District of Columbia EMS protocols,
in your pocket.

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).

Which fundal-height landmark is used to identify a pregnancy around 20 weeks in the trauma protocol?

Fundal height at or above the belly button (umbilicus) is used as the landmark for a pregnancy of approximately 20 weeks or greater. This protocol uses known pregnancy >20 weeks or this fundal-height landmark in its inclusion criteria. The original card’s detailed 12-, 36-, and 37–40-week measurements and postpartum claims are not supplied by this source page.

According to the September 2022 ECPR/ECMO checklist, which hospital and availability statement is correct?

• Georgetown University Hospital offers ECMO 24/7
• ✓ George Washington University Hospital (H8) offers ECMO Monday–Friday, 0800–1700; H13 offers ECMO 24/7
• H13 offers ECMO only Monday–Friday, 0700–1900
• Howard University Hospital offers ECMO only on weekends

The September 24, 2022 checklist lists H8 on weekdays from 0800–1700 and H13 24 hours per day, seven days per week. The older January 2022 chart footnote should not exclude the H13 availability explicitly listed in the later checklist.

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

The protocol states that providers are directed to 'quickly check for a pulse and to promptly start compressions when a pulse is not definitely palpated.' It further emphasizes: 'When in doubt, start chest compressions,' noting that initiating compressions in a non-arrest patient carries low risk compared to withholding CPR from a true arrest patient.