EMS Forms & Documents

Below are some of the most requested forms from the Division of EMS in PDF format. These forms are specifically designed for personnel working under the medical direction of the Division of EMS. If state forms are needed we have provided a link to NCOEMS here and below under Resources. If you need assistance with any of our forms, please contact us at (252) 744-2154 and we will be glad to assist you.

Pitt County Functioning Policy Packet
	Policies (effective 4/6/2011) Personnel Verification Form (effective 4/2011) Database Information (effective 1/2011) 12-month Continuing Education Report (effective 1/2011) Please see appropriate skill level sheets below.

Skills Sheets/Worksheets
	Basic (effective 4/7/2010) Intermediate (effective 4/7/2010) Paramedic (effective 4/7/2010) Intradermal Injection Re-credential Worksheet (effective 5/2011)

Protocols
	2010 NCCEP Protocols (effective 1/15/2009) Induced Hypothermia Protocol

Specific to Pitt County EMS: Standards Procedure
	Bus Crash Nitronox Administration (Skill) Intradermal Injection (Skill) Airway Surgical Cricothyrotomy (Skill) Rectal Administration (Skill) NCCEP Table of Content (Skill)

Standards Policy
	Medical Errors Non-Emergency Medical Transports Patient Refusal of Transport Paramedic Triage Children with Special Health Care Needs

Triage/Destination Plans
	Trauma and Burn Triage (2011) Pediatric (2011) Stroke (2011) STEMI (2011-pending)

Other Useful Documents/Forms
	Drug List (Pitt County Formulary) EMS Blood Borne Pathogens (BBP) Exposure EMS Pitt County Required Drug Lists for EMT-B, EMT-I, and Paramedics Patient Refusal of Transport and/or Treatment
Resources & Links
	North Carolina Office of Emergency Medical Services (NCOEMS) National Association of Emergency Medical Physicians (NAEMSP) American College of Emergency Physicians (ACEP) North Carolina Association of Rescue and Emergency Medical Services University Health Systems of Eastern Carolina

EMS Forms & Documents

Resources & Links