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North Carolina EMS protocols,
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Offline, county-specific protocols for North Carolina EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 100 counties in North Carolina · Protocols current as of June 18, 2026
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North Carolina State Protocols
Imported 2026-06-17 00:41 from PDF bundle — 93 PDFs
PDF document
934
Flashcards
360
Quiz questions
46
Medications
23
Resources
Study tools for North Carolina State Protocols
A few real flashcards and quiz questions from North Carolina's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Cauda equina syndrome: definition and symptoms
Cauda equina syndrome occurs when the terminal nerves of the spinal cord are compressed. Symptoms include saddle anesthesia (numbness between genitalia and rectum), recent onset of bladder and bowel dysfunction (urine retention and bowel incontinence), severe or progressive neurological deficit in the lower extremity, and motor weakness of thigh muscles or foot drop.
AC 12: Criteria to NOT begin resuscitation (downtime + rhythm)
If the patient is an adult (age > 18) with a downtime ≥ 15 minutes AND the initial rhythm on AED/ECG monitor is Asystole or PEA (no shock indicated), do not begin resuscitation and follow the Deceased Persons Policy.
Symptomatic Bradycardia: Definition and Threshold HR
Symptomatic bradycardia is defined as a heart rate < 60/min accompanied by hypotension, acute altered mental status, ischemic chest pain, acute CHF, seizures, syncope, or shock secondary to bradycardia. It typically occurs at rates < 50 beats per minute.
Unstable narrow tachycardia: definition and serious signs/symptoms
An unstable condition is one that acutely impairs vital organ function where cardiac arrest may be imminent. Serious signs/symptoms include hypotension, acutely altered mental status, signs of shock/poor perfusion, chest pain with evidence of ischemia (STEMI, T wave inversions or depressions), acute CHF, seizures, and syncope secondary to tachycardia. HR is typically ≥ 150 bpm.
STEMI ECG Diagnostic Criteria
STEMI is defined as ≥1 mm ST segment elevation in ≥2 contiguous leads, ≥2 mm ST/J point elevation in V2-V3 for men, or ≥1.5 mm ST/J point elevation in V2-V3 for women. ECG software diagnosing Acute MI in a symptomatic patient also meets criteria.
Unstable signs/symptoms indicating immediate cardioversion in wide complex tachycardia
Unstable signs and symptoms include hypotension, acute altered mental status, ischemic chest pain, acute CHF, seizures, syncope, or shock secondary to tachycardia, typically with HR > 150. These conditions acutely impair vital organ function and indicate that cardiac arrest may be impending.
Polymorphic QRS — definition
QRS complexes in a single lead will change shape from complex to complex. This distinguishes polymorphic tachycardia from monomorphic tachycardia, where all QRS complexes in a single lead are similar in shape.
Criteria for initiating Target Temperature Management (TTM) — what are the THREE requirements?
1) ROSC not related to blunt/penetrating trauma or hemorrhage (drowning and hanging/asphyxiation are permissible); 2) Initial rectal temperature ≥ 93.2°F (34°C); 3) Advanced airway (including BIAD) in place with EtCO2 > 20 mmHg and no purposeful response to verbal commands.
Quiz questions
You are managing an adult patient in PEA arrest. An advanced airway (ETT) has been successfully placed and confirmed. According to protocol AC 1, what is the correct ventilation rate?
- ✓ 1 breath every 6 seconds (10 breaths/min) with continuous, uninterrupted compressions
- 1 breath every 5 seconds (12 breaths/min) with compressions paused for each breath
- 30:2 compression-to-ventilation ratio with pauses for ventilation
- 1 breath every 3 seconds (20 breaths/min) with continuous compressions
According to the AC 3 Adult Cardiac Arrest protocol, what is the correct compression-to-ventilation ratio when NO advanced airway is in place?
- 15:2
- ✓ 30:2
- 30:1
- Continuous compressions with 1 breath every 6 seconds
You are treating a stable adult patient with a wide, polymorphic tachycardia. A 12-lead ECG reveals a QT interval of 560 msec. Which medication should be considered according to this protocol?
- Amiodarone 150 mg IV/IO over 10 minutes
- Lidocaine 1–1.5 mg/kg IV/IO
- ✓ Magnesium 2 g IV/IO
- Adenosine 6 mg rapid IV push
You are treating a stable adult patient with a narrow-complex, IRREGULAR tachycardia at a rate of 138 bpm. After obtaining IV access and placing the patient on the cardiac monitor, what is the MOST appropriate next pharmacological intervention per protocol?
- Adenosine 6 mg IV rapid push with flush
- ✓ Diltiazem 0.25 mg/kg IV over 2–3 minutes, maximum 25 mg
- Amiodarone 150 mg in 100 mL D5W IV
- Synchronized cardioversion at 50–100J
You are treating a stable adult patient with a regular, wide-complex (≥0.12 sec) monomorphic tachycardia at a rate of 164 bpm. Per protocol AC 7, which of the following is the correct initial dose of adenosine if you elect to use it?
- 3 mg IV rapid push with flush
- ✓ 6 mg IV/IO rapid push with flush
- 12 mg IV/IO rapid push with flush
- 6 mg IV slow push over 2 minutes
According to the NC OEMS VF/Pulseless VT protocol, when should Epinephrine administration be delayed in a patient presenting in VF/VT?
- Until IV/IO access has been established for at least 5 minutes
- ✓ Until after the second defibrillation attempt
- Until antiarrhythmics have been administered first
- Until EtCO2 rises above 20 mmHg
Sourced from North Carolina's EMS authority
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North Carolina protocols — FAQ
Are North Carolina's EMS protocols available offline?
Yes. Download North Carolina'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 North Carolina?
Yes. North Carolina'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 North Carolina?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring North Carolina's protocols into a faster, fully offline app and link the authority's own source for every set.
How do North Carolina 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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