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Offline, county-specific protocols for District of Columbia EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 1 county in District of Columbia · Protocols current as of October 17, 2026
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District of Columbia EMS Manual
Revision: March 17, 2026 ↗
PDF document
809
Flashcards
413
Quiz questions
39
Medications
3
Resources
Study tools for District of Columbia EMS Manual
A few real flashcards and quiz questions from District of Columbia's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Primary blast injury: which anatomical sites are most severely affected and why?
Primary injury occurs due to the over pressurized blast wave. Most severe injury occurs at air-fluid interface in the brain, lungs, eardrums, and bowel.
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 corresponds to gestational age ≥ 20 weeks (viable fetus). The Trauma in Pregnancy protocol applies to the female patient with known pregnancy greater than 20 weeks gestational age or fundal height at or above the level of the belly button.
Agonal breathing in OHCA: prevalence and significance
40-60% of out-of-hospital cardiac arrest (OHCA) victims have agonal breathing on presentation. Agonal breathing is a common reason to misdiagnose a patient as not being in cardiac arrest.
Defibrillation energy sequence for adults in VF/pVT (Shocks #1, #2, #3)
Shock #1: 120 J, Shock #2: 150 J, Shock #3: 200 J. After each defibrillation, CPR must be immediately resumed and continued for 2 minutes before the next pulse or rhythm check.
ROSC Transport Destination — Adult vs. Pediatric
All adult patients successfully resuscitated from a medical cardiac arrest MUST be transported directly to a STEMI/ROSC receiving facility, regardless of initial rhythm or 12-lead EKG findings. All pediatric patients successfully resuscitated from cardiac arrest shall be transported to Children's National Hospital.
Definition of Refractory VF/pVT
Refractory VF or pVT is the failure to achieve sustained return of spontaneous circulation (ROSC) after treatment with 3 defibrillations and administration of an antiarrhythmic medication IV/IO (e.g., amiodarone). The patient must still be in VF or pVT despite these interventions to meet the definition.
Wide Complex Tachycardia — Definition & EKG Criteria
A cardiac rhythm with a rate greater than 100 BPM and a QRS width greater than or equal to 120 ms. The wide complex results from electrical impulses originating in the ventricle or abnormal conduction due to structural or metabolic causes (e.g., bundle branch block, hyperkalemia, acidosis).
Quiz questions
According to the DC Fire and EMS ECPR / ECMO Candidate 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
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
You arrive on scene to find an adult patient in cardiac arrest. The monitor shows an organized rhythm with QRS complexes but no pulse is detected. According to the DC Fire and EMS PEA/Asystole Protocol, when should the first dose of epinephrine be administered?
- ✓ As soon as possible via IV/IO access
- After the second defibrillation attempt
- Only after 2 minutes of CPR have been completed
- After ROSC is confirmed and then lost again
According to the DC Fire and EMS ROSC protocol, where MUST all adult patients successfully resuscitated from a medical cardiac arrest be transported, regardless of initial rhythm or 12-lead EKG findings?
- The nearest emergency department
- ✓ A STEMI/ROSC receiving facility
- Children's National Hospital
- Any trauma center
You arrive at the scene of a 58-year-old male in cardiac arrest. Your monitor confirms VF. The monitor is NOT yet precharged. What is the correct immediate action per the DC FEMS VF/pVT protocol?
- Wait for the monitor to charge before resuming chest compressions
- Administer epinephrine 1 mg IV/IO immediately before defibrillating
- ✓ Resume chest compressions after the pulse check while charging the monitor/defibrillator
- Defibrillate immediately at 200 J, then resume CPR
According to the DC Fire and EMS protocol, when does the 30-minute ALS care clock officially START for the purpose of Termination of Resuscitation (TOR)?
- When the first EMS unit arrives on scene
- When the first chest compression is delivered by EMS
- ✓ When the monitor/defibrillator is both turned on AND attached to the patient
- When the ALS unit arrives and assumes care from BLS
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District of Columbia protocols — FAQ
Are District of Columbia's EMS protocols available offline?
Yes. Download the protocol set for your area once and every protocol, medication, and hospital is available with no signal — built for basements, rural calls, and dead zones.
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Pocket Protocols covers District of Columbia County in District of Columbia today, not the whole state. Protocol sets are scoped by county, so a provider in a covered county gets exactly the set that governs where they respond, and you can add more than one if you work across areas. Other counties are added as their EMS authorities come on board.
Is Pocket Protocols official, or affiliated with District of Columbia?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring District of Columbia's protocols into a faster, fully offline app and link the authority's own source for every set.
How do District of Columbia 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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