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Offline, county-specific protocols for District of Columbia EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 1 county in District of Columbia · Protocols current as of July 1, 2026
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District of Columbia EMS Manual
Effective: August 1st, 2024 ↗
PDF document
834
Flashcards
434
Quiz questions
39
Medications
3
Resources
Study tools for District of Columbia EMS Manual
A few real flashcards and quiz questions from District of Columbia's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Primary blast injury: which anatomical sites are most severely affected and why?
The most severe primary blast injury occurs at air-fluid interfaces in the body. The organs most vulnerable are the brain, lungs, eardrums, and bowel, because the blast overpressure wave causes maximal damage where gas and tissue meet.
Three types of abdominal pain perception
Visceral pain is vague, colicky, and poorly localized, arising from inside the organs and typically felt first. Somatic pain is specific, localized, and constant, arising from peritoneal inflammation (e.g., appendicitis = RLQ; diverticulitis = LLQ). Referred pain originates from a distant structure (e.g., epigastric pain from acute MI, or abdominal pain from pneumonia).
Fundal Height Landmarks by Gestational Age
At 12 weeks, the fundal height reaches the pubic symphysis; at 20 weeks, the umbilicus; at 36 weeks, the xiphoid process; at 37–40 weeks, fundal height regresses to between 36–32 cm. Postpartum (≤ 24 hrs), the fundus returns to the level of the umbilicus.
Agonal breathing in OHCA: prevalence and significance
40-60% of out-of-hospital cardiac arrest (OHCA) victims present with agonal breathing. This is a common reason providers misdiagnose a patient as NOT being in cardiac arrest, leading to dangerous delays in CPR initiation.
Defibrillation energy sequence for adults in VF/pVT (Shocks #1, #2, #3)
Shock #1: 120 J, Shock #2: 150 J, Shock #3: 200 J. After each defibrillation, CPR must be immediately resumed and continued for 2 minutes before the next pulse or rhythm check.
ROSC Transport Destination — Adult vs. Pediatric
All adult patients successfully resuscitated from a medical cardiac arrest MUST be transported directly to a STEMI/ROSC receiving facility, regardless of initial rhythm or 12-lead EKG findings. All pediatric patients successfully resuscitated from cardiac arrest shall be transported to Children's National Hospital.
Definition of Refractory VF/pVT
Refractory VF or pVT is the failure to achieve sustained return of spontaneous circulation (ROSC) after treatment with 3 defibrillations and administration of an antiarrhythmic medication IV/IO (e.g., amiodarone). The patient must still be in VF or pVT despite these interventions to meet the definition.
Wide Complex Tachycardia — Definition & EKG Criteria
A cardiac rhythm with a rate greater than 100 BPM and a QRS width greater than or equal to 120 ms. The wide complex results from electrical impulses originating in the ventricle or abnormal conduction due to structural or metabolic causes (e.g., bundle branch block, hyperkalemia, acidosis).
Quiz questions
A patient is in refractory ventricular fibrillation cardiac arrest. According to the DC Fire and EMS Hospital Capability Chart, at which hospital is ECMO/ECPR available, and during what hours?
- Georgetown University Hospital, 24 hours a day, 7 days a week
- ✓ George Washington University Hospital (H8), Monday–Friday, 0800–1700 only
- MedStar Washington Hospital Center, Monday–Friday, 0700–1900 only
- Howard University Hospital, weekends only, 0800–1700
According to the DC Fire and EMS Cardiac Arrest protocol, when a provider is uncertain whether a pulse is present, what action should be taken?
- Continue assessing for up to 30 seconds before starting compressions
- Start chest compressions immediately without checking for a pulse
- ✓ Promptly start compressions when a pulse is not definitely palpated
- Apply an AED first, then reassess for a pulse
You arrive on scene to find an adult patient in cardiac arrest. The monitor shows an organized rhythm with QRS complexes but no pulse is detected. According to the DC Fire and EMS PEA/Asystole Protocol, when should the first dose of epinephrine be administered?
- ✓ As soon as possible via IV/IO access
- After the second defibrillation attempt
- Only after 2 minutes of CPR have been completed
- After ROSC is confirmed and then lost again
According to the DC Fire and EMS ROSC protocol, where MUST all adult patients successfully resuscitated from a medical cardiac arrest be transported, regardless of initial rhythm or 12-lead EKG findings?
- The nearest emergency department
- ✓ A STEMI/ROSC receiving facility
- Children's National Hospital
- Any trauma center
You arrive at the scene of a 58-year-old male in cardiac arrest. Your monitor confirms VF. The monitor is NOT yet precharged. What is the correct immediate action per the DC FEMS VF/pVT protocol?
- Wait for the monitor to charge before resuming chest compressions
- Administer epinephrine 1 mg IV/IO immediately before defibrillating
- ✓ Resume chest compressions after the pulse check while charging the monitor/defibrillator
- Defibrillate immediately at 200 J, then resume CPR
According to the DC Fire and EMS protocol, when does the 30-minute ALS care clock officially START for the purpose of Termination of Resuscitation (TOR)?
- When the first EMS unit arrives on scene
- When the first chest compression is delivered by EMS
- ✓ When the monitor/defibrillator is both turned on AND attached to the patient
- When the ALS unit arrives and assumes care from BLS
Sourced from District of Columbia's EMS authority
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District of Columbia protocols — FAQ
Are District of Columbia's EMS protocols available offline?
Yes. Download District of Columbia's protocol set once and every protocol, medication, and hospital is available with no signal — built for basements, rural calls, and dead zones.
Are the protocols specific to my county in District of Columbia?
Yes. District of Columbia's protocols are scoped by county and region, so every provider sees exactly the set that governs where they respond. You can add more than one if you run in multiple areas.
Is Pocket Protocols official, or affiliated with District of Columbia?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring District of Columbia's protocols into a faster, fully offline app and link the authority's own source for every set.
How do District of Columbia protocol updates reach the app?
When the EMS authority publishes a new version and it goes live in Pocket Protocols, the app refreshes automatically — crews are never working from a stale copy. We monitor official sources for changes every day.
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