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South Carolina EMS protocols,
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Offline, county-specific protocols for South Carolina EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 46 counties in South Carolina · Protocols current as of June 18, 2026
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South Carolina EMS Clinical Operating Guidelines
2025 ↗
PDF document
335
Flashcards
170
Quiz questions
51
Medications
31
Resources
Study tools for South Carolina EMS Clinical Operating Guidelines
A few real flashcards and quiz questions from South Carolina's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
STEMI Definition (EMS Criteria)
A positive STEMI is defined as cardiac symptoms lasting greater than 15 minutes and less than 12 hours AND ST segment elevation of ≥1 mm in 2 or more anatomically contiguous leads, OR a Left Bundle Branch Block NOT KNOWN to be present in the past. The Reperfusion Checklist must be completed for all acute STEMI patients.
Criteria for Withholding CPR: Downtime >15 minutes
CPR may be withheld from patients >18 years of age, not known to be pregnant, with documented downtime >15 minutes without CPR, found apneic, pulseless, no pupillary reflex, asystolic, and with no suspicion of hypothermia. This criterion does NOT apply if hypothermia is suspected.
ECG criteria for V-Tach with a pulse
Ventricular tachycardia is identified by a wide, regular rhythm with QRS > 0.12 seconds and a palpable pulse. The rate for sustained V-Tach is usually 150–180 bpm. If the rhythm changes or becomes pulseless, exit to the appropriate C.O.G.
LVAD CPR Decision: When is CPR initiated?
CPR is initiated ONLY when two conditions are both met: (1) the pump is confirmed stopped AND troubleshooting efforts have failed, AND (2) the patient is unresponsive without detectable signs of life. CPR should NOT be performed if there is evidence the pump is functioning; the decision is based on best clinical judgment.
Fibrinolysis Contraindications: Blood Pressure Thresholds
Fibrinolysis MAY be contraindicated if the systolic blood pressure is greater than 180 mmHg, diastolic blood pressure is greater than 110 mmHg, or if there is a right vs. left arm systolic blood pressure difference of greater than 15 mmHg. These findings must be checked on the Reperfusion Checklist.
VF/Pulseless VTach: Treatment Priority Order
The protocol prioritizes treatment in this order: uninterrupted high-quality chest compressions first, then defibrillation, then IV access and airway control. If arrest was not witnessed by EMS, 2 full minutes of high-quality CPR must be performed prior to the first defibrillation.
Symptomatic pediatric bradycardia: rate threshold and serious signs
Symptomatic bradycardia in pediatric patients typically occurs at rates less than 50 beats per minute. Serious signs and symptoms include hypotension, acutely altered mental status, signs of shock/poor perfusion, and acute CHF. Pharmacological treatment is only given when symptomatic; otherwise, monitor only.
STEMI Transport Decision: Unstable Patient
If a STEMI patient has an unstable airway, cardiac arrest, and/or hemodynamic instability, they should be transported to the nearest facility to stabilize rather than a STEMI-specific center. Stabilization takes priority over direct STEMI center transport in these cases.
Quiz questions
You arrive on scene to find a 45-year-old male patient who is apneic, pulseless, and in ventricular fibrillation. The arrest was NOT witnessed by EMS. According to the VF/Pulseless VTach protocol, what is the correct FIRST action?
- Immediately defibrillate x1, then begin CPR
- ✓ Perform 2 full minutes of high-quality CPR, then defibrillate
- Establish vascular access, administer epinephrine, then defibrillate
- Apply the cardiac monitor, obtain a 12-lead ECG, then defibrillate
You are treating a stable patient with a wide, regular, monomorphic ventricular tachycardia at a rate of 162 bpm. After establishing vascular access, which medication does the SC COG 200-313 protocol indicate you should CONSIDER before antidysrhythmic therapy?
- Amiodarone
- ✓ Adenosine
- Magnesium Sulfate
- Lidocaine
According to the Reperfusion Checklist, which of the following blood pressure findings would indicate that fibrinolysis MAY be contraindicated?
- Systolic Blood Pressure of 170 mm Hg
- Diastolic Blood Pressure of 100 mm Hg
- ✓ Right vs. Left Arm Systolic Blood Pressure difference of 20 mm Hg
- Systolic Blood Pressure of 160 mm Hg with a Diastolic of 90 mm Hg
You arrive on scene to find an LVAD patient who is unresponsive and not breathing normally. There is no loud alarm from the external controller. You auscultate the chest and hear NO humming sound. According to Algorithm 1, what is your next action?
- Immediately begin chest compressions at standard CPR rate
- ✓ Assume LVAD failure, prioritize moving to Algorithm 2, and start ventilations at 10-12 per minute without starting chest compressions
- Contact the VAD coordinator and await further instructions before intervening
- Defibrillate immediately, as VF is the assumed rhythm
A STEMI patient has confirmed ST-elevation on ECG, chest pain onset 45 minutes ago, and is found to be cool and clammy with a systolic BP of 82 mm Hg. According to the STEMI Transport protocol, which destination consideration applies to this patient?
- Transport to the nearest STEMI Referral Hospital because there are no contraindications to fibrinolysis
- Transport to the nearest facility to stabilize due to hemodynamic instability
- ✓ Transport to the nearest STEMI Receiving Hospital because the patient may benefit more from a PCI-capable facility
- Complete the Pre-Fibrinolytic Survey and transport to the nearest STEMI Referral Hospital
According to SC C.O.G. 200-317, under which TWO conditions must BOTH be met before initiating CPR on an LVAD patient in cardiac arrest?
- The patient has no palpable pulse AND the device alarm is sounding
- ✓ The confirmed pump has stopped and troubleshooting has failed, AND the patient is unresponsive without detectable signs of life
- The VAD coordinator has been contacted AND medical control has given authorization
- The patient has no audible hum AND the battery is confirmed dead
Sourced from South Carolina's EMS authority
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South Carolina protocols — FAQ
Are South Carolina's EMS protocols available offline?
Yes. Download South 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 South Carolina?
Yes. South 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 South Carolina?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring South Carolina's protocols into a faster, fully offline app and link the authority's own source for every set.
How do South 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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