REMAC OLMC Examination
Please submit a completed (1) Exam Answer Sheet, and (2) Physician Information Sheet, within 5 days of the course date to the NYC REMAC via:
Regional EMS Council of NYC 475 Riverside Drive, Suite 1929 New York, NY 10115
Attn: On-Line Medical Control
Date of OLMC Class
Instructor of OLMC Class
OLMC Facility Affiliation (check all that apply)
Northwell SIUH South
NY Presbyterian Methodist
Maimonides Medical Center
1. A physician is present at a scene where patient care is being provided by REMAC credentialed paramedics. His/her requests regarding the care and movement of this patient can only be followed if they are:
a. Confined to Advanced Life Support Standing orders only.
b. Confined to Medical Control Options only.
c. Include Advanced Life Support Standing Orders, Medical Control Options, and Discretionary Decisions.
d. Confined to Advanced Life Support Standing Orders. Any Medical Control Options contained in the appropriate protocol must still be approved by a REMAC Credentialed Online Medical Control Physician/designee
2. All of the following are true EXCEPT: ‘Discretionary Decisions’ may include, but are not limited to:
a. Use of drugs contained in the REMAC Formulary at doses other than those described in the protocols.
b. Use of drugs contained in the REMAC Formulary for purposes other than those described in the protocols.
c. Use of drugs contained in the REMAC Formulary outside the EMT-P scope of practice.
d. The most appropriate treatment within the EMT-P's scope of practice.
3. Of the following, the CORRECT answer is: In the absence of intravenous access, the following medications are approved for intranasal administration when an appropriate atomizer device is available:
a. Glucagon, Fentanyl, Lorazepam, Midazolam, and Naloxone
b. Lorazepam, Midazolam, Naloxone
d. None of the above
4. According to the General Operating Procedures (GOP), which of the following is NOT included in the definition of an unstable dysrhythmia
a. Non-ischemic chest pain (in an adult patient).
b. Altered mental status (in an adult patient).
c. Absent peripheral pulses (in a pediatric patient).
5. EMT-Basics are permitted to transport a patient:
a. With an IV NS drip in place in which clearly marked medications have been added.
b. With an IV NS drip in place in which no medications have been added.
c. With a secured saline lock device in place, with no fluid or medication attached to the port.
d. If directed by a Medical Control Physician.
6. Which of the following is NOT a standing order for a patient experiencing severe respiratory distress due to chronic obstructive pulmonary disease?
a. Albuterol Sulfate.
b. Ipatropium Bromide.
d. Magnesium Sulfate.
7. An emancipated minor is someone under the age of 18 years, and ALL of the following EXCEPT:
a. A pregnant female who has no living children.
b. A pregnant female who has a living child.
c. Is enlisted in the Armed Forces.
d. Is requesting treatment for child abuse.
8. Paramedics are on-scene with a 94-year-old female who has a past history of CHF and insulin- dependent diabetes mellitus. The patient presents: cool, pale and diaphoretic, bilateral diffuse rales, pink frothy sputum, B/P 190/120, HR 124, RR 32 and labored. The patient weighs 84 pounds, IV access has been established, the patient will not tolerate CPAP. The paramedics are requesting 2mg of Lorazepam and 80 mg of Furosemide. What is the correct dose of Furosemide to be administered to this patient?
9. An ALS unit is enroute to the hospital with a 400-pound patient in cardiac arrest. CPR is in progress, the patient is intubated, however IV access cannot be established due to excessive adipose tissue. The unit is requesting Discretionary Orders to administer the cardiac arrest drug regimen via the Endotracheal Tube. The crew should be instructed to:
a. Proceed with administering medication via the Endotracheal Tube.
b. Establish IO access and then proceed with the appropriate drug regimen.
c. Continue attempts to establish IV access and transport patient without drug therapy.
d. Administer medication IM and hope for the best.
10. An ALS unit is on scene with a 36-year-old male who is unconscious after suffering severe oral/dental trauma via a baseball bat to the face. Upon palpation, the patient’s jaw appears to be unhinged and in several pieces. The patient has no other visible or palpable deformities, C-Spine precautions have been initiated, IV access has been established and spinal restriction rendered. The crew has contacted Medical Control for Discretionary Orders in order to perform nasal intubation. The paramedic states he has performed this technique successfully at least a dozen times in the cadaver lab where he works part time. As the Medical Control Physician, you should tell the paramedic:
a. Based on his experience, he should make the attempt at nasal intubation.
b. To insert a nasopharyngeal airway and assist ventilations.
c. Suction the patient’s airway PRN and transport to nearest Trauma Center while supporting ventilation
d. Place patient in left lateral recumbent position to allow drainage and rapid transport.
11. You have a patient presenting with historical/physical findings of an acute stroke. Which one of the following conditions would prevent you from transporting the patient to the nearest NYS DOH designated Stroke Center?
a. The patient began having slurred speech and facial drooping 90 minutes ago.
b. The total time from when the patient's symptoms/signs first began to when the patient is first assessed by EMS is two (2) hours.
c. The patient's primary care physician is not affiliated with the nearest NYS DOH designated Stroke Center.
d. The patient has other conditions that warrant transport to the nearest appropriate hospital emergency department.
12. Who makes the ultimate decision on who accompanies the patient in the patient compartment of the ambulance?
a. Ranking NYPD officer on scene.
b. Ranking FDNY EMS officer on scene.
c. Medical Control physician.
d. Provider who is responsible for patient care.
13. A paramedic unit calls with a dialysis patient who is in stable SVT that has not responded to Adenosine. They call medical control and request orders for Diltiazem. What dose should be ordered?
a. 0.25 mg/kg
b. 0.5 mg/kg
c. double the normal dose
d. half the normal dose
14. A Paramedic is treating an adult burn patient with severe 3rd degree burns of the lower extremities. There is no airway compromise and vital signs are as follows: B/P 100/60, HR 110 regular, RR 30 and deep, SPo2 is 96% with the patient receiving oxygen at 15 LPM via a Non- Rebreather mask. What would be the appropriate medication to use for this patient?
a. Fentanyl, 1 mcg/kg (max 100 mcg).
b. Morphine Sulfate 0.1mg/kg (not to exceed 5mg), IV bolus.
c. Diazepam 5 mg.
d. Lorazepam 2 mg.
15. According to Article 30 of the New York State Public Health Law, which entity is charged with coordinating emergency medical services in New York City?
a. FDNY .
b. Medical Control.
c. Greater New York Hospital Association.
d. New York City REMSCO.
16. When may an EMT or Paramedic (EMT-P) exceed their level of training?
a. Under direct Physician supervision.
b. Under no circumstances may CFRs, EMTs, and AEMT-Ps provide emergency treatment that exceeds the limit of their training.
c. Under REMAC Physician direct supervision.
d. Under direction of online medical control.
17. If a scene is determined to be unsafe for EMS personnel while on assignment, what is the correct action to be taken?
a. Continue to operate on scene while awaiting police.
b. Retrieve equipment and patient and withdraw to a safe area.
c. Withdraw to a safe location and await public safety personnel.
d. Stop medical operations and attempt to correct the situation while awaiting additional resources.
18. How is ondansetron administered under Severe Nausea/Vomiting Protocol?
a. No Specific stipulation under this protocol.
b. In conjunction with 50mL of Normal Saline.
c. Rapidly, within 10 seconds.
d. Slowly, over 1-2 minutes.
19. A paramedic is treating a victim that was trapped in a burning building. The victim was rescued by firefighters, but not before sustaining smoke inhalation injury. The patient is unconscious and an ET Tube has been properly placed, but only one IV infusion line is available. As per the Smoke Inhalation Protocol, which of the following is correct?
a. Administer the Hydroxycobalamin before the Sodium Thiosulfate.
b. Administer the Sodium Thiosulfate first before the Hydroxocobalamin.
c. Administer both the Hydroxocobalamin and the Sodium Thiosulfate simultaneously through the same line.
d. Do not administer either, since they must both be given at the same time in two (2) separate sites, or not at all.
20. A paramedic is treating a patient in cardiac arrest secondary to ventricular fibrillation. As per the REMAC Protocols [and no medication shortages], which of the following represents the correct sequence of medications that would be administered under standing orders?
a. Amiodarone, Epinephrine, Vasopressin
b. Vasopressin, Epinephrine, Amiodarone
c. Epinephrine, Amiodarone, Vasopressin
d. Epinephrine, Amiodarone, Epinephrine
21. A paramedic is treating a 45-year-old male who presents with palpitations, shortness of breath and is very anxious. He has been placed on a monitor, which shows a Supraventricular Tachycardia at a rate of 180. His vital signs are stable and the paramedic decides to administer Adenosine. What is the total amount of Adenosine that can be given to this patient under standing orders?
a. 6 mg
b. 12 mg
c. 24 mg
d. 30 mg
22. A paramedic is treating a patient who has second degree burns to the neck, shoulders, and upper chest. The patient denies any respiratory distress but is in extreme pain from the burns. The patient’s vitals are blood pressure of 132/84, pulse of 110, respiratory rate of 20 and regular. Which of the following is a true statement regarding treatment of this patient's pain?
a. Administer Morphine Sulfate, 0.1 mg/kg, (not to exceed 5 mg), and may be repeated in five minutes, not to exceed a total of 10 mg.
b. Administer Morphine Sulfate, 1 – 5 mg, and may be repeated in five (5) minutes, not to exceed a total of 10 mg.
c. Administer Morphine Sulfate, 0.1 mg/kg (not to exceed 5 mg) may be repeated twice in the next ten minutes, not to exceed a total of 15 mg.
d. Administer Fentanyl 0.1 mcg/kg to a maximum of 100 mcg.
23. A NYC 911 participating EMS Agency ambulance arrives on the scene of a medical emergency. A non-NYC 911 Agency ambulance is already on the scene and caring for the patient. Both the NYC 911 ambulance, as well as, the other ambulance are Paramedic ambulances. As per the General Operating Procedure, the NYC 911 ambulance should:
a. Take over patient care since this is within the jurisdiction of the NYC 911 system.
b. Act as an operational resource to the treating crew including scene safety, environmental conditions, potentially dangerous situations.
c. Request a 911 EMS Supervisor to respond to the scene to determine who should have patient care responsibilities.
d. Immediately leave without asking if assistance is needed, and allow the non-NYC 911 Agency ambulance to continue since the level of care is the same and they were there first.
24. The proper dosage for Amiodarone for an 87-year-old male who weighs 85lbs is:
25. Paramedic calls and requests permission for chemical restraint for an extremely agitated patient with a history of severe schizophrenia who is non-compliant with medication. The patient weights about 175 lbs. The paramedic should be advised to administer
a. Ketamine 40 mg IntraNasal.
b. Diazepam 5mg IntraMuscular.
c. Lorazepam 5mg IntraNasal
d. Midazolam 10mg IntraMuscular.
26. What medication and dose are available as sedation for cardioversion?
a. Etomidate 0.15 mg/kg to a maximum total dose of 20 mg IV bolus
b. Etomidate 0.3 mg/kg to a maximum total dose of 20 mg IV bolus
c. Diazepam 1 - 2 mg IV bolus
d. Midazolam 1 - 2 mg IV/IN with repeat doses of 1 - 2 mg IV/IN
27. Which of the following is NOT an approved site for prehospital intraosseous access in the NYC region?
a. Distal femur.
b. Tibial tuberosity.
c. Medial malleolus.
28. What medication and dose are available for Transcutaneous Pacing?
a. Midazolam 1-2 mg, IV / IN with repeat doses of 1-2 mg, IV / IN (maximum total dose is 10 mg).
b. Diazepam 5-10 mg, IV bolus with repeat doses of 5-10 mg, IV bolus, (maximum total dose is 20 mg).
c. Etomidate 0.15 mg/kg to a maximum total dose of 20 mg, IV bolus.
d. Etoimdate 0.3 mg/kg to a maximum total dose of 40 mg, IV bolus. Follow up with Diazepam 5 mg IV bolus or Lorazepam 2 mg IV, IV bolus or IM if needed for continued releief or sedation.
29. With respect to the Medical Orders of Life-Sustaining Treatment (MOSLT) form, which of the following is a true statement?
a. This form replaces the Non-Hospital Order for Do Not Resuscitate
b. It is acceptable to honor the Non-Hospital Do Not Intubate bracelet.
c. A photocopy or face of the original MOLST form is acceptable and legal.
d. The MOLST form allows EMS personnel to honor other advanced directives such as a Living Will.
30. You are operating as Telemetry (On-Line Medical Control) Physician when the FDNY Office of Medical Affairs and NYC REMAC issue an Influenza-Like-Illness (ILI) Notification. While in this activated state, which of the following are TRUE:
a. EMS crews must wear an N95 mask while treating all patients.
b. Endotracheal Intubation is contraindicated for all cases.
c. Intranasal drug delivery is contraindicated.
d. Intraosseous cannulation should be avoided.
31. All of the following medications are approved by NYC REMAC for intranasal (IN) administration when an appropriate atomizer is available EXCEPT:
32. A patient becomes critical or unstable, and a transport decision is requested from On-Line Medical Control. The On-Line Medical Control physician MUST direct the patient to be transported to the:
a. Nearest Hospital, even if it is not a NYC 911 system ambulance destination.
b. Nearest NYC 911 system Trauma Center.
c. Nearest NYC 911 system ambulance destination.
d. Any NYC 911 system hospital that is less than 10 minutes from the nearest hospital.
33. If a patient cannot tolerate a non-rebreather mask, the EMT/Paramedic should use a nasal cannula set at ___liters per minute:
34. A 78-year-old male presents with: BP 80/50, HR 40, RR 26 with signs/symptoms of decompensated shock. Standing orders have been completed, including transcutaneous pacing and the patient exhibits insufficient improvement in cardiac status. Under Medical Control Options, the appropriate dose of Dopamine for this patient would be:
a. 2 mcg/kg/min with titration up to 10 mcg/kg/min.
b. 2 mcg/kg/min with titration up to 15 mcg/kg/min.
c. 5 mcg/kg/min with titration up to 10 mcg/kg/min.
d. 5 mcg/kg/min with titration up to 15 mcg/kg/min.
35. A paramedic calls for a 68-year-old female presenting with shortness of breath and difficulty breathing. Patient has brought up pinkish sputum twice since the crew arrived. Patient is not febrile and has a history of CHF, MI four years ago, and CAD. Vitals are: HR: 70R, RR 26, BP 190/110. SPO2 is 90 on non-rebreather mask. CPAP therapy is available under Standing Orders. What would prevent application of CPAP?
a. Patient’s age.
b. Patient’s blood pressure.
c. Patient is unable to maintain an open and patent airway.
d. Patient has significant respiratory distress.
36. What is the maximum dose of etomidate for sedation-facilitated intubation?
a. 0.3 mg/kg up to maximum 20 mg.
b. 0.15 mg/kg up to maximum 20 mg.
c. 0.3 mg/kg up to maximum 40 mg.
d. 0.3 mg/kg up to maximum 60 mg.
37. You are working at FDNY On Line Medical Control and receive a call for a STEMI. Paramedics are caring for an 86-year-old male with acute exacerbation of chronic chest pain and dyspnea. He is unsure of any prior cardiac workup results. There has been no relief with the patient’s nitroglycerin at home. Paramedics have administered 162 mg aspirin and have the following vital signs: BP 170/90, HR 96, RR 14, SpO2 96% on 2 liters via nasal cannula. They have sent the EKG to you for review as it is a wide-complex rhythm with ST elevations in the lateral leads. What is the next step to take?
a. Activate the STEMI pathway and redirect the patient to the nearest PCI center.
b. Have the crew transport the patient to the nearest 911 receiving center.
c. Ensure the crew checks BPs in bilateral arms to rule out aortic dissection.
d. Withhold any additional nitroglycerin for obvious contraindications.
38. Severe sepsis criteria include all of the following except:
a. Unexplained altered mental status.
b. Systolic BP < 90 mmHg or Mean Arterial Pressure < 65 mmHg.
c. ETCO2 > 30 mmHg.
d. Tactile fever / hypothermia.
39. Which of the following is not an acceptable destination facility for a patient to be redirected to by 911 Online Medical Control?
a. Memorial Sloan Kettering Cancer Center.
b. Brooklyn Veteran's Administration Hospital.
c. New York Eye & Ear Medical Center.
d. A freestanding Urgent Care facility.
40. Which of the following would preclude a patient from having CPAP being instituted?
a. Burns to the ears and hair.
b. Morbid obesity.
c. Anaphylaxis with drooling.
d. Elderly patient.
41. Which of the following is available under standing orders for out-of-hospital treatment of a witnessed partial seizure?
a. Lorazepam 2 mg IV / IM / IN
b. Diazepam 5 mg IV
c. Etomidate 0.15 mg/kg up to 20 mg total
d. None of the above
42. A nurse in a Trauma Center calls OLMC to inquire, why two (2) tourniquets were used on a 13- year-old boy with an amputation above the wrist? Bleeding was controlled and a distal pulse was absent on the affected extremity. The most appropriate response would be?
a. Only one (1) tourniquet is allowed to be used in the New York City region for bleeding control.
b. The tourniquets should only be used for bleeding control, but allow a distal pulse to be present.
c. Tourniquets are allowed to be used but only on adult patients.
d. They provided care within their scope of practice.
43. Which of the following does not require a class order by an FDNY Office of Medical Affairs Medical Director to administer?
a. Hydroxycobalamin for suspected or confirmed cyanide exposure
b. Pralidoxime for suspected or confirmed organophosphate poisoning
c. Sodium thiosulfate for smoke inhalation
44. In which cardiac protocol is sodium bicarbonate available as a Medical Control Option?
a. 505-D: Bradydysrhythmias and Complete Heart Block
b. 505-C: Ventricular Tachycardia with a Pulse / Wide Complex Tachycardia of Uncertain Etiology
c. 504-B: Cardiogenic Shock
d. A & B
45. Which of the following is FALSE regarding prehospital tourniquet application?
a. The patient may be delivered to a non-trauma center.
b. The date of application must be documented.
c. Should be applied before direct pressure in the majority of extremity wounds.
d. All of the above are false
46. A REMAC-credentialed paramedic is attempting endotracheal intubation on a patient in respiratory distress with AMS. What is an acceptable therapy in this region to prevent deoxygenation during laryngoscopy?
a. Pre-oxygenation with CPAP prior to sedation.
b. Proning the patient.
c. Administering oxygen by nasal cannula at maximum flow rate during laryngoscopy and intubation.
d. Prophylactic administration of naloxone regardless of the cause of respiratory distress.
47. What is the initial dose of anesthetic for infusion after intraosseous access has been obtained?
a. 0.5 mg/kg of 1% lidocaine up to maximum of 75 mg.
b. 0.25 mg/kg of 2% lidocaine up to maximum of 25 mg.
c. 0.25 mg/kg of 2% preservative-free lidocaine up to a maximum of 50 mg.
d. 0.5 mg/kg of 2% preservative-free lidocaine up to maximum of 50 mg.
48. A paramedic unit is on the scene of a 60-year-old diabetic male being treated for osteomyelitis. The patient has a peripherally inserted central catheter (PICC) in the brachial vein of his left arm. The patient’s wife states she thinks it’s clogged because she cannot administer his antibiotic infusion through the catheter. She states this has happened in the past, rectified at the hospital by “pushing some fluid through the line”. The patient and wife state transport is unnecessary and only want the line fixed. The paramedic calls Online Medical Control for a discretionary decision to flush the catheter with saline because it states in the REMAC General Operating Procedures “Any line that cannot be easily flushed with 10 mL of normal saline should be considered NOT functional”. Which of the following choices is the best response to this scenario?
a. The medical control contact is unnecessary because attempts to flush the line is an expected action under standing orders.
b. Approve the discretionary order to flush the catheter with 10 mL of normal saline.
c. Make an attempt with 5 mL initially using a push-and-withdraw motion with the syringe plunger, continue as needed up to 10 mL.
d. Do not attempt to troubleshoot the catheter and recommend transport to the hospital.
49. Which of the following is NOT a contraindication to CPAP use in the NYC region?
a. Altered mental status.
c. Impending respiratory arrest.
d. Facial burns.
50. A patient is being treated for myocardial ischemia. Under which condition should nitroglycerin ALWAYS be withheld by the paramedic crew?
a. Inferior wall EKG changes with SBP 140 mmHg.
b. Anterior wall EKG changes with SBP 180 mmHg.
c. Usage of erectile dysfunction medications within the last 72 hours.
d. Patient reports headache after nitroglycerin administration in the past.
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