Free NYC REMAC Practice Questions (2026 Protocols) with Answers

Here are 15 free NYC REMAC practice questions written to the 2026 NYC REMAC Prehospital Treatment Protocols (version 2026-01, effective August 1, 2026), each with the correct answer, an explanation and the protocol page so you can check it yourself. They come from the RemacReady practice bank and cover the General Operating Procedures (GOP), cardiac, airway, medical, OB and pediatrics, trauma, the appendices, and scenario-style questions.

Try each question before you scroll to the answer. If you miss one, open your protocol book to the cited page and read the whole section, not just the line.

Key facts

• 15 questions, one or two from each major area of the protocol book
• Answers sit directly below each question, so cover them if you want a real test
• Every answer cites the 2026 NYC REMAC Protocols section and printed page number
• Page numbers restart in each part of the book. GOP pages, Treatment Protocol pages and Appendix pages are numbered separately, so the section name tells you which part to open
• The real exam: 120 questions, 3 hours, 80% to pass. Our NYC REMAC exam guide covers the details

These questions are for exam study only. In the field, follow the current official protocols and medical control.

GOP questions

Question 1: OLMC can't be reached

You are treating a patient and repeatedly try to reach Online Medical Control by radio and phone, but you cannot establish contact. Under the REMAC General Operating Procedures, what may you still provide?

• A. Only medications and treatments that fall under standing orders
• B. Both standing orders and any medical control options normally requiring OLMC
• C. Discretionary orders based on your own clinical judgment
• D. Any intervention that is within the paramedic scope of practice

Answer and explanation

A. Only medications and treatments that fall under standing orders.

The GOP definition of Online Medical Control says that when providers are unable to contact OLMC, they may only administer standing order medications and treatments. Standing orders are, by definition, the medications and treatments you can give without contacting OLMC.

• Medical control options may only be given after contacting OLMC, so they are off the table.
• Discretionary orders still need a physician's order. Your own judgment can't authorize them.
• Scope of practice is not the test. Many paramedic interventions are medical control options.

(2026 NYC REMAC Protocols, GOP: Definitions, pp. 2-3)

Question 2: Two failed intubation attempts

You have made two unsuccessful endotracheal intubation attempts on an adult patient, counting attempts by both providers on scene. According to the GOP, what must happen next?

• A. A third intubation attempt may be made by the more experienced provider
• B. A supraglottic airway device shall be used or the patient shall receive effective bag valve mask ventilation
• C. Nasotracheal intubation should be attempted as a rescue airway
• D. Transport must begin immediately with no further airway management

Answer and explanation

B. A supraglottic airway device or effective BVM ventilation.

After two unsuccessful attempts at endotracheal intubation, counted as total attempts even when more than one provider tries, the GOP requires either a supraglottic airway or effective bag valve mask ventilation. For adults, effective BVM ventilation is an acceptable alternative to an advanced airway unless a protocol specifically requires one.

• A third attempt by a second provider is not allowed. The count is total, not per provider.
• Nasal intubation is not an approved form of advanced airway management in the NYC region.
• Stopping airway management is never the answer. The GOP calls for a rescue device or BVM.

Also worth knowing from the same page: an intubation attempt is defined as the laryngoscope blade passing the teeth, even if no tube is inserted.

(2026 NYC REMAC Protocols, GOP: Airway Management and Airway Monitoring, p. 13)

Cardiac questions

Question 3: First antiarrhythmic in adult VF

An adult in cardiac arrest is in ventricular fibrillation after the second rhythm analysis. Under paramedic standing orders, which antiarrhythmic option may be administered?

• A. Amiodarone 300 mg IV or lidocaine 100 mg IV
• B. Amiodarone 150 mg IV only
• C. Lidocaine 50 mg IV or magnesium sulfate 2 g IV
• D. Magnesium sulfate 2 g IV only

Answer and explanation

A. Amiodarone 300 mg IV or lidocaine 100 mg IV.

For VF or pulseless VT, the adult Non-Traumatic Cardiac Arrest paramedic standing orders give two options: amiodarone 300 mg IV (Option A) or lidocaine 100 mg IV (Option B). You pick one.

• Amiodarone 150 mg IV is the repeat dose for persistent or recurring VF/pVT, and it is a Medical Control Option.
• Lidocaine 50 mg IV and magnesium sulfate 2 g IV (diluted in 10 ml Normal Saline over 2 minutes) are also Medical Control Options for persistent or recurring VF/pVT, not standing orders.

(2026 NYC REMAC Protocols, Non-Traumatic Cardiac Arrest (Adult), pp. 2-3)

Question 4: Unstable SVT energy

An adult in unstable supraventricular tachycardia requires synchronized cardioversion. What is the initial energy per the SVT sub-protocol, and how does it escalate?

• A. 100 J initially, then repeat as needed at 200, 300 and 360 J
• B. 200 J initially, then 300 and 360 J
• C. 50 J initially, then 100 J
• D. 360 J for the first and all subsequent attempts

Answer and explanation

A. 100 J, then 200, 300 and 360 J as needed.

The adult SVT sub-protocol starts synchronized cardioversion for unstable SVT at 100 joules and repeats as needed at 200, 300 and 360 joules.

• 200 J, then 300 and 360 J, is the sequence for unstable atrial fibrillation or flutter. Easy to mix up, and a classic exam trap.
• 50 J then 100 J is not an adult sequence in these protocols.
• The protocol escalates. It does not start at 360 J.

If your monitor can't deliver more than 200 J, the adult Dysrhythmia key points say to use the monitor's maximum setting for further attempts.

(2026 NYC REMAC Protocols, Supraventricular Tachycardia (SVT) (Adult), p. 26; Dysrhythmia (Adult), p. 23)

Question 5: STEMI patient arrests en route

A STEMI patient is being transported to the closest STEMI Center as previously directed by OLMC. En route, the patient goes into cardiac arrest. What does the protocol direct regarding destination?

• A. Continue transport to the STEMI Center as previously directed by OLMC
• B. Divert to the nearest emergency department because the patient is now in arrest
• C. Stop and stage until a second OLMC order is obtained
• D. Return to the scene

Answer and explanation

A. Continue to the STEMI Center.

The GOP's specialty-care transport rules say that if the patient deteriorates into cardiac arrest during transport, the unit shall continue transport to the STEMI Center as previously directed by OLMC. You keep running the arrest en route.

• Diverting contradicts the explicit instruction.
• Staging for a new order delays care. OLMC already set the destination.
• Returning to the scene has no clinical basis.

Related fact from the same page: STEMI Center transport applies when the 12-lead shows at least 1 mm of ST elevation in two or more contiguous leads, after consultation with OLMC.

(2026 NYC REMAC Protocols, GOP: Transportation to Specialty Care Facilities, p. 9)

Pediatric questions

Question 6: Pediatric defibrillation energy

A pediatric patient in cardiac arrest is in ventricular fibrillation. Per the pediatric protocol, what is the correct sequence of weight-based defibrillation energies?

• A. 2 J/kg for the initial shock, 4 J/kg for the second shock, then 10 J/kg for subsequent shocks
• B. 2 J/kg for every shock
• C. 4 J/kg initially, then 2 J/kg for subsequent shocks
• D. 1 J/kg initially, then 2 J/kg escalating

Answer and explanation

A. 2 J/kg, then 4 J/kg, then 10 J/kg.

The pediatric Non-Traumatic Cardiac Arrest standing orders use appropriately sized pads and set the energy at 2 J/kg initially, 4 J/kg for the second shock as needed and 10 J/kg for subsequent shocks as needed. If the monitor can't deliver the exact weight-based setting, use the closest setting without exceeding it.

• 2 J/kg every time never escalates.
• Dropping from 4 J/kg to 2 J/kg reverses the sequence.
• 0.5-1 J/kg, then 1-2 J/kg, is the pediatric synchronized cardioversion range, and it is a Medical Control Option. Don't confuse the two.

(2026 NYC REMAC Protocols, Non-Traumatic Cardiac Arrest (Pediatric), pp. 4-5)

Question 7: Suspected epiglottitis

A paramedic is caring for a child with high fever, drooling, a muffled voice and a toxic appearance who is sitting in a tripod position with stridor. What does the protocol direct regarding airway management?

• A. Suspect epiglottitis: do not attempt advanced airway management, avoid agitating the child, and ventilate with a bag valve mask if needed
• B. Perform rapid endotracheal intubation to secure the airway early
• C. Administer nebulized albuterol and reassess
• D. Lay the child supine and insert an oropharyngeal airway

Answer and explanation

A. No advanced airway, don't agitate, BVM if needed.

Stridor, muffled voice, high fever, tripod position, drooling and a toxic appearance match the protocol's description of suspected epiglottitis. If there is clinical concern for epiglottitis, the paramedic section says do NOT attempt advanced airway management and ventilate using a bag valve mask. The key points add: avoid agitating the child, particularly if epiglottitis or upper airway edema is a concern.

• Early intubation is exactly what the protocol prohibits here.
• Albuterol is not part of this protocol's treatment.
• Laying the child flat and placing an OPA takes away the position they are using to keep the airway open, and agitates them.

(2026 NYC REMAC Protocols, Stridor / Croup / Epiglottitis (Pediatric), pp. 41-42)

Medical questions

Question 8: Midazolam for seizures

A paramedic gives midazolam to an actively seizing adult. What is the single-dose maximum and the maximum cumulative dose after a repeat?

• A. 0.2 mg/kg IV/IN/IM (maximum 5 mg per dose), repeated after 5 minutes to a maximum cumulative dose of 10 mg
• B. 0.2 mg/kg (maximum 10 mg per dose) with no cumulative limit
• C. 0.1 mg/kg (maximum 2 mg per dose), cumulative 4 mg
• D. 0.5 mg/kg (maximum 20 mg per dose)

Answer and explanation

A. 0.2 mg/kg, max 5 mg per dose, repeat after 5 minutes, max 10 mg total.

Option A in the Seizures paramedic section is midazolam 0.2 mg/kg IV/IN/IM (maximum 5 mg), repeated as needed after 5 minutes to a maximum cumulative dose of 10 mg. The key points list midazolam as the preferred seizure medication because of its fastest onset, followed by lorazepam and then diazepam.

• 0.2 mg/kg with a 10 mg max matches the IM/IN chemical restraint dose in Behavioral Emergencies, not seizures.
• 0.1 mg/kg, max 2 mg per dose and 4 mg cumulative, is the lorazepam seizure regimen.
• 0.5 mg/kg is not a midazolam dose anywhere in the protocols.

(2026 NYC REMAC Protocols, Seizures (Adult and Pediatric), pp. 51-52)

Question 9: Why paramedics titrate naloxone

Why does the protocol direct paramedics to titrate naloxone in small 0.5 mg increments rather than give the larger CFR/EMT intranasal dose?

• A. The lowest effective dose reverses respiratory depression while reducing the risk of precipitated withdrawal and pulmonary edema
• B. Small doses are cheaper and conserve the naloxone supply
• C. Paramedics are not permitted to carry higher-concentration naloxone
• D. Intranasal naloxone becomes ineffective once a paramedic is present

Answer and explanation

A. Lowest effective dose, less risk of withdrawal and pulmonary edema.

The Overdose key points say it is safest to use the lowest dose of naloxone that reverses an opioid overdose patient's respiratory depression, because it lowers the risk of precipitating opioid withdrawal and pulmonary edema. Paramedics should not give the CFR or EMT dose. They titrate in 0.5 mg increments IV/IM/IN to response: adult maximum 4 mg, pediatric maximum 1 mg under age 2 and 2 mg at age 2 or older.

• Cost and supply are not reasons the protocol gives.
• Nothing bars paramedics from carrying other concentrations.
• The paramedic titration can itself be given IN, so the route is not the issue.

(2026 NYC REMAC Protocols, Overdose (Adult and Pediatric), pp. 48-49)

OB and neonatal questions

Question 10: Eclampsia

A 32-week-pregnant patient has a witnessed generalized tonic-clonic seizure with a blood pressure of 176/114. Operating under standing orders as a paramedic, which magnesium sulfate order matches the Obstetric Emergencies protocol for eclampsia?

• A. Magnesium sulfate 4 g IV, diluted in 50-100 ml Normal Saline, over 10 minutes
• B. Magnesium sulfate 2 g IV, diluted in 10 ml Normal Saline, over 2 minutes
• C. Magnesium sulfate 4 g IV push over 1 minute, undiluted
• D. No magnesium may be given without first contacting medical control

Answer and explanation

A. 4 g IV in 50-100 ml Normal Saline over 10 minutes.

For eclampsia (seizures secondary to elevated blood pressure in pregnancy), the paramedic standing order is magnesium sulfate 4 g IV diluted in 50-100 ml Normal Saline over 10 minutes. The key points add: don't delay treatment of the seizure while preparing or giving magnesium.

• 2 g in 10 ml over 2 minutes is the cardiac arrest Medical Control Option, not the OB dose.
• The protocol specifies dilution and a 10-minute infusion, not an undiluted push.
• Medical control is required for pre-eclampsia with severe features (no seizure). Eclampsia is a standing order. Same 4 g dose, different authorization.

(2026 NYC REMAC Protocols, Obstetric Emergencies, p. 30)

Question 11: Newborn heart rate of 50

About two minutes after birth, a neonate's heart rate is 50 despite 30 seconds of effective ventilation. According to the Neonatal Care / Resuscitation protocol, what is the next step?

• A. Begin chest compressions while continuing ventilations
• B. Stop ventilations and provide blow-by oxygen only
• C. Continue ventilations alone and reassess in five minutes
• D. Administer epinephrine before starting compressions

Answer and explanation

A. Start compressions and keep ventilating.

At two minutes after birth, if the heart rate is below 60 after 30 seconds of ventilations, start compressions while continuing ventilations at a 3:1 compression-to-ventilation ratio. Reassess every minute. Once the heart rate is above 60, stop compressions and keep ventilating at 40-60 breaths/min.

• Supplemental oxygen alone is only for a neonate with a respiratory rate above 30, a heart rate above 60 and no central cyanosis.
• Waiting five minutes ignores both the threshold and the one-minute reassessment.
• Epinephrine is a paramedic step for when transport is delayed and the neonate remains in arrest. It doesn't replace compressions.

(2026 NYC REMAC Protocols, Neonatal Care / Resuscitation, pp. 35-36)

Trauma questions

Question 12: Tourniquet placement

A patient has uncontrolled, life-threatening hemorrhage from a mid-forearm laceration. Per the Bleeding / Hemorrhage Control protocol, where is the initial tourniquet placed?

• A. 2-3 inches proximal to the wound
• B. Directly over the wound
• C. 2-3 inches distal to the wound
• D. At the wrist, distal to the injury

Answer and explanation

A. 2-3 inches proximal to the wound.

For uncontrolled, life-threatening extremity bleeding, place the tourniquet 2-3 inches proximal to the wound. If bleeding continues, place a second tourniquet proximal to the first. If the wound is distal to the knee or elbow, the second tourniquet goes proximal to those joints. If the bleeding site can't be rapidly identified, place the tourniquet "high and tight."

• Over the wound or distal to it won't stop flow into the wound.
• The wrist is distal to a mid-forearm wound.

Key point to remember: do not remove a tourniquet that was used to control life-threatening hemorrhage, and note the time and location.

(2026 NYC REMAC Protocols, Bleeding / Hemorrhage Control (Adult and Pediatric), pp. 75-76)

Question 13: Burn fluids

A paramedic is treating an adult with partial- and full-thickness burns covering an estimated 30% TBSA. Per the standing-order Burns protocol, crystalloid fluid is indicated at what dose?

• A. 20 ml/kg IV, maximum 1 L, for partial- and full-thickness (2nd degree or higher) burns greater than 20% TBSA
• B. 20 ml/kg IV, maximum 2 L, for any burn greater than 10% TBSA
• C. 40 ml/kg IV, maximum 2 L, for all full-thickness burns
• D. No fluids are indicated for burn patients in the prehospital setting

Answer and explanation

A. 20 ml/kg IV, maximum 1 L, for 2nd degree or higher burns over 20% TBSA.

The paramedic standing order for partial- and full-thickness burns greater than 20% TBSA is crystalloid 20 ml/kg IV, maximum 1 L. For a delay in transport, another 20 ml/kg (maximum 1 L) is a Medical Control Option. The key points note that most burn patients do not need aggressive prehospital fluid resuscitation, and that superficial (1st degree) burns are not counted toward TBSA.

• The 10% figure in the Burns protocol is the EMT limit for moist dressings, not a fluid trigger, and the burn fluid maximum is 1 L, not 2 L.
• 40 ml/kg is far more than this protocol allows.
• Fluids are indicated at this size and depth.

(2026 NYC REMAC Protocols, Burns (Adult and Pediatric), pp. 77-78)

Appendix and scenario questions

Question 14: S-LAMS score of 4

A patient with new stroke signs has a NYC S-LAMS score of 4. Based on the stroke triage appendix, what is the correct transport decision?

• A. Contact online medical control for a transport decision to the closest appropriate Thrombectomy Stroke Center
• B. Transport directly to the closest Primary Stroke Center without contacting OLMC
• C. Transport to the nearest emergency department regardless of stroke designation
• D. Treat in place and arrange outpatient neurology follow-up

Answer and explanation

A. Contact OLMC for a decision on the closest appropriate Thrombectomy Stroke Center.

Appendix G splits stroke transport by score. NYC S-LAMS 3 or less goes to the closest appropriate Primary Stroke Center. A score of 4 or more means contacting OLMC for a transport decision to the closest appropriate Thrombectomy Stroke Center. OLMC decides based on exclusion criteria: symptom onset to EMS contact over 24 hours, wheelchair- or bed-bound, seizure or trauma as the cause, loss of consciousness, or transport time over 30 minutes.

• Going straight to a Primary Stroke Center without OLMC is the pathway for a score of 3 or less.
• The GOP sends acute stroke (symptoms under 24 hours) to the closest appropriate Stroke Center unless an exception applies, so "nearest ED regardless" is wrong.
• Acute stroke carries a high index of suspicion, which excludes treat-in-place under Appendix P.

(2026 NYC REMAC Protocols, Appendix G: Stroke Patient Assessment Triage and Transportation, p. 12)

Question 15: Scenario, ALS is 18 minutes out

An EMT crew on scene with a patient who needs ALS has requested paramedics. Dispatch reports the nearest available ALS unit is roughly 18 minutes out, while the closest appropriate hospital is about 7 minutes away. What should the EMT crew do?

• A. Wait on scene for the paramedics regardless of how long it takes
• B. Begin transport toward the hospital rather than delay waiting for ALS
• C. Cancel the ALS request and treat the patient with BLS interventions only on scene
• D. Split the difference and wait 9 minutes before deciding

Answer and explanation

B. Begin transport.

Under GOP: Initiating Transport, when EMTs request ALS, transport procedures should begin. If the paramedics' arrival time exceeds the transport time to the destination facility, transport should not be delayed unless a particular protocol says otherwise. Eighteen minutes for ALS against a 7-minute transport means you go.

• Waiting regardless of time is exactly what the GOP warns against.
• Canceling ALS and staying on scene delays care the patient still needs.
• "Wait 9 minutes" is not a protocol concept. The rule compares ALS arrival time to transport time.

The GOP applies to every provider level, so learn the BLS rules too, not just the paramedic ones.

(2026 NYC REMAC Protocols, GOP: Initiating Transport, p. 7)

How did you do?

Count your correct answers and multiply by 100/15 to get a percentage. The real exam's passing mark is 80%, which here would be 12 of 15.

A small set like this can't tell you whether you'll pass, but it does show you patterns. Look at what you missed:

• Mixed up two numbers? (100 J vs. 200 J, 1 L vs. 2 L) You need more reps on exact doses and settings.
• Picked an OLMC option as a standing order, or the reverse? Re-read the Introduction on page 1 of the Treatment Protocols and the GOP Definitions on pages 2-3.
• Missed a GOP or appendix question? Those sections are about a quarter of the exam. Give them real study time.

For a full plan, see How to Study for the NYC REMAC Exam in 30 Days, and for a tour of what each part of the book covers, the 2026 NYC REMAC Protocols study overview.

Frequently asked questions

Are these real NYC REMAC exam questions?

No. They are practice questions written by RemacReady from the 2026 NYC REMAC Prehospital Treatment Protocols. Real exam content is confidential, and candidates sign a confidentiality statement. Practice questions help you learn the same protocol facts the exam is built on.

Which protocol version do these questions use?

The 2026 NYC REMAC Prehospital Treatment Protocols, version 2026-01, effective August 1, 2026. Every answer cites the section and printed page number.

Why do the page numbers restart?

The protocol book has three parts, the General Operating Procedures, the Treatment Protocols and the Appendices, and each part numbers its pages from 1. The section name in each citation tells you which part to open.

How many questions are on the real REMAC Basic exam?

120 multiple-choice questions with four choices, a 3-hour limit and an 80% passing grade. The exam may also include noncredit pilot questions. See our complete NYC REMAC exam guide.

What is the best way to use a REMAC practice test?

Answer first, then read the explanation for every question, including the ones you got right. When you miss one, open the cited page and read the whole protocol section. Track which areas you miss most and spend your next session there.

Is there a full-length REMAC practice exam?

RemacReady's Mock Exam is 120 questions with a 3-hour clock, drawn from a separate mock bank so it doesn't repeat practice questions. You see no feedback until you finish, then you get your score against the 80% mark and every explanation.

Want 1,000 more?

These 15 are a sample. RemacReady has 1,000 NYC REMAC practice questions across GOP, cardiology and resuscitation, airway, medical, OB and peds, trauma, the appendices and clinical-judgment scenarios, and every explanation cites the 2026 protocol page. Start free with a daily Quick 10 (opens in a new tab): ten random questions with full explanations, every day. See all eight study modes on the exam prep page, or read the FAQ.