1. Evolution of EMS Decision-Making and Critical Thinking (File: 4.

pdf)

 Four-Stage Process in EMS Decision-Making:

1. Assessment: Ensuring scene safety, gathering information (subjective &
objective), and generating hypotheses.
2. Planning: Prioritizing critical needs, setting treatment goals, and outlining
interventions.
3. Implementation: Delivering interventions, monitoring outcomes, and adapting as
needed.
4. Evaluation: Measuring effectiveness, gathering feedback, continuous
improvement.
 10-Step EMS Field Decision Process includes clarifying the issue, assessing capability,
reviewing protocols and risks, then implementing and documenting the decision.
 Traditional vs Modern EMS:

o Traditional: Protocol-driven, passive.

o Modern: Critical thinker, autonomous, adaptive.

 Improvement Methods: Simulation, reflection, case debriefings, mentorship, and

evidence-based practice.

2. Professional Issues in Paramedic Practice (File: 3.pdf)

 Key Ethical Challenges:

o Informed Consent vs Implied Consent.
o Refusal of Care.
o End-of-Life Decisions (DNR handling).
o Confidentiality and patient dignity.
 Communication & Cultural Sensitivity:
o Patient-centered language, empathy, 7Cs of communication.
o Cultural, religious, and gender-specific care considerations.
 Legal Responsibilities:
o Work within defined scope.
o Avoid negligence.
o Maintain accurate documentation.
 Mental Health and Professionalism:
o Address responder burnout/PTSD.
o Uphold professional boundaries.
o Engage in CPD and mentorship.
3. Roles and Functions of Paramedics (File: 1.pdf)

 Evolving Role: From protocol executor to clinical leader and critical thinker.
 Core Clinical Roles:
o Assessment, diagnostics, medication administration.
o Transport, triage, communication with hospitals.
 Decision-Making Skills:
o Analytical (logic, guidelines).
o Intuitive (pattern recognition).
o Dual Processing (combo of both).
 Scope of Practice:
o Basic & Advanced Life Support (BLS & ALS), ECG interpretation, critical care
transfer.
 Simulation Training: Enhances real-time decision-making and critical care application.

4. Decision-Making Strategies in Paramedic Practice (File: 6.pdf)

 Four Strategies:
1. Intuition – Fast, gut-based (used under pressure).
2. Experience – Decisions from pattern memory and prior exposure.
3. Hypothesis – Educated guesses under uncertainty.
4. Deduction – Logical reasoning via protocols (e.g., ABCDE, START triage).
 Integration in Practice: All four should be used in dynamic cases (e.g., bus crash:
intuition suspects hidden victims; deduction applies triage).
 Improvement Tools: Simulation, reflection, team discussions, and updating protocols.

5. Decision-Making Theories in EMS (File: 5.pdf)

 Key Theories:
o NDM: Naturalistic Decision-Making – intuitive under pressure.
o RPD: Recognition-Primed – rapid pattern recognition.
o Rational Model: Step-by-step, used in planning, not emergencies.
o Bounded Rationality: “Satisficing” when under constraint.
o Team-Based: Collaborative, MCI-focused.
 Scenario Applications:
o MCI = Team-Based.
o Hypoglycemia in remote = RPD.
o Equipment choice = Rational.
 o Elderly confused pt in market = Bounded Rationality.
o Gas leak = NDM.

6. Clinical Case Applications

(all files combined)

 Various EMS scenarios test ethical/legal decisions, patient safety, and field management:
o Stroke, STEMI, CHF, multi-system trauma, pediatric cases, and mass casualty
incidents.
o Topics like implied consent, capacity assessment, communication breakdown,
confidentiality breach, cultural conflict, and off-protocol interventions.
o Emphasis on reflective learning, team leadership, clinical reasoning, and ethical
judgment.

Q1. A paramedic arrives at a bus crash scene and intuitively senses that more victims may be
trapped under the vehicle. What decision-making strategy is being used?

A. Deduction

B. Hypothesis

C. Intuition ✅

D. Experience

Q2. In a case where multiple patients are involved in a high-stress environment, and decisions
must be made collaboratively within ICS structure, which decision model is best applied?

A. Naturalistic

B. Rational

C. Team-Based ✅

D. Recognition-Primed
Q3. A junior paramedic follows a checklist and misses signs of internal bleeding. What does this
scenario highlight?

A. Effective use of intuition

B. Over-reliance on protocols ✅

C. Correct application of RPD

D. Proper scope of practice

Q4. When a paramedic uses both pattern recognition and a structured approach to manage an
unconscious diabetic, which combined decision-making method is being used?

A. Deduction only

B. Hypothesis generation

C. Recognition-primed + bounded rationality ✅

D. Team-based model

Q5. Which factor most limits rational decision-making in the EMS field?

A. Presence of team support

B. Access to diagnostic tools

C. Time pressure and limited information ✅

D. Training level

Q6. Which approach allows a paramedic to rapidly make decisions without evaluating multiple
options?

A. Rational
B. Bounded Rationality

C. Recognition-Primed Decision-Making ✅

D. Simon’s Dual Processing

Q7. A paramedic documents the refusal of a competent patient to be transported to hospital.

Which principle is being upheld?

A. Non-maleficence

B. Autonomy ✅

C. Beneficence

D. Confidentiality

Q8. Which of the following BEST reflects critical thinking in the modern EMS role?

A. Strict adherence to protocols

B. Passive patient assessment

C. Questioning assumptions during assessment ✅

D. Always seeking medical control approval

Q9. During a chemical plant gas leak response, a paramedic decides to wait for Hazmat before
entering. Which theory applies?

A. Bounded Rationality

B. NDM ✅

C. Rational Model

D. Hypothesis
Q10. A paramedic’s experience helps predict likely spinal injuries in an overturned vehicle
crash. This illustrates the role of:

A. Intuition

B. Hypothesis testing

C. Experience ✅

D. Team dynamics

Q11. In what scenario should the paramedic apply deductive reasoning?

A. Suspected myocardial infarction

B. Multi-patient triage requiring START ✅

C. Cultural refusal of treatment

D. Managing off-protocol medication

Q12. A paramedic is considering equipment vendors for new monitors. Which method is most
appropriate?

A. Bounded Rationality

B. Deductive reasoning

C. Rational Decision-Making ✅

D. RPD

Q13. Which factor may cause a paramedic to make “satisficing” decisions rather than optimal
ones?

A. Experience
B. Complete data

C. Information overload ✅

D. Reflection time

Q14. Which best defines the benefit of combining decision-making strategies?

A. Faster decision-making

B. Eliminates need for documentation

C. Improves adaptability and patient outcomes ✅

D. Reduces the need for protocols

Q15. The 10-step decision-making process for EMS encourages paramedics to:

A. Follow orders blindly

B. Defer every decision to supervisors

C. Pause and clarify issues before acting ✅

D. Avoid risk at all costs

Q16. A confused diabetic refuses care. You suspect impaired capacity. What is your best action?

A. Leave the patient

B. Document and proceed with implied consent ✅

C. Wait for police

D. Call hospital for immediate advice

Q17. Which element is most crucial in implementing effective treatment after field planning?
A. Availability of PPE

B. Scene documentation

C. Continuous patient reassessment ✅

D. Protocol memorization

Q18. A responder develops emotional stress after an MCI and avoids further calls. What is this
most indicative of?

A. Loss of skills

B. PTSD or burnout ✅

C. Need for more protocols

D. Poor leadership

Q19. In EMS, what differentiates a critical thinker from a traditional responder?

A. Obeying standing orders

B. Leading field intubation

C. Judging, reflecting, adapting ✅

D. Faster transport to ED

Q20. Which of the following improves both ethical and legal accountability?

A. Documenting patient’s refusal of care ✅

B. Delegating all decisions

C. Leaving the scene quickly

D. Avoiding communication with family

Q21. A responder fails to recognize a DNR due to poor legibility. What should be done?

A. Assume it’s valid

B. Proceed with resuscitation ✅

C. Ignore family’s request

D. Wait on medical control indefinitely

Q22. A paramedic applies CPAP on a geriatric CHF patient with SpO2 of 86%. This reflects:

A. Ethical violation

B. Scope breach

C. Prehospital critical care application ✅

D. BLS protocol

Q23. What improves EMS decision-making over time the most?

A. Social media feedback

B. Peer reflection and simulation ✅

C. Radio communication

D. Using fewer medications

Q24. What action supports safe practice during off-protocol care?

A. No documentation

B. Acting on intuition only

C. Consult medical control and document rationale ✅

D. Hiding from quality audits

Q25. What’s the best action when facing cultural refusal that risks the patient’s life?

A. Leave the patient alone

B. Use force

C. Try to involve same-gender caregiver, then proceed respectfully if critical ✅

D. Call police immediately

Q26. A 70-year-old cardiac arrest patient has a partially torn DNR order. Family pleads for help.
What’s the safest and most ethical response?

A. Ignore DNR and do nothing

B. Resuscitate due to document uncertainty ✅

C. Wait for supervisor

D. Ask family to sign new DNR

Q27. A junior paramedic posts a scene selfie on Instagram (no visible patient). What should you
do as team lead?

A. Ignore it

B. Praise creativity

C. Document and refer to confidentiality policy ✅

D. Publicly reprimand the paramedic

Q28. What is the primary ethical justification for obtaining informed consent?
A. To satisfy the supervisor

B. To reduce paperwork

C. To respect patient autonomy ✅

D. To avoid extra treatment

Q29. A patient refuses transport despite signs of shock. You suspect impaired cognition. What
assessment tool helps ethically justify intervention?

A. FAST approach ✅

B. SBAR

C. GCS

D. SOAP notes

Q30. Which element defines non-programmed decision-making in EMS?

A. Routine transport

B. Medication refills

C. Unique trauma with unclear protocols ✅

D. Equipment check

Q31. You’re leading an EMS student who frequently misses key trauma signs and deflects
blame. What’s your best response?

A. Dismiss the student

B. Continue without action

C. Document issues and engage clinical educator ✅

D. Avoid giving feedback to protect rapport

Q32. In what situation is implied consent invalid?

A. Patient unconscious

B. Valid DNR present ✅

C. Cardiac arrest with no family

D. GCS 3 patient with severe trauma

Q33. A confused trauma patient refuses treatment. You are unsure of his capacity. What’s the
best critical action?

A. Provide treatment under implied consent ✅

B. Leave immediately

C. Call media for advice

D. Threaten the patient with law enforcement

Q34. During an MCI, a triage officer allocates responders and manages resources. What decision
theory best applies?

A. Deduction

B. Rational

C. Team-Based ✅

D. Hypothesis

Q35. Which action ensures inter-agency communication during an MCI?

A. Using SBAR, unified command, and shared triage reports ✅

B. Acting independently per agency

C. Letting fire services lead all decisions

D. Ignoring hospital feedback

Q36. What is the key difference between intuition and experience in EMS?

A. Intuition is faster but less informed ✅

B. Experience relies on protocol

C. Intuition requires documentation

D. Experience is spontaneous

Q37. A female patient refuses examination by a male paramedic due to cultural reasons. She’s
hypotensive and pale. What’s your best action?

A. Wait for a female responder while monitoring

B. Respectfully explain situation, proceed if critical, and document ✅

C. Ignore the refusal

D. Let the family decide

Q38. How does bounded rationality affect EMS decisions?

A. It ensures perfect choices

B. It relies on checklists only

C. Decisions are made within limits and under pressure ✅

D. It replaces protocols completely

Q39. Which legal principle allows treatment when a patient is unconscious and has no DNR or
guardian?

A. Informed Consent

B. Beneficence

C. Implied Consent ✅

D. Coercion

Q40. What best improves ethical reasoning in high-pressure EMS scenarios?

A. Critical incident stress management

B. Routine paperwork

C. Regular review of ethical case studies and reflection ✅

D. Protocol memorization

Q41. Why is reflection important after each EMS case?

A. To blame team members

B. To avoid feedback

C. To improve future decision-making through learning ✅

D. To complete insurance reports

Q42. A trauma patient receives off-protocol medication by a paramedic without medical control
approval. As a partner, what is your duty?

A. Ignore the action

B. Support the partner unconditionally

C. Ensure safety, report event, and initiate reflection ✅

D. Administer another medication to balance

Q43. What’s the best method to support a colleague showing signs of PTSD?

A. Ignore and let them recover naturally

B. Publicly confront them

C. Privately engage, offer peer support, suggest professional help ✅

D. Remove them from field work immediately

Q44. A patient is unconscious, no family is present, and no DNR found. What’s your obligation?

A. Wait until someone arrives

B. Treat immediately under implied consent ✅

C. Begin palliative care

D. Refuse intervention

Q45. Which BEST demonstrates the shift from traditional to modern EMS decision-making?

A. More medications in ambulance

B. Longer transport times

C. Greater independence and situational judgment ✅

D. Better uniforms

Q46. How does the dual-processing model enhance paramedic performance?

A. Avoids any intuitive response

B. Prioritizes guesswork over training

C. Combines analytical logic with pattern recognition ✅

D. Eliminates teamwork

Q47. What makes a critical thinker different from a protocol follower in the EMS field?

A. Ability to repeat steps

B. Prioritizes speed over safety

C. Evaluates, adapts, and challenges assumptions ✅

D. Avoids new methods

Q48. When communicating with patients’ families under stress, what’s most essential?

A. Quick dismissal

B. Clinical jargon

C. Empathy and clarity ✅

D. Avoiding details

Q49. A patient’s glucose is 1.7 mmol/L, and they refuse IV dextrose. What ethical factor justifies
treatment?

A. Beneficence with impaired capacity ✅

B. Non-maleficence with consent

C. Legal consent from friend

D. Verbal agreement
Q50. Which element should be included when handing over a critical care patient during
transfer?

A. Just patient age

B. Only medications given

C. Full status, interventions, and ongoing needs ✅

D. General impression only

Q51. A paramedic’s actions during a viral video scene are misrepresented online. What is the
best initial course of action?

A. Publicly respond online

B. Ignore the situation

C. Refer case to media/public relations and document the event ✅

D. Post a counter video

Q52. What key strategy helps paramedics stay legally protected after complex cases?

A. Rely on memory

B. Defer reports to team leads

C. Complete detailed and timely documentation ✅

D. Call the hospital after transport

Q53. In a case of conflicting family wishes versus a valid DNR, what must guide the
paramedic’s action?

A. Public opinion

B. Medical control refusal

C. Legal validity of the DNR ✅

D. Emotional appeal from relatives

Q54. What is a primary benefit of simulation-based learning in paramedic education?

A. Replaces all clinical hours

B. Builds memorization of drugs

C. Enables real-time decision-making and safe error correction ✅

D. Improves CPR speed

Q55. During triage in a highway accident, one patient walks, another is not breathing, and one
has a pulse and uncontrolled bleeding. Who is “immediate” in START?

A. Walking wounded

B. No breathing after airway repositioning

C. Pulse with uncontrolled bleeding ✅

D. All are “delayed”

Q56. A new EMS student is defensive during feedback. What principle should guide your
mentoring?

A. Avoid feedback to maintain peace

B. Use structured evaluation tools and offer constructive guidance ✅

C. Report them without support

D. Let another preceptor handle the student

Q57. You must choose between two ambulance monitor vendors. Which process best supports
the decision?

A. Team-based intuition

B. Vendor advertisement

C. Structured rational analysis (cost, training, outcomes) ✅

D. Popular opinion

Q58. A paramedic interprets lab data and EKG during a cardiac call. Which skill domain is this?

A. Motor

B. Communication

C. Clinical reasoning ✅

D. Ethical judgment

Q59. Which of the following would improve inter-professional communication during handover?

A. Speaking casually

B. Avoiding technical language

C. Using SBAR (Situation, Background, Assessment, Recommendation) ✅

D. Letting the ED team read the PCR only

Q60. In which scenario is Naturalistic Decision Making (NDM) most appropriate?

A. Reviewing medication list in the station

B. Comparing service vendors

C. Dynamic chemical gas leak with limited info ✅

D. Routine BLS transport

Q61. What is the main ethical risk in failing to explain a medical procedure before doing it?

A. Delay in care

B. Misunderstanding treatment

C. Violating patient autonomy ✅

D. Poor documentation

Q62. Which element BEST reflects modern EMS education priorities?

A. Protocol memorization

B. Critical thinking and scenario adaptability ✅

C. Long classroom hours

D. Reduced exposure to clinical practice

Q63. Why is the FAST approach used in capacity assessment?

A. Determines if the patient has low sugar

B. Assesses stroke likelihood

C. Helps evaluate mental capacity and urgency of situation ✅

D. Decides which hospital to use

Q64. Which of the following reflects bounded rationality in action?

A. Delaying care until all data is gathered

B. Making the best possible plan based on full info

C. Choosing “good enough” option under time pressure ✅

D. Using only team consensus

Q65. In decision-making theory, “satisficing” is best defined as:

A. Choosing the cheapest method

B. Prioritizing patient feelings

C. Selecting the first acceptable option under constraints ✅

D. Delaying decision until supervisor arrives

Q66. A paramedic in an MCI makes spontaneous decisions without consulting others. This
approach may risk violating which principle?

A. Autonomy

B. Team-based decision-making model ✅

C. Bounded rationality

D. Recognition-primed theory

Q67. In a multi-casualty crash with limited responders, what should guide patient prioritization?

A. Protocol memorization

B. Patient age

C. START triage and resource availability ✅

D. First-come-first-serve logic

Q68. Which of the following would most help prevent future ethical dilemmas in EMS?

A. Rapid case handover

B. Use of sedation
C. Reflective practice and protocol revision ✅

D. Avoiding DNR discussions

Q69. A trauma victim clearly refuses care but is in shock. You suspect impaired decision-
making. What should you do?

A. Respect the refusal

B. Immediately transport without treatment

C. Initiate treatment and document reasoning under implied consent ✅

D. Wait for law enforcement

Q70. A patient’s family insists on transport, but the patient with capacity refuses. What principle
applies?

A. Beneficence

B. Confidentiality

C. Autonomy ✅

D. Teamwork

Q71. During an MCI, you activate ICS structure and assign roles. What are you demonstrating?

A. Hypothesis testing

B. Deductive logic

C. Effective team-based leadership ✅

D. Traditional EMS flow

Q72. In the Simon model of decision-making, what is the difference between programmed and
non-programmed decisions?

A. One is legal, the other isn’t

B. Programmed are repetitive and pre-planned; non-programmed are novel and complex ✅

C. Programmed are intuitive

D. Non-programmed are for students only

Q73. Which is a psychological factor that may limit EMS critical thinking?

A. High blood pressure

B. Crew size

C. Stress and fatigue ✅

D. Number of medications

Q74. A patient with chest pain has a normal ECG but appears anxious and pale. The protocol
says transport is optional. What’s the best action?

A. Leave patient after signing refusal

B. Use judgment and recommend transport ✅

C. Ignore anxiety

D. Apply monitor and leave

Q75. Why is contextual awareness important in EMS decisions?

A. It helps memorize drug doses

B. It evaluates every situation the same

C. It adapts care based on age, location, condition, and available resources ✅

D. It slows down decision-making

Q76. A confused elderly patient is found wandering with no identification and unclear
symptoms. What’s your most appropriate decision-making model?

A. Rational

B. Deductive

C. Bounded Rationality ✅

D. Team-Based

Q77. What best improves clinical reasoning in prehospital care?

A. More hours on radio

B. Reviewing old cases and integrating experience with new scenarios ✅

C. Memorizing protocols

D. Avoiding uncertain patients

Q78. You’re unsure whether a medication given off-protocol caused harm. What is the first step
in ethical accountability?

A. Hide the event

B. Wait for patient to complain

C. Report, document, and initiate case review ✅

D. Retake the protocol test

Q79. What’s the key purpose of evaluation in the 4-stage EMS decision-making process?

A. Deliver faster care

B. Finalize documentation

C. Determine if the intervention achieved its goal ✅

D. Prepare for court cases

Q80. You see a colleague withdrawing and using dark humor after a traumatic call. How do you
proceed?

A. Give them space and ignore

B. Tease them back

C. Offer peer support and recommend wellness resources ✅

D. Report them immediately to HR

Q81. Why is reflective practice emphasized in EMS critical thinking training?

A. Helps memorize protocol

B. Boosts rapid airway skills

C. Encourages learning from experience to improve future decisions ✅

D. Satisfies evaluation forms only

Q82. Which is an example of dual processing in EMS?

A. Ignoring emotional cues

B. Making decisions only from training

C. Using both past experience and analytical reasoning to treat a patient ✅

D. Relying only on gut instinct

Q83. In a burn MCI, your team starts treating walking wounded first. What error has occurred?

A. Communication error

B. Triage prioritization failure ✅

C. Equipment failure

D. Medication mismatch

Q84. A trauma patient is sedated and intubated. What must be communicated to the receiving
ED?

A. Just vital signs

B. Medications given

C. All interventions, sedation level, transport course, and changes in status ✅

D. Only patient ID

Q85. A confused patient demands to go home during transport. How should you respond?

A. Let them out

B. Sedate immediately

C. Assess capacity, reassure, and document findings ✅

D. Ignore completely

Q86. Which factor contributes MOST to poor EMS decisions in disaster settings?

A. Poor scene lighting

B. Use of protocol sheets

C. Stress, limited information, and role confusion ✅

D. Lack of uniforms

Q87. A junior paramedic inappropriately posts scene updates online. What long-term action
should follow besides immediate correction?

A. Ignore it

B. Ban social media use

C. Update training to include digital professionalism ✅

D. Take over their account

Q88. A stroke patient needs rapid access to a stroke unit. What EMS action most improves
outcome?

A. Take vitals only

B. Call medical control

C. Perform prehospital notification and rapid transport ✅

D. Wait for CT results

Q89. A patient with capacity refuses care, but their family insists you proceed. What should
guide your decision?

A. Family wishes

B. EMS team decision

C. Respect for patient autonomy and full documentation ✅

D. Protocol flowchart
Q90. In scenario debriefing, a team realizes their triage categorization delayed care to a critical
patient. What’s the next best step?

A. Reassign team

B. Punish the triage lead

C. Analyze decisions, review triage guidelines, and update training ✅

D. Ignore to avoid blame

Q91. Why are decision-making frameworks like ABCDE and START crucial in field care?

A. Reduce documentation

B. Prevent equipment loss

C. Provide structured assessment and reduce errors ✅

D. Save fuel and time

Q92. During MCI, which leadership behavior improves care delivery?

A. Leading from front with no feedback

B. Assigning roles, maintaining communication, ensuring feedback ✅

C. Doing most treatments yourself

D. Ignoring hospital instructions

Q93. A trauma patient deteriorates en route. What’s your priority action?

A. Wait until arrival

B. Continue initial treatment

C. Reassess vitals, adjust interventions, and alert receiving facility ✅

D. Administer sedatives
Q94. Which of the following best promotes cultural competence in EMS?

A. Wearing international uniforms

B. Having bilingual team members

C. Adapting care to beliefs and involving families appropriately ✅

D. Avoiding culturally complex cases

Q95. A paramedic’s ability to manage multiple trauma patients in chaos reflects what?

A. Advanced documentation skills

B. Emotional detachment

C. High-level situational awareness and leadership ✅

D. BLS training

Q96. In evaluating EMS student performance, what supports objective feedback?

A. Verbal compliments only

B. Daily checklists and learning reflections ✅

C. Social comparison

D. Repeating the same task

Q97. A 59-year-old STEMI patient receives aspirin and nitrates prehospital. What’s the next
critical step?

A. Wait for ED evaluation

B. Continue monitoring

C. Transmit 12-lead ECG and notify cardiac unit ✅

D. Offer water and rest

Q98. What does Simon’s decision theory add to EMS education?

A. It promotes only protocols

B. It ignores emotional factors

C. It highlights psychological limits and satisficing in field decisions ✅

D. It requires managerial approval

Q99. In a scenario with no clear guidelines, what should a critical-thinking paramedic rely on?

A. Waiting for orders

B. Guesswork

C. Integrated experience, assessment, ethics, and risk-benefit analysis ✅

D. Crew majority

Q100. What’s the ultimate goal of integrating all decision-making models in EMS?

A. Follow checklists efficiently

B. Avoid complaints

C. Achieve optimal patient outcomes through adaptable, intelligent, and ethical decisions ✅

D. Reduce vehicle mileage