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North Dakota EMS protocols,
North Dakota EMS protocols,
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Offline, county-specific protocols for North Dakota EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 53 counties in North Dakota · Protocols current as of June 18, 2026
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What's covered in North Dakota
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North Dakota EMS Treatment Guidelines/Protocols
2024, Version 1 ↗
PDF document
651
Flashcards
320
Quiz questions
62
Medications
16
Resources
Study tools for North Dakota EMS Treatment Guidelines/Protocols
A few real flashcards and quiz questions from North Dakota's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
12-Lead EKG: Precordial lead placement (V1–V6)
V1: 4th intercostal space right of sternum; V2: 4th intercostal space left of sternum; V3: between V2 and V4; V4: 5th intercostal space midclavicular line; V5: 5th intercostal space at left anterior axillary line (level with V4); V6: 5th intercostal space at midaxillary line (level with V4 and V5).
Saddle Distribution Sensory Loss: Significance in Back Pain
Loss of sensation in the saddle distribution (the perineal/inner thigh area) is a red-flag finding indicating possible spinal cord compression. This finding, along with urinary/bowel incontinence or new extremity neurologic deficits, requires immediate ALS escalation.
Unstable Tachycardia Criteria (Adult)
An adult tachycardia patient is considered unstable and should proceed directly to synchronized cardioversion if they are unconscious, have a systolic BP <80 mmHg, chest pain, or severe shortness of breath. These findings indicate hemodynamic compromise regardless of tachycardia type.
Bradycardia inclusion criteria
Heart rate less than 60 BPM with symptoms (AMS, chest pain, CHF, seizure, syncope, shock, pallor, diaphoresis) OR evidence of hemodynamic instability. EKG rhythms include sinus bradycardia, second-degree AV block (Types I & II), third-degree AV block, and ventricular escape rhythms.
What are the three types of implantable ventricular assist devices (VADs)?
The three types are the Left Ventricular Assist Device (LVAD), Right Ventricular Assist Device (RVAD), and Biventricular Assist Device (BiVAD). This protocol applies to adult patients with any of these implantable devices who present with cardiovascular compromise, VAD malfunction, or unrelated medical/injury events.
EtCO2 threshold for termination of resuscitation in asystole/slow wide complex PEA
An EtCO2 of less than 20 mmHg is required (in conjunction with no ROSC after 20 minutes and absence of hypothermia) to terminate resuscitation in asystole or slow wide complex PEA. Quantitative capnography requires additional training at the EMT level.
Syncope occurring during exercise — clinical significance
Syncope that occurs during strenuous exercise, especially in young and seemingly healthy patients, often indicates an ominous cardiac cause. These patients should be evaluated in the emergency department.
Defibrillation energy setting — monophasic device in cardiac arrest
For monophasic defibrillators, the energy setting should be 360 joules for adults (or 4 J/kg for children). The maximum setting should be used for initial and all subsequent defibrillation attempts. For biphasic devices, follow manufacturer's recommendation; if unknown, use the highest setting possible.
Quiz questions
A stable adult patient presents with a regular narrow complex tachycardia (SVT). Vagal maneuvers have failed. You administer adenosine 6 mg IV without conversion. What is your next step per protocol?
- Immediately proceed to synchronized cardioversion
- ✓ Administer adenosine 12 mg IV
- Administer diltiazem 0.25 mg/kg IV over 2 minutes
- Administer metoprolol 5 mg IV over 1–2 minutes
A 17-year-old male collapses while running a cross-country race. Bystanders state he lost consciousness briefly and fell to the ground. He is now awake and alert. According to the protocol, what does syncope occurring during exercise most likely indicate?
- Vasovagal response from dehydration
- ✓ An ominous cardiac cause requiring emergency department evaluation
- Orthostatic hypotension from transitioning positions
- Seizure activity that self-resolved
You arrive on scene to find an LVAD patient who is unresponsive with no detectable signs of life. The pump appears to be functioning — you can auscultate a hum. According to protocol, what is the most appropriate next action regarding CPR?
- Begin CPR immediately, as the patient is unresponsive with no signs of life.
- ✓ Do not perform CPR; evidence of a functioning pump is a contraindication to CPR per protocol.
- Begin CPR only after contacting medical direction, regardless of pump status.
- Perform CPR at a reduced rate to avoid damaging the device.
You arrive on scene to find an adult patient in cardiac arrest. Bystanders have been performing high-quality, uninterrupted CPR since before your arrival. According to the protocol, what is the most appropriate next action?
- Take over compressions from bystanders and perform 2 minutes of CPR before rhythm analysis
- ✓ Immediately proceed with rhythm analysis and defibrillation, if appropriate
- Establish IV/IO access and administer epinephrine before rhythm analysis
- Apply the mechanical CPR device before attempting defibrillation
You arrive on scene to find a 54-year-old male in cardiac arrest with asystole on the monitor. ALS resuscitation is initiated. After 20 minutes with no return of spontaneous circulation and no evidence of hypothermia, which additional finding is required before termination of resuscitation can be considered?
- Absence of a bystander witness to the arrest
- ✓ EtCO2 reading of less than 20 mmHg
- EtCO2 reading of less than 40 mmHg
- Patient age greater than 65 years
During LUCAS Device operation, the rhythm strip cannot be assessed during compressions. Per protocol, what is the maximum allowable interruption time if compressions must be paused for rhythm analysis?
- 5 seconds
- ✓ 10 seconds
- 15 seconds
- 20 seconds
Sourced from North Dakota's EMS authority
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North Dakota protocols — FAQ
Are North Dakota's EMS protocols available offline?
Yes. Download North Dakota'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 Dakota?
Yes. North Dakota'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 Dakota?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring North Dakota's protocols into a faster, fully offline app and link the authority's own source for every set.
How do North Dakota 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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