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Covering 56 counties in Montana · Protocols current as of June 17, 2026
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Montana Pre-Hospital Treatment Protocols
Current Revision# 12 on 11/2020 ↗
PDF document
414
Flashcards
210
Quiz questions
37
Medications
8
Resources
Study tools for Montana Pre-Hospital Treatment Protocols
A few real flashcards and quiz questions from Montana's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
EMR initial actions for adult cardiac arrest
The EMR initiates CPR per current AHA standards, attaches and utilizes an AED, suctions secretions as needed, and administers high flow oxygen with assisted ventilation as necessary. Hypothermic patients are referred to the Cold Emergencies – Systemic Hypothermia Protocol.
AED use in hypothermia: core temp < 86°F (30°C)
If patient temperature is less than 86°F (30°C) or unknown, administer ONE shock, then provide no further shocks until temperature rises above 86°F. If temperature is greater than 86°F, follow the standard AED protocol.
AEMT (I99 Endorsement) role in adult cardiac arrest
The AEMT with I99 Endorsement attaches a cardiac monitor, identifies the rhythm, and treats specific dysrhythmias within their scope of practice according to the most recent ACLS protocols as directed by the medical director.
Paramedic 12-lead ECG indication in adult cardiac arrest
The Paramedic obtains, interprets, and transmits a 12-lead ECG only if there is return of spontaneous circulation (ROSC). This is not performed during active arrest.
Why must hypothermia patients be handled gently?
Rough handling of hypothermia patients may precipitate ventricular fibrillation. All hypothermia patients must be handled with care regardless of their level of consciousness.
Response time threshold that may support consideration of discontinuing bystander-initiated CPR
A response time greater than 15 minutes, combined with a transport time that is equal to or greater, may support consideration of discontinuing resuscitative efforts. The AED must also indicate 'no shock advised' and the patient must be pulseless and breathless on initial ECP assessment.
Are ACLS/PALS dysrhythmia algorithms included in the Montana protocol manual?
No. ACLS and PALS algorithms for dysrhythmias are NOT reproduced in this protocol manual. Providers are expected to reference them from other sources and treat patients within their individual scope of practice and as directed by their medical director.
Contraindications to initiating CPR in the field (hypothermia)
CPR should NOT be initiated if the chest is frozen/non-compliant, the victim has been unquestionably submerged more than 1 hour AND core temp is greater than 30°C, or an obvious lethal injury is present. Chest compressions must never be performed if any clinical signs of functional cardiac activity are present, even if a pulse is not palpable.
Quiz questions
An EMR arrives first on scene to an adult cardiac arrest. Which of the following actions is within the EMR's scope per this protocol?
- Attach a cardiac monitor and identify the rhythm
- Start a peripheral IV with Normal Saline
- ✓ Initiate CPR, attach/utilize AED, suction as needed, and administer high flow oxygen
- Obtain and interpret a 12-lead ECG
You arrive on scene to find a hypothermic patient with a core temperature of 82°F (28°C) who is in cardiac arrest. According to the Montana Systemic Hypothermia protocol, what is the correct AED management for this patient?
- Follow standard AED protocol and continue shocking as indicated
- Do not attach the AED; hypothermic patients should not be defibrillated in the field
- ✓ Administer one shock, then provide no further shocks until core temperature exceeds 86°F
- Administer two shocks in rapid succession, then reassess rhythm
You arrive on scene to find a pulseless, apneic adult patient. Bystanders report CPR was not started and the patient has been down for approximately 20 minutes. Per the Montana Resuscitation Triage protocol, what is the most appropriate action?
- Immediately begin full resuscitation and transport to a medical facility.
- ✓ Consider not initiating resuscitation, as more than 15 minutes elapsed before your arrival without resuscitation being begun.
- Contact medical control before making any decision, as this is a special circumstance.
- Initiate resuscitation only if a shockable rhythm is confirmed on the cardiac monitor.
According to the Montana Resuscitation Triage Best Practice, which of the following is NOT listed as a consideration when deciding whether to discontinue resuscitative efforts started by lay persons prior to ECP arrival?
- Quality of CPR performed by bystanders
- Time CPR was begun
- ✓ The patient's age and medical history
- Cause of the arrest
You are an EMT with both airway and IV/IO initiation endorsements responding to an adult cardiac arrest. Which combination of interventions is authorized for you under this protocol?
- ✓ Establish an advanced airway and start a peripheral IV with Normal Saline or Lactated Ringers
- Establish an advanced airway and attach a cardiac monitor to identify the rhythm
- Start a peripheral IV and administer antidysrhythmics per ACLS
- Obtain a 12-lead ECG and transmit to the receiving facility
A Paramedic is treating a patient with chest pain whose 12-lead EKG reveals an inferior STEMI. In addition to considering fibrinolytics and anticoagulation per local protocol, what additional EKG action does the protocol specifically require?
- Obtain a posterior lead V8–V9 to rule out posterior extension
- ✓ Obtain a right-sided V4 lead
- Repeat the 12-lead EKG every 5 minutes until arrival at the hospital
- Attach a continuous ST-segment monitoring lead II strip
Sourced from Montana's EMS authority
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Montana protocols — FAQ
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