Agency Information
Agency Name
Boston Emergency Medical Services
County
Suffolk County
State
Massachusetts
Official Source
What You'll Study
EMT / BLS
EMT protocols for Boston/Suffolk County.
Paramedic / ALS
ALS paramedic protocols for Boston EMS.
Sample Questions (Free Preview)
PARAMEDIC
Q1. A 65-year-old Boston patient presents with sudden-onset crushing chest pain radiating to the left arm, diaphoresis, and ST elevation in leads II, III, and aVF. The closest PCI-capable center is 18 minutes away. Per Boston EMS STEMI protocol, what is the PRIORITY action?
A. 12-lead ECG transmission to activate cath lab, aspirin 324 mg, IV access, rapid transport with ALS crew notified
B. Administer 0.4 mg nitroglycerin SL, then repeat every 5 min × 3 before transport
C. Transport to nearest ED regardless of PCI capability since STEMI may be inferior RV
D. Administer thrombolytics (tPA) prehospital since PCI center is >15 minutes away
Inferior STEMI (ST elevation in II, III, aVF) with PCI center <20 min: Activate cath lab via prehospital ECG transmission, aspirin 324 mg PO if not contraindicated, IV access, 12-lead ECG, rapid transport. Do NOT delay transport for additional medications. Nitroglycerin with caution in inferior STEMI — may cause hypotension especially if RV involvement.
PARAMEDIC
Q2. A 45-year-old Boston patient is found unresponsive by family. Bystanders began CPR 5 minutes ago. Your ETCO2 reading immediately after intubation is 8 mmHg. What does this indicate?
A. Poor CPR quality or very low cardiac output — improve CPR depth and rate
B. Excellent CPR — ETCO2 of 8 mmHg is normal during cardiac arrest resuscitation
C. Definitive confirmation of esophageal intubation — remove tube immediately
D. Hyperventilation — reduce ventilation rate to lower ETCO2
ETCO2 of 8 mmHg during cardiac arrest resuscitation indicates either very poor CPR quality (insufficient cardiac output to deliver CO2 to lungs), possible tube misplacement (check placement), or severe metabolic acidosis with bicarbonate depletion. Target ETCO2 during CPR is >10-20 mmHg as a sign of adequate perfusion. Sudden rise to >40 mmHg may indicate ROSC.
EMT
Q3. A 70-year-old Boston patient calls EMS with "I can't breathe." You find her sitting upright, respiratory rate 30, SpO2 84% on room air, bilateral crackles throughout lung fields, and pink frothy sputum in her mouth. Which condition does this MOST likely represent?
A. Acute pulmonary edema — administer O2, CPAP, position upright, request ALS
B. Pneumonia — administer O2, transport, antibiotics at hospital
C. Pulmonary embolism — administer O2 and aspirin, transport rapidly
D. COPD exacerbation — administer O2 at controlled rate to prevent CO2 retention
Acute pulmonary edema (APE) / acute decompensated heart failure presents with: respiratory distress, SpO2 decrease, bilateral crackles (fluid in alveoli), pink frothy sputum (protein-rich fluid from alveoli), patient preferring upright position. Treatment: high-flow O2, CPAP if available, position upright, ALS for furosemide/nitroglycerin, rapid transport.
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