
maximizing high-yield therapies. The analysis indicates a systemic shift toward mechanical
perfusion optimization and streamlined pharmacology.
Clinical Domain v25.1 Protocol Update / Clinical Implication / Rationale
Actionable Directive
Cardiac Arrest Maximum of 5 doses of Prevents severe end-organ
Epinephrine 1:10,000 ischemia and refractory
permitted. Vector change myocardial oxygen demand.
,Clinical Domain v25.1 Protocol Update / Clinical Implication / Rationale
Actionable Directive
required for refractory VF/pVT. Vector changes physically
bypass resistant electrical axes.
Airway Continuous quantitative Eliminates unrecognized
waveform capnography is an esophageal intubations. PEEP
absolute mandate for all maintains alveolar recruitment
advanced airways. PEEP (5-10 during arrest and severe
cm H2O) added. pulmonary edema.
Hemorrhagic Shock Tranexamic Acid (TXA) dosing Optimizes early antifibrinolytic
increased to a single 2 gram activity in profound
IV/IO infusion over 10 minutes. hemorrhage, matching current
military and Level I trauma
center standards.
Trauma Triage Red Criteria strictly dictates Prioritizes immediate surgical
transport to the highest-level hemorrhage control for
trauma center. Yellow Criteria physiological collapse (Red)
allows transport to any trauma over strictly kinetic mechanisms
service. (Yellow).
Hospice / Behavioral Olanzapine (10mg IM or 5mg Provides rapid, non-invasive
SL) added for hospice agitation; chemical de-escalation for
Haloperidol explicitly removed. terminal delirium without the
profound QTc prolongation risks
of legacy antipsychotics.
The "Critical Axioms" Cheat Sheet
● The Capnography Absolute: If a Supraglottic Airway (SGA) or Endotracheal Tube is
placed, continuous quantitative waveform capnography is non-negotiable.
● The Electrical Parity Rule: Amiodarone and Lidocaine hold equal weight and are
interchangeable in the treatment of shockable pediatric and adult cardiac arrests.
● The Ischemic Window: Stroke patients with a highly positive S-LAMS score (≥ 4) and a
Last Known Well (LKW) of < 24 hours must bypass Primary centers for a Thrombectomy
Center if transport is < 30 minutes.
● The Antibiotic Mandate: Amputations and open fractures with delayed extrication now
require prophylactic Cefazolin or Moxifloxacin to prevent catastrophic sepsis.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Under the NYS v25.1 protocols, a patient in refractory ventricular fibrillation has received
three shocks and standard anti-arrhythmic dosing. What is the NEXT mandated action
regarding electrical therapy? A) Increase energy to 360 Joules biphasic. B) Administer a
precordial thump. C) Perform a vector change by altering pad placement. D) Withhold
defibrillation for 4 minutes of continuous CPR.
● The Answer: C (Perform a vector change by altering pad placement.)
● Distractor Analysis:
, ○ A is incorrect: Energy levels are determined by manufacturer guidelines, not an
arbitrary escalation mandate.
○ B is incorrect: Precordial thumps are an obsolete practice for unmonitored arrests.
○ D is incorrect: Withholding defibrillation for a shockable rhythm directly contravenes
all survival chains.
The Mentor's Analysis: Refractory VF indicates the current electrical pathway is missing critical
myocardial mass. By utilizing a vector change, you bypass the common trap of repeating
ineffective interventions. Professional/Academic Intuition: If the current vector fails thrice, the
axis must be altered.
Q2: An EMT is managing an apneic pediatric patient in cardiac arrest. Under v25.1, which
advanced airway intervention is now MOST APPROPRIATE for the EMT scope of practice? A)
Endotracheal intubation with a Miller blade. B) Placement of a Supraglottic Airway (SGA) with
capnography. C) Surgical cricothyrotomy. D) Administration of Ketamine for drug-assisted
intubation.
● The Answer: B (Placement of a Supraglottic Airway (SGA) with capnography.)
● Distractor Analysis:
○ A is incorrect: EMTs are not credentialed for endotracheal intubation.
○ C is incorrect: This is a restricted paramedic/physician procedure.
○ D is incorrect: EMTs cannot perform induction, and the patient is already in arrest.
The Mentor's Analysis: Policy 25-04 explicitly expanded the EMT scope to include Supraglottic
airway placement in pediatric cardiac arrests. By utilizing this adjunct, you bypass the common
trap of inadequate BLS ventilation during prolonged transports. Professional/Academic Intuition:
Supraglottic airways bridge the gap between BLS limitations and ALS delays.
Q3: When calculating pediatric defibrillation doses, what is the INITIAL energy setting for a 10
kg infant in pulseless Ventricular Tachycardia? A) 10 Joules B) 40 Joules C) 20 Joules D) 50
Joules
● The Answer: C (20 Joules)
● Distractor Analysis:
○ A is incorrect: 1 J/kg is an outdated calculation for synchronized cardioversion, not
defibrillation.
○ B is incorrect: 4 J/kg is the setting for the second defibrillation.
○ D is incorrect: 5 J/kg is an invalid starting metric.
The Mentor's Analysis: Pediatric defibrillation strictly follows an escalating algorithm: 2 J/kg,
then 4 J/kg, up to 10 J/kg. By utilizing the initial 2 J/kg dose, you bypass the common trap of
causing myocardial stunning from excessive initial energy. Professional/Academic Intuition:
Pediatric electrical therapy scales sequentially: 2, 4, 10.
Q4: Under the NYS Trauma Triage Guidelines, an adult patient with a respiratory rate of 8
breaths/min and a GCS of 13 meets which destination criteria? A) Yellow Criteria B) Green
Criteria C) Red Criteria D) Black Criteria
● The Answer: C (Red Criteria)
● Distractor Analysis:
○ A is incorrect: Yellow criteria focus on the mechanism of injury (e.g., fall > 10 feet),
not severe physiological deficits.
○ B is incorrect: Green indicates minor, ambulatory injuries.
○ D is incorrect: Black indicates deceased or expectant in an MCI, not a single
trauma.
The Mentor's Analysis: Any altered mental status (GCS < 15) or severe physiological
compromise immediately triggers Red Criteria. By utilizing rapid physiological assessment, you
New York
EMS/Paramedic State
Protocol v25.1 Mastery
PART 0: THE NAVIGATOR
● PART I: THE PRIMER: Core structural intelligence, v25.1 protocol synthesis, and critical
axiom matrices.
● PART II: THE ELITE TEST BANK:
○ Tier 1 (Questions 1–28) - Foundational Syntax & Application: Protocol
hardlines, procedural memorization, and v25.1 baseline directives.
○ Tier 2 (Questions 29–58) - Complex Application & Simulation: Variable-driven
clinical scenarios assessing single-pivot critical thinking, updated medication
dosing, and triage logic.
○ Tier 3 (Questions 59–88) - Grandmaster Synthesis: High-stakes, multi-system
emergencies requiring the flawless simultaneous integration of pharmacology,
operations, and physiology.
PART I: THE PRIMER
Mastering the New York State EMS Collaborative Protocols (v25.1) transcends rote
memorization; it demands algorithmic, instinctual execution under extreme physiological
pressure. This document forges practitioners into elite clinical operators, translating complex
state mandates directly into decisive, high-stakes prehospital intervention.
The v25.1 Protocol Evolution (Effective July 2025)
The most recent iterations of the NYS Collaborative Protocols (Policies 25-01 and 25-04)
radically optimize prehospital resuscitation by restricting ineffective interventions and
maximizing high-yield therapies. The analysis indicates a systemic shift toward mechanical
perfusion optimization and streamlined pharmacology.
Clinical Domain v25.1 Protocol Update / Clinical Implication / Rationale
Actionable Directive
Cardiac Arrest Maximum of 5 doses of Prevents severe end-organ
Epinephrine 1:10,000 ischemia and refractory
permitted. Vector change myocardial oxygen demand.
,Clinical Domain v25.1 Protocol Update / Clinical Implication / Rationale
Actionable Directive
required for refractory VF/pVT. Vector changes physically
bypass resistant electrical axes.
Airway Continuous quantitative Eliminates unrecognized
waveform capnography is an esophageal intubations. PEEP
absolute mandate for all maintains alveolar recruitment
advanced airways. PEEP (5-10 during arrest and severe
cm H2O) added. pulmonary edema.
Hemorrhagic Shock Tranexamic Acid (TXA) dosing Optimizes early antifibrinolytic
increased to a single 2 gram activity in profound
IV/IO infusion over 10 minutes. hemorrhage, matching current
military and Level I trauma
center standards.
Trauma Triage Red Criteria strictly dictates Prioritizes immediate surgical
transport to the highest-level hemorrhage control for
trauma center. Yellow Criteria physiological collapse (Red)
allows transport to any trauma over strictly kinetic mechanisms
service. (Yellow).
Hospice / Behavioral Olanzapine (10mg IM or 5mg Provides rapid, non-invasive
SL) added for hospice agitation; chemical de-escalation for
Haloperidol explicitly removed. terminal delirium without the
profound QTc prolongation risks
of legacy antipsychotics.
The "Critical Axioms" Cheat Sheet
● The Capnography Absolute: If a Supraglottic Airway (SGA) or Endotracheal Tube is
placed, continuous quantitative waveform capnography is non-negotiable.
● The Electrical Parity Rule: Amiodarone and Lidocaine hold equal weight and are
interchangeable in the treatment of shockable pediatric and adult cardiac arrests.
● The Ischemic Window: Stroke patients with a highly positive S-LAMS score (≥ 4) and a
Last Known Well (LKW) of < 24 hours must bypass Primary centers for a Thrombectomy
Center if transport is < 30 minutes.
● The Antibiotic Mandate: Amputations and open fractures with delayed extrication now
require prophylactic Cefazolin or Moxifloxacin to prevent catastrophic sepsis.
PART II: THE ELITE TEST BANK
Tier 1: Foundational Syntax & Application
Q1: Under the NYS v25.1 protocols, a patient in refractory ventricular fibrillation has received
three shocks and standard anti-arrhythmic dosing. What is the NEXT mandated action
regarding electrical therapy? A) Increase energy to 360 Joules biphasic. B) Administer a
precordial thump. C) Perform a vector change by altering pad placement. D) Withhold
defibrillation for 4 minutes of continuous CPR.
● The Answer: C (Perform a vector change by altering pad placement.)
● Distractor Analysis:
, ○ A is incorrect: Energy levels are determined by manufacturer guidelines, not an
arbitrary escalation mandate.
○ B is incorrect: Precordial thumps are an obsolete practice for unmonitored arrests.
○ D is incorrect: Withholding defibrillation for a shockable rhythm directly contravenes
all survival chains.
The Mentor's Analysis: Refractory VF indicates the current electrical pathway is missing critical
myocardial mass. By utilizing a vector change, you bypass the common trap of repeating
ineffective interventions. Professional/Academic Intuition: If the current vector fails thrice, the
axis must be altered.
Q2: An EMT is managing an apneic pediatric patient in cardiac arrest. Under v25.1, which
advanced airway intervention is now MOST APPROPRIATE for the EMT scope of practice? A)
Endotracheal intubation with a Miller blade. B) Placement of a Supraglottic Airway (SGA) with
capnography. C) Surgical cricothyrotomy. D) Administration of Ketamine for drug-assisted
intubation.
● The Answer: B (Placement of a Supraglottic Airway (SGA) with capnography.)
● Distractor Analysis:
○ A is incorrect: EMTs are not credentialed for endotracheal intubation.
○ C is incorrect: This is a restricted paramedic/physician procedure.
○ D is incorrect: EMTs cannot perform induction, and the patient is already in arrest.
The Mentor's Analysis: Policy 25-04 explicitly expanded the EMT scope to include Supraglottic
airway placement in pediatric cardiac arrests. By utilizing this adjunct, you bypass the common
trap of inadequate BLS ventilation during prolonged transports. Professional/Academic Intuition:
Supraglottic airways bridge the gap between BLS limitations and ALS delays.
Q3: When calculating pediatric defibrillation doses, what is the INITIAL energy setting for a 10
kg infant in pulseless Ventricular Tachycardia? A) 10 Joules B) 40 Joules C) 20 Joules D) 50
Joules
● The Answer: C (20 Joules)
● Distractor Analysis:
○ A is incorrect: 1 J/kg is an outdated calculation for synchronized cardioversion, not
defibrillation.
○ B is incorrect: 4 J/kg is the setting for the second defibrillation.
○ D is incorrect: 5 J/kg is an invalid starting metric.
The Mentor's Analysis: Pediatric defibrillation strictly follows an escalating algorithm: 2 J/kg,
then 4 J/kg, up to 10 J/kg. By utilizing the initial 2 J/kg dose, you bypass the common trap of
causing myocardial stunning from excessive initial energy. Professional/Academic Intuition:
Pediatric electrical therapy scales sequentially: 2, 4, 10.
Q4: Under the NYS Trauma Triage Guidelines, an adult patient with a respiratory rate of 8
breaths/min and a GCS of 13 meets which destination criteria? A) Yellow Criteria B) Green
Criteria C) Red Criteria D) Black Criteria
● The Answer: C (Red Criteria)
● Distractor Analysis:
○ A is incorrect: Yellow criteria focus on the mechanism of injury (e.g., fall > 10 feet),
not severe physiological deficits.
○ B is incorrect: Green indicates minor, ambulatory injuries.
○ D is incorrect: Black indicates deceased or expectant in an MCI, not a single
trauma.
The Mentor's Analysis: Any altered mental status (GCS < 15) or severe physiological
compromise immediately triggers Red Criteria. By utilizing rapid physiological assessment, you
