Preview the 2020 Protocol Revisions HERE

Coronavirus Disease 2019 (COVID-19) Protocol

Regional Stroke Protocol Modifications

The regional prehospital protocol for stroke management has been modified. Changes are effective immediately. The Changes include:

  • Indications for VAN Assessment
  • 24 hour window of symptom onset for “Stroke Alert.”
  • Stroke Alert terminology at Augusta Health

Click here for a printable version of the modified stroke protocol. Use this to replace pages in any printed copies you or your agency possesses.

Click here for the full 2017 Prehospital Standard Patient Treatment Protocols.

CPAP Protocol Corrections – 12/5/2017

Errors have been identified in the 2017 Standard Patient Treatment Protocols document that has been available for download from the CSEMS Protocols webpage. These errors have been corrected and a revised version of the 2017 Standard Patient Treatment Protocols is now available for download from the CSEMS Protocols webpage.

For a quick overview of the revisions or to inspect your copy of the protocols for accuracy, please download the Corrections Guide to 2017 Standard Patient Treatment Protocols – 12/5/2017.

The Corrected Pages Packet – 12/5/2017 may be used to replace the individual pages containing revisions.

Quick Links:

2017 Prehospital Standard Patient Treatment Protocols – Revised 12/5/2017

Corrections Guide to 2017 Standard Patient Treatment Protocols – 12/5/2017

Corrected Pages Packet – 12/5/2017





To: All agencies and EMS personnel in the CSEMS region

From: Asher Brand, MD, CSEMS Regional Medical Director

The Rollout of the updated CSEMS protocols is delayed until further notice.

Apparently, technical issues with the Online Learning Management System continue.

Mr. Critzer took the LMS off line this past Friday, as it was not working. I do not understand the technical issues involved. Please look for a letter from Gary Critzer tomorrow explaining the technical side of this issue and hopefully a time frame.

Thank you for your dedication,

Asher Brand



Released: 2017 Prehospital Standard Patient Treatment Protocols

I-GEL supraglottic airway, EMT administered naloxone, and VAN stroke assessment highlight 2017 protocol changes

The Central Shenandoah EMS Council is proud to announce the release the 2017 Prehospital Standard Patient Treatment Protocols. The modified protocols are highlighted by the introduction of the i-gel and i-gel O2 supraglottic airways, EMT administ


ered naloxone, and the VAN Stroke Assessment. Other protocols introduced in the updated 2017 protocols include Cardiac Arrest

– Special Resuscitation Circumstances, Septic Shock, and Mean Arterial

Pressure. Important changes to certain drug profiles have resulted in modifications to protocols that call for the administration of ketamine, calcium chloride, dextrose 50%, and prednisone, which has been removed from the protocols and no longer stocked in CSEMS drug boxes.

The protocol changes will become effective on November 1, 2017.

Following are documents related to the 2017 protocols.

  • 2017 Prehospital Standard Patient Treatment Protocols – Full protocol document with all updates.
  • 2017 Protocol Modification Guide – Document that lists each modification to the protocols, referencing the protocol number, page number, line number (if applicable) and a brief description of the change.
  • 2017 Field Guide – Updated, printable field guide insert pages are coming soon.
  • Protocol Modifications Memo (11/1/17) – Memo from the CSEMS Council introducing the protocol modifications.

Protocol Training

All Providers. The Council has produced on-line protocol training modules to update and train all EMS providers on the protocol changes.  It is important all providers complete this training as there have been many modifications to treatment protocols that affect each level provider’s scope of practice.  Training is available on the Council’s CSEMS Learning Hub, Moodle, at  To access the online training courses, providers need to first create an account by clicking the “Create an Account” icon at the bottom of the CSEMS Learning Hub information page located at Providers that have an existing CSEMS Learning Hub account must update any changes to their certification number and affiliations through the ‘Edit Profile’ feature. After creating an account, Council staff will verify your account request, enroll you in any training courses that you’ll need, and make getting started easy for you. Instructions are included with the training. Important: Please ensure the following when creating your account request:

  • Double check your Virginia EMS certification number when entering it.
  • Make sure you select the correct agency that you are affiliated with from the drop down list.
  • Incorrect information cannot be processed and will delay your registration until corrected.

Providers that completed training modules released during July are not require to repeat the training, however, are still responsible for understanding and integrating the latest update.

After fulfilling the objectives of the online training, a certificate of completion will be available and must be downloaded to finish the training module. There is an online training module for EMTs that, amongst other changes, covers intramuscular naloxone administration, which EMTs that fulfill updated BLS Local Protocol training will be responsible for effective November 1st, 2017.

EMTs, Stand-by for intramuscular naloxone skills training and testing that will be conducted through the BLS Local Protocol Program.

Drug Boxes

As of August 1st, 2017, regional hospital pharmacies have modified the cardiac drug boxes based on the changes to the protocols. Prednisone will be removed from the Drug.

Field Guides

Updated Field Guide inserts are under development. An announcement will be posted when they are available.


To:                       All Regional EMS Providers and Agency Leaders

From:                  Asher Brand, Regional Medical Director

Date:                   July 24, 2017

Reissued:           July 25, 2017

Subject:              Delay of Implementation of 2017 Pre-hospital Standard Patient Treatment Protocols


Earlier today, at a meeting of the Medical Control Review Committee meeting, it was determined that the implementation of the 2017 Pre-hospital Standard Patient Treatment Protocols will be delayed.

The new effective date for the implementation of the 2017 Pre-hospital Standard Patient Treatment Protocols is Nov 1, 2017.  Further guidance will be provided by Council staff in the near future.

The protocolupdate on the CSEMS Learning Hub is being revised.  Until the revision is complete, the program will not be available on Learning Hub.   Providers who have completed the existing update will not be required to re-take the new protocol-update.

KETAMINE is not authorized outside of the pain protocol that currently exists.  Clarification: Ketamine in dissociative doses will not be authorized in the new protocols.  Agency Medical Directors can, in concert with individual agencies, develop such protocols.

Please ensure that agency leadership reinforces this information with staff and volunteers.

Thank you.

Drug Boxes

Starting October 1st, 2017, regional hospital pharmacies will begin modifying the cardiac drug boxes based on the changes to the protocols. Prednisone will be removed from the drug box.

OMDs issue statement on intubation by Intermediate providers

The regional Operational Medical Directors recently issued a position on the practice of endotracheal intubation by Intermediate level providers in the Central Shenandoah EMS Council region. Dr. Asher Brand, Regional Medical Director, has released a memorandum on behalf of all regional Operational Medical Directors, outlining the position of the medical directors, including additional clinical guidance. The full memorandum can be downloaded below.

Memo (2017-01-26): Video Laryngoscopy by Intermediate Providers (0.3 MiB, 1178 downloads)

Operational Medical Director Credentialing

Each agency’s Operational Medical Director is responsible for credentialing EMS providers. Below are some tools that may be used to evaluate skill performance for providers. These are NOT designed as teaching sheets, and may not cover all aspects of performing clinical skills.

BLS Local Protocol Checksheets

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