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2026 Statistics

Key Facts: PHECC Advanced Paramedic Exam

100

Written MCQs

PHECC NQEMT

80%

Passing Score

PHECC NQEMT

2 hours

Exam Time Limit

PHECC NQEMT

5 domains

Syllabus Areas

PHECC Education Standards

€100

Base Exam Fee

PHECC Ireland

Waveform

Capnography Mandatory

PHECC Airway CPG

The PHECC Advanced Paramedic written exam in Ireland consists of 100 written MCQs (2-hour time limit, 80% passing score). The NQEMT exam fee is €100. It covers Clinical Practice Guidelines, advanced pharmacology, 12-lead ECGs, airway skills, trauma resuscitation, and MIMMS operational triage.

Sample PHECC Advanced Paramedic Practice Questions

Try these sample questions to test your PHECC Advanced Paramedic exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 112+ question experience with AI tutoring.

1You are treating a patient with symptomatic bradycardia (heart rate 34 bpm, blood pressure 82/50 mmHg, diaphoretic). According to the PHECC Clinical Practice Guidelines (CPGs), what is the first-line pharmacotherapeutic intervention?

A.Adrenaline 1 mg IV.

B.Atropine 600 mcg IV.

C.Amiodarone 150 mg IV.

D.Atropine 3 mg IV.

Explanation: For symptomatic bradycardia, the PHECC CPGs specify Atropine 600 mcg IV as the first-line medication, which can be repeated every 3 to 5 minutes up to a maximum dose of 3 mg (or 0.04 mg/kg). If Atropine is ineffective, transcutaneous pacing (TCP) or chronotropic infusions should be initiated.

2A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in leads I and aVL. An Advanced Paramedic performs a right-sided ECG which shows 1.5 mm ST elevation in lead V4R. Which of the following is contraindicated in this patient's management?

A.Aspirin 300 mg chewed.

B.Glyceryl Trinitrate (GTN) administration.

C.Intravenous sodium chloride 0.9% bolus.

D.Oxygen therapy if oxygen saturation is 90%.

Explanation: The patient is presenting with an acute inferior ST-elevation myocardial infarction (STEMI) with right ventricular involvement (confirmed by V4R elevation). In right ventricular infarction, the patient is highly preload-dependent, and the administration of venodilators like Glyceryl Trinitrate (GTN) or Morphine can cause severe, refractory hypotension and is therefore contraindicated.

3During a resuscitation attempt for a patient in refractory Ventricular Fibrillation (VF), the team has delivered three shocks and administered the first dose of Adrenaline. According to the PHECC cardiac arrest guidelines, what is the drug and dose that should be administered next?

A.Amiodarone 150 mg IV/IO.

B.Lidocaine 100 mg IV/IO.

C.Atropine 3 mg IV/IO.

D.Amiodarone 300 mg IV/IO.

Explanation: In refractory shockable rhythms (VF/pVT), the first dose of Amiodarone (300 mg IV/IO) is administered after the third shock, alongside or immediately following the first dose of Adrenaline. A second dose of Amiodarone (150 mg IV/IO) is given after the fifth shock if VF/pVT persists.

4While managing a patient in cardiac arrest, you monitor continuous waveform capnography. During CPR, you note a sudden, sustained increase in End-Tidal Carbon Dioxide (ETCO2) from 12 mmHg to 42 mmHg. What does this clinical change most likely indicate?

A.Return of Spontaneous Circulation (ROSC).

B.Displacement of the endotracheal tube into the esophagus.

C.An improvement in chest compression depth and rate.

D.The development of a tension pneumothorax.

Explanation: A sudden, sustained increase in ETCO2 (typically to >35-40 mmHg) during cardiac arrest resuscitation is a reliable indicator of Return of Spontaneous Circulation (ROSC). It occurs because the spontaneous heart beats restore cardiac output and pulmonary perfusion, delivering accumulated CO2 from the tissues to the lungs for elimination.

5You are treating an unstable patient with monomorphic Ventricular Tachycardia (VT) who has a palpable pulse but displays signs of poor perfusion (altered mental status, chest pain, hypotension). What is the preferred immediate treatment under the PHECC guidelines?

A.Amiodarone 150 mg IV infusion over 10 minutes.

B.Unsynchronized defibrillation at maximum energy.

C.Synchronized cardioversion.

D.Vagal maneuvers followed by Adenosine IV.

Explanation: For tachyarrhythmias (including monomorphic VT) with a pulse where the patient is clinically unstable, synchronized electrical cardioversion is the immediate treatment of choice. Synchronized cardioversion delivers a shock timed with the R-wave of the QRS complex, avoiding the vulnerable T-wave and minimizing the risk of inducing Ventricular Fibrillation.

6Which of the following 12-lead ECG criteria is most characteristic of a Left Bundle Branch Block (LBBB)?

A.QRS duration ≥ 120 ms, rSR' pattern in lead V1, and slurred S waves in leads I and V6.

B.PR interval > 200 ms with a normal QRS complex.

C.QRS duration ≥ 120 ms, dominant S wave in V1, and broad, notched R waves in leads I, aVL, and V6.

D.ST-segment elevation in leads V1 to V4 with reciprocal depression in II, III, aVF.

Explanation: Left Bundle Branch Block (LBBB) is characterized by a prolonged QRS duration of 120 ms (0.12 seconds) or greater, a deep dominant S wave in lead V1 ( QS or rS complex), and a broad, notched, or slurred R wave in lateral leads (I, aVL, V5, V6), with an absence of Q waves in these lateral leads.

7You arrive on scene to find a 65-year-old male collapsed. The monitor shows Ventricular Fibrillation (VF). You deliver a shock. According to the current ERC and PHECC resuscitation guidelines, what is the immediate next step?

A.Resume chest compressions immediately for 2 minutes without checking the rhythm or pulse.

B.Perform a rhythm check on the monitor to see if the shock was successful.

C.Check the carotid pulse for up to 10 seconds to assess for ROSC.

D.Administer Adrenaline 1 mg IV immediately.

Explanation: Resuscitation guidelines emphasize minimizing interruptions to chest compressions. Immediately after a shock is delivered, CPR (chest compressions and ventilations) should be resumed immediately for 2 minutes before any rhythm or pulse check is performed. Checking the rhythm or pulse immediately after a shock is contraindicated, as the heart is rarely in a perfusing rhythm immediately and compressions are vital to maintain coronary perfusion.

8A renal dialysis patient is found lethargic and hypotensive. The ECG shows tall, symmetrical, peaked T waves, a widened QRS complex (140 ms), and flattened P waves. Which of the following pharmacotherapeutic agents is indicated first to stabilize the cardiac membrane?

A.Sodium Bicarbonate 8.4% IV.

B.Salbutamol 5 mg nebulized.

C.Calcium Chloride 10% IV.

D.Insulin and Dextrose infusion.

Explanation: This patient presents with classic ECG signs of severe hyperkalemia (tall peaked T waves, QRS widening, P wave flattening). In hyperkalemia with ECG changes, the immediate priority is to stabilize the cardiac membrane against dysrhythmias, which is achieved by administering Calcium Chloride 10% IV (or Calcium Gluconate). Calcium antagonizes the cardiotoxic effects of hyperkalemia without lowering the serum potassium level.

9A 28-year-old female presents with rapid palpitations and chest tightness. The monitor shows a regular, narrow-complex tachycardia at 190 bpm. Her blood pressure is 118/76 mmHg. Vagal maneuvers are unsuccessful. What is the next clinical step under the PHECC guidelines?

A.Administer Adenosine 6 mg rapid IV bolus followed by a saline flush.

B.Perform synchronized cardioversion at 50 Joules.

C.Administer Amiodarone 150 mg IV over 10 minutes.

D.Administer Adenosine 12 mg rapid IV bolus.

Explanation: This patient is presenting with stable Supraventricular Tachycardia (SVT) (narrow QRS, regular, heart rate > 150, normotensive). If vagal maneuvers fail, the first pharmacological step is Adenosine 6 mg administered as a rapid IV bolus through a large vein, immediately followed by a rapid saline flush. If unsuccessful, a second dose of 12 mg (and a third of 12 mg if required) can be administered.

10Which of the following describes the Sgarbossa criteria, which are used to identify acute myocardial infarction in the presence of a Left Bundle Branch Block (LBBB)?

A.ST elevation ≥ 1 mm in leads II, III, aVF, and reciprocal depression ≥ 1 mm in lead aVL.

B.ST depression ≥ 2 mm in leads V1 to V4 with upright T waves.

C.PR interval prolongation > 200 ms with progressive lengthening until a QRS is dropped.

D.Concordant ST elevation ≥ 1 mm in any lead, concordant ST depression ≥ 1 mm in leads V1-V3, or discordant ST elevation ≥ 5 mm.

Explanation: The Sgarbossa criteria are used to diagnose acute MI in patients with pre-existing LBBB or paced rhythms. They include three criteria: (1) Concordant ST-segment elevation ≥ 1 mm in any lead with a positive QRS complex (5 points); (2) Concordant ST-segment depression ≥ 1 mm in leads V1, V2, or V3 (3 points); (3) Discordant ST-segment elevation ≥ 5 mm in leads with a negative QRS complex (2 points). A score of ≥ 3 is highly specific for MI.

About the PHECC Advanced Paramedic Exam

The Ireland PHECC Advanced Paramedic written exam is the theoretical qualification hurdle for registration as an Advanced Paramedic in Ireland. The exam comprises 100 MCQs covering the full depth of the PHECC Clinical Practice Guidelines (CPGs) and Advanced Paramedic Medication Formulary. Key areas tested include advanced cardiology (12-lead ECG diagnosis, ACLS algorithm paths, acute coronary syndrome protocols), advanced pharmacology (indications, contraindications, exact dosing), advanced airway skills (endotracheal intubation, needle cricothyrotomy, waveform capnography), trauma life support (needle decompression, TXA administration, spinal motion restriction), and operational decision making (MIMMS triage sieve/sort, consent and capacity law).

Assessment

100 multiple-choice questions (MCQ), computer-based or written format.

Time Limit

2 hours

Passing Score

80%

Exam Fee

€100 (Pre-Hospital Emergency Care Council (PHECC), Ireland)

PHECC Advanced Paramedic Exam Content Outline

25%

Cardiology and ECG Interpretation

12-lead ECG analysis, acute coronary syndrome (ACS) pathways, dysrhythmia management, and Advanced Cardiac Life Support (ACLS)

25%

Advanced Pharmacology

PHECC AP Medication Formulary, drug indications, contraindications, dosages, administration protocols, and adverse reactions

20%

Trauma Life Support

Needle thoracocentesis, hemorrhage control (TXA), spinal immobilization protocols, blast/burn management, and advanced trauma care

20%

Advanced Airway Management

Supraglottic airways, endotracheal intubation, needle cricothyrotomy, capnography, and ventilatory support

10%

Operational Decision Making

Major Incident Medical Management and Support (MIMMS), CPG legal frameworks, clinical leadership, and patient refusal/ethics

How to Pass the PHECC Advanced Paramedic Exam

What You Need to Know

Passing score: 80%
Assessment: 100 multiple-choice questions (MCQ), computer-based or written format.
Time limit: 2 hours
Exam fee: €100

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

PHECC Advanced Paramedic Study Tips from Top Performers

1Thoroughly memorize the current PHECC Clinical Practice Guidelines (CPGs) for Advanced Paramedics, focusing on the specific indicators and contraindications for each drug.

2Master 12-lead ECG interpretation, particularly identifying STEMI mimics, block locations (LBBB vs. RBBB), and unstable tachyarrhythmias requiring immediate synchronized cardioversion.

3Understand the exact dosing, infusion rates, and contraindications for critical medications in the AP Medication Formulary, such as Amiodarone, Tenecteplase, Benzylpenicillin, and Fentanyl.

4Review advanced airway management protocols, specifically the indications for endotracheal intubation, needle cricothyrotomy, and the mandatory use of waveform capnography.

5Learn the MIMMS major incident triage sieve and sort flowcharts, alongside the CSCATTT operational framework.

6Practice drug dosage calculations for paediatric emergencies based on weight estimation or using the Broselow tape as referenced in PHECC guidelines.

7Study the legal and ethical boundaries of patient care in Ireland, including capacity assessments, patient refusal of treatment, and child protection reporting requirements.

Frequently Asked Questions

What is the PHECC Advanced Paramedic Written Exam?

It is the theoretical component of the National Qualification in Emergency Medical Technology (NQEMT) examination at the Advanced Paramedic (AP) level. The exam evaluates the candidate's understanding of the PHECC Clinical Practice Guidelines (CPGs) and advanced clinical emergency medical skills.

What is the passing score for the PHECC Advanced Paramedic exam?

The passing threshold for the NQEMT written MCQ exam is 80%. Candidates must also pass the practical Objective Structured Clinical Examination (OSCE) to obtain their Advanced Paramedic certification.

How many questions are on the written exam, and what is the time limit?

The written MCQ exam consists of 100 multiple-choice questions. Candidates are given 2 hours to complete the examination.

What are the core clinical topics covered on the Advanced Paramedic exam?

The exam covers five core domains based on the PHECC CPGs: cardiology and 12-lead ECG interpretation, advanced pharmacology (PHECC AP Medication Formulary), trauma life support (such as chest decompression and TXA), advanced airway management (such as intubation), and operational decision making (such as MIMMS).

How much does the PHECC Advanced Paramedic exam cost?

The exam fee is approximately €100 for the NQEMT registration/examination, though it is usually incorporated into the training program fees charged by UCD or the National Ambulance Service College (NASC).