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Covering 55 counties in West Virginia · Protocols current as of June 18, 2026
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West Virgina Statewide EMS Pre-Hospital Protocols
2024 ↗
PDF document
67
Flashcards
36
Quiz questions
41
Medications
1
Resource
Study tools for West Virgina Statewide EMS Pre-Hospital Protocols
A few real flashcards and quiz questions from West Virginia's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Atropine: when should you NOT rely on it for AV block?
Atropine should not be relied upon in type II second-degree or third-degree AV block, or in patients with third-degree AV block with a new wide-QRS complex. These patients require immediate pacing, as Atropine is unlikely to be effective and may worsen the condition.
Epinephrine 1:1,000 — Pediatric Cardiac Arrest Dose
Epinephrine 1:1,000 is indicated for anaphylaxis, bronchial asthma, and respiratory distress due to epiglottitis or croup (per MCP). For pediatric cardiac arrest, the paramedic administers 0.1 mg/kg via the ET route. Supplied as an ampule containing 1 mg in 1 mL or a multidose vial containing 30 mg in 30 mL.
Nitroglycerin contraindications
Nitroglycerin is contraindicated in hypotension (SBP < 90 mmHg), bradycardia (HR < 60), increased intracranial pressure (e.g., CVA, head injury), hypersensitivity, and use of anti-impotence agents (Cialis, Levitra, Viagra) within the last 3 days. Concurrent use with anti-impotence agents potentiates severe hypotension.
LVAD Patient Assessment: Why Pulse and BP Are Unreliable
In LVAD patients, traditional pulse and blood pressure assessment can be unreliable indicators of stability because the device pumps blood mechanically. Mental status and skin color must be used to determine patient stability, and quantitative continuous waveform capnography remains accurate in LVAD patients.
Nitroglycerin dosing for chest pain, severe hypertension, and pulmonary edema
For chest pain and severe hypertension, administer 0.4 mg SL and repeat every 5 minutes to a maximum of 3 doses. For cardiogenic pulmonary edema, the same 0.4 mg SL dose applies but requires SBP ≥ 110 mmHg, repeated every 5 minutes to a maximum of 3 doses.
CPR Decision Point in the LVAD Patient
CPR should only be initiated when there is confirmation that the LVAD pump has stopped working AND all other clinical indicators indicate CPR is required. LVAD patients should almost never be pronounced dead at the scene.
Labetalol (Trandate) — Adult Dosing Protocol for Hypertension
Administer 10 mg slow IVP over 2 minutes per MCP. If BP remains >180/120 and symptoms persist, repeat at 20 mg in 10 minutes. Labetalol is contraindicated in uncompensated HF, pulmonary edema, cardiogenic shock, and bradycardia or heart block.
Unfractionated Heparin: indication, dose, and administration
Indicated for ST-elevation myocardial infarction (STEMI). Adult dose is 60 units/kg IV bolus to a maximum of 5,000 units, administered as a slow IV push over 2–4 minutes. Onset of action via IV is immediate with a half-life of 1–2 hours.
Quiz questions
A paramedic is treating an adult patient in third-degree (complete) AV block with a new wide-QRS complex and a heart rate of 38. The patient is hypotensive and confused. Which statement BEST reflects the protocol's guidance for atropine use in this situation?
- Administer atropine 1 mg IV immediately as the first-line treatment.
- Administer atropine 2 mg IV because the heart rate is below 50.
- ✓ Avoid relying on atropine; these patients require immediate pacing.
- Atropine is contraindicated in all third-degree AV blocks regardless of QRS morphology.
A patient presents with chest pain and reports taking Levitra two days ago. His blood pressure is 148/88 mmHg and heart rate is 78. Which of the following is the most appropriate action regarding nitroglycerin administration?
- Administer 0.4 mg SL nitroglycerin since his blood pressure is above 90 mmHg
- Administer 0.4 mg SL nitroglycerin since Levitra was taken more than 24 hours ago
- ✓ Withhold nitroglycerin because Levitra was taken within the last 3 days
- Contact MCP for a reduced dose of 0.2 mg SL nitroglycerin
You are caring for an adult LVAD patient who is unresponsive and you cannot palpate a pulse. Per GL019, when should CPR be initiated in an LVAD patient?
- Immediately upon finding the patient unresponsive, just as with any other cardiac arrest patient
- Only after calling the patient's VAD coordinator and receiving authorization
- ✓ Only when confirmation that the LVAD pump has stopped working AND all other clinical indicators indicate CPR is required
- CPR is contraindicated in all LVAD patients and should never be performed
You respond to a patient in rapid atrial fibrillation with a heart rate of 158 and a blood pressure of 88/60 mmHg. The patient has no known pacemaker. Per protocol, which of the following is a contraindication to administering diltiazem in this patient?
- The patient's atrial fibrillation with rapid ventricular rate.
- ✓ The patient's systolic blood pressure of 88 mmHg.
- The patient's heart rate of 158 bpm.
- The patient's age-related decrease in body mass.
Per the Furosemide protocol, a patient with known heart failure and a current furosemide prescription presents with pulmonary edema. Her blood pressure is 118/74 mmHg. What is the correct furosemide dose?
- 20 mg IV, because a lower dose is safer in the field
- 40 mg IV, because the SBP is below 120 mmHg
- 40 mg IV, because the patient is not prescribed furosemide
- ✓ 80 mg IV, because the patient is currently prescribed furosemide and SBP ≥ 100 mmHg
You respond to a patient involved in a building collapse 2 hours ago with crush injuries to both lower extremities. His ECG shows peaked T-waves and his potassium is suspected to be elevated. Which medication(s) listed in the protocol are indicated for this patient's suspected hyperkalemia AND crush syndrome?
- Succinylcholine only
- ✓ Sodium Bicarbonate only
- Tranexamic Acid only
- Both Sodium Bicarbonate and Tranexamic Acid
Sourced from West Virginia's EMS authority
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West Virginia protocols — FAQ
Are West Virginia's EMS protocols available offline?
Yes. Download West Virginia'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 West Virginia?
Yes. West Virginia'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 West Virginia?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring West Virginia's protocols into a faster, fully offline app and link the authority's own source for every set.
How do West Virginia 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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