Taking the HVREMSCO MAC Exam

A number of  medics taking their MAC exam do not pass it on their first attempt!  

This section of the HVREMSCO website has been designed to assist the new medic or new-to-the Region medic with some insight as to what to expect when you sit down to take your MAC exam.

The HVREMSCO MAC Exam consists of five modules:
Module 1 – Cardiac
Module 2 – General & Environmental
Module 3 – General Operations
Module 4 – Respiratory
Module 5 – Trauma

The majority of the questions are derived directly from the protocols; however, there are a substantial number of questions that refer to the Medical Control Policies and Procedures Manual, as well as the HVREMAC Credentialing Manual.  We cannot emphasize strongly enough how important it is to be intimately familiar with that particular manual.

Each Module is comprised of twenty questions, and each module must be passed with a grade of 80% or better.  All questions are drawn form the Collaborative Protocols and from the Medical Control Policies and Procedures Manual, and the HVREMAC Credentialing & CME Policies and Procedures Manual.

Retesting Policy:

1. Candidates who fail the credentialing exam may be eligible for a retest, but not on the same day as their initial examination.
2. Candidates will be issued an Examination Retest Form that identified the module(s) the candidate must retest.
3. Authorized agents of the candidate’s sponsoring ALS Agency must reauthorize, in signature, the ability of the candidate to take the credentialing exam.
a. It is incumbent upon the authorizing ALS Agency to ensure that remediation of the provider has occurred prior to reauthorizing the provider to schedule a retest.
4. Candidates having failed of two (2) or less modules during the initial exam will be eligible to schedule a retest with the HVREMSCO office within three (3) business days of their initial exam, providing the provider submits the agency signed form authorizing them to take the retest. The provider will take a different test version of the specific modules that require retest. Failure to successfully complete any/all of the retest modules will be counted as an exam failure.
5. Failure of three (3) or more modules constitutes an exam failure, and the candidate is not eligible for a module-based retest. The provider must schedule an appointment to take the entire certification examination over. The Provider will not be scheduled for this exam for a minimum of five (5) business days from the date of the initial failure, and only after the submission of the signed form authorizing the schedule of the retest.
6. Candidates who have failed any retest are not eligible for a new examination for thirty (30) days from the date of their failed retest. Failure of any re-test will deem the Provider ineligible for a new certification examination until the authorizing agency submits detailed documentation of remediation, and a new letter of authorization.

MAC Test Preparation:

To assist in your preparation for the MAC Test, we urge you to study the following Key Considerations for each Protocol, as well as the Protocol itself.

Cardiac – Key Considerations Respiratory – Key Considerations Trauma – Key Considerations
Pediatric – Key Considerations General/Environmental – Key Considerations General Operations – Key Considerations

Sample MAC questions:

1. Which protocol allows for an infusion of up to two (2) liters of Normal Saline?

A. Cardiogenic shock
B. Burns
C. Anaphylaxis
D. Diabetic ketoacidosis

2. To prepare a norepinephrine drip:

A. 1mg in 1000ml of NS
B. 4mg in 100ml of NS
C. 1gm in 1000ml of NS
D. 4mg in 1000ml of NS

3. What is the formula for calculating Mean Arterial Pressure (MAP)?

A. MAP = DBP x SBP/3
B. MAP = (2 x DBP) + SBP/3
C. MAP = 1/3 DBP + 2/3 SBP
D. MAP = (3 x SBP) + SBP/3

4. Per the Operations: Emergency Incident Rehab Protocol, if, after protective gear has been removed, at what time interval should vital signs return to normal and the individual be allowed to return to work?

A. 5 minutes
B. 10 minutes
C. 15 minutes
D. 20 minutes

5. According to the General Practice: Airway Management and Oxygen Delivery Protocol, during intubation attempts as well as MFI, a nasal cannula must be used at 15 lpm.

A. True
B. False

6. According to the Respiratory: COPD Exacerbation/Bronchospasm protocol, the Physician Option for magnesium sulfate is:

A. Magnesium 2gm slow IVP
B. Magnesium 4gm in 250ml NS over 20 minutes
C. Magnesium 2gm in 100ml NS over 10 minutes
D. Magnesium is not an option in this protocol

7. For which cardiac arrest patient would sodium bicarbonate be contraindicated?

A. A crush injury patient with suspected acidosis
B. A patient exhibiting signs and symptoms of heat stroke with suspected hyponatremia
C. An unresponsive patient with a measured blood glucose of 900mg/dl
D. A dialysis patient with suspected hyperkalemia

8. Under the Medical: Suspected Sepsis Protocol Norepihephrine should be considered:

A. Titrated at 2 to 20 mcg/kg
B. This is a physician option
C. After a 500 ml fluid bolus
D. At 2 – 20 mcg/kg after a 2000 ml fluid bolus

9. If a provider is directed by Medical Control to perform an action or to give an inappropriate dose of a medication, the provider should, per the Protocol Exceptions Policy, may:

A.  Follow the instructions, provided Med Control talks the provider through the process
B.  Disregard the order, document it and have the Med Control Physician sign the PCR
C.  Repeat the order back to Med Control, requesting clarification
D.  Refuse to follow an order or perform a procedure that the provider believes would increase the risk to the patient

10. In order to remain credentialed in the HVREMS you must maintain the following:

C.  NYS Paramedic Certification
D.  None of the above is a complete list

11. According to the protocol, “Respiratory: COPD Exacerbation”, under standing order Albuterol 2.5 mg in 3 ml + Atrovent 0.5 mg in 2.5 ml mixed together, via nebulizer or ET tube; may be given a total of:

A.  Twice
B.  Once
C.  It may NOT be repeated under standing order.
D.  Three times

12.The trauma flow chart is a document from:

B.  The CDC
C.  NYS Trauma Committee
D.  The National Standards for Paramedics

13. True or False? According to the Collaborative Protocols “Trauma: General”, Trauma arrest patients MUST go to any level of the nearest trauma center.

A.  True
B.  False

14. The lowest level of EMS provider that may assist in administration of prescribed Diastat is the:

A.   CCT
B.   EMT
C.   Paramedic

15.  True or False? According to the protocol “Procedure: Avulsed Tooth” all levels of certification from
EMT to paramedic may replace an avulsed tooth.

A.  True
B.   False

16.  True or False? According to the protocol “Cardiac: Wide Complex Tachycardia with a Pulse”, Procedural Sedation is considered for Synchronized cardioversion but MUST be approved by
Medical Control. (Is a Physician Option).

A.   True
B.   False

17.  A conscious and alert nursing home patient that has a worsening UTI, a pulse of 108 and a MAP of
65, should be treated under which protocol:

A.   Medical: Shock/Hypoperfusion
B.   Cadiac: Cardiogenic Shock
C.   Medical: Suspected Sepsis
D.   This patient does not yet meet any of the above protocols

18.  Complaints or concerns can be made by a patient, the public, participating organizations or
individual participants, including HVREMSCO staff members. All such complaints or concerns
should be brought to the attention of the:

A.  HVREMSCO Executive Director
B.  HVREMSCO President
D.  HVREMSCO Protocol Committee

19.  If an ALS provider has initiated any ALS procedure(s) and/or administered any medication(s), the
provider must consult Medical Control immediately after terminating care to the patient but prior
to patient signing a refusal form.

A.   True
B.   False

20.  Patients shall be transported to the nearest appropriate hospital, as defined by state/regional
protocols, medical condition, and patient choice. When transportation is not to the nearest
appropriate hospital, the ALS Provider shall:

A.  Never transport anywhere but the nearest hospital
B.  Inform dispatch to receive a supervisors confimation of the decision
C.  If the intended receiving hospital is not a Medical Control hospital, the provider must contact medical control at any Medical Control Hospital.
D.  Inform Medical Control at the nearest hospital to receive their approval