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Michigan EMS protocols,
Michigan EMS protocols,
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Offline, county-specific protocols for Michigan EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 83 counties in Michigan · Protocols current as of June 17, 2026
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Michigan Statewide Protocols
Revised Date: 05/08/2022 ↗
PDF document
511
Flashcards
260
Quiz questions
32
Medications
90
Resources
Study tools for Michigan Statewide Protocols
A few real flashcards and quiz questions from Michigan's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Serious symptomatic bradycardia: definition and treatment goal
Serious symptomatic bradycardia is defined as a heart rate less than 60 bpm with hypotension or shock. The treatment goal is to titrate interventions to achieve a heart rate above 60 bpm. If the patient remains hypotensive after treatment, refer to the Shock Treatment Protocol.
Tachycardia protocol activation threshold
This protocol is activated for persistent tachycardia with a ventricular rate ≥150/minute where the tachycardia is believed to be the primary cause of the patient's symptoms. For rates <150 believed to be causing symptoms, contact Medical Control for possible orders. It is not intended to treat tachycardia secondary to underlying causes such as dehydration, trauma, sepsis, or toxins.
ROSC scene stabilization time before transport
After ROSC, patients should be stabilized on scene prior to transport for five to ten minutes before moving the patient. If the arrest is of known traumatic origin, refer to the Traumatic Arrest Treatment Protocol instead.
Signs and symptoms of an UNSTABLE tachycardia patient
An unstable tachycardia patient presents with one or more of the following likely due to the arrhythmia: hypotension, acutely altered mental status, signs of shock, significant ischemic chest discomfort, shortness of breath, or pulmonary edema. Unstable patients will usually have a ventricular rate >150 BPM.
Transcutaneous pacing (TCP): when is it the treatment of CHOICE?
TCP is the treatment of choice for high-degree AV block, specifically second-degree Type II or third-degree AV block. For these rhythms, pacing should be initiated without delay. TCP may also be initiated prior to IV access or before atropine takes effect.
ROSC hypotension definition and initial treatment
Hypotension post-ROSC is defined as a systolic blood pressure less than 90 mmHg. Initial treatment is an IV/IO fluid bolus of up to 1 liter of NS or LR.
Pediatric defibrillation energy — initial and subsequent doses
The initial defibrillation dose is 2 J/kg (or the closest energy setting on the defibrillator being used). Subsequent defibrillations must be at least 4 J/kg and may escalate up to 10 J/kg or adult dosage. Rhythm should be checked every 2 minutes.
Abdominal Pain (Non-traumatic): When and how should a 12-Lead ECG be considered?
A 12-Lead ECG should be considered for non-traumatic abdominal pain patients and performed following the 12 Lead ECG-Procedure Protocol. Depending on MCA selection, obtaining a 12-Lead may be a BLS or Specialist-level procedure.
Quiz questions
You are treating an adult cardiac arrest patient and have just successfully placed a supraglottic airway. According to the protocol, how should ventilations be delivered and at what rate?
- Synchronously with compressions at a ratio of 30:2
- ✓ Asynchronously at 10 breaths per minute (1 breath every 6 seconds)
- Asynchronously at 12 breaths per minute (1 breath every 5 seconds)
- Synchronously at 8 breaths per minute during compression pauses
After achieving ROSC in a medical cardiac arrest, how long should a patient be stabilized on scene before transport?
- Immediately load and go without delay
- Two to three minutes
- ✓ Five to ten minutes
- Fifteen to twenty minutes
You are treating a 68-year-old male in respiratory distress with crackles bilaterally and a SBP of 130 mmHg. He denies taking any erectile dysfunction medications. IV access has NOT yet been established. Which of the following is the correct nitroglycerin action per protocol?
- Withhold nitroglycerin until IV access is established
- ✓ Administer nitroglycerin 0.4 mg SL, up to a maximum of 3 doses
- Administer nitroglycerin 0.4 mg SL and repeat every 3-5 minutes as long as SBP remains above 100 mmHg
- Contact medical control before administering any nitroglycerin
You are treating a 58-year-old male complaining of chest pain. He tells you he took sildenafil (Viagra) 36 hours ago. Which of the following actions is most appropriate regarding nitroglycerin?
- Administer nitroglycerin 0.4 mg SL as normal, since 36 hours have passed.
- ✓ Do NOT administer or assist with nitroglycerin and contact Medical Control.
- Administer nitroglycerin only if systolic BP is above 120 mmHg.
- Administer half the normal nitroglycerin dose and monitor BP closely.
You are treating a patient with a wide, irregular QRS tachycardia. The rhythm is suspected to be Torsades de Pointes. Which of the following is the correct treatment per this protocol?
- Administer amiodarone 150 mg IV over 10 minutes
- Administer lidocaine 1 mg/kg IV push
- ✓ Administer magnesium sulfate 2 gm IV over 10 minutes
- Perform synchronized cardioversion immediately
A paramedic is treating a patient in third-degree AV block with serious symptomatic bradycardia. IV access has not yet been established. According to the protocol, what is the most appropriate next action?
- Delay all treatment until IV access is established and atropine can be administered
- Administer atropine 1 mg via endotracheal tube while establishing IV access
- ✓ Initiate transcutaneous pacing (TCP) immediately, as it is the treatment of choice for high-degree AV block
- Administer push-dose epinephrine IO before attempting TCP
Sourced from Michigan's EMS authority
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Michigan protocols — FAQ
Are Michigan's EMS protocols available offline?
Yes. Download Michigan'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 Michigan?
Yes. Michigan'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 Michigan?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring Michigan's protocols into a faster, fully offline app and link the authority's own source for every set.
How do Michigan 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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