Appendix A. Facility Codes for EMS Region 1

Transcription

1 Appendix A Facility Codes for EMS Region 1 Code Facility City County Zip 100 Funeral Home 101 Beckley ARH Beckley Raleigh Bluefield Regional Med. Ctr. Bluefield Mercer Heathsouth - Southern Hills Princeton Mercer Princeton Community Princeton Mercer Raleigh General Beckley Raleigh St. Luke s Bluefield Mercer Summers County ARH Hinton Summers Veterans Administration Beckley Welch Welch Community Welch McDowell Other 114 Home 115 Pinecrest Hospital Beckley Raleigh Nursing Home 117 Doctor s Office/Clinic 830 No Patient Transported 930 Patient Refused Transport Revised 7/16/02

2 Appendix A Facility Codes for EMS Region 2 Code Facility City County Zip 200 Funeral Home 201 Cabell-Huntington Huntington Cabell Guyan Valley Logan Logan Mildred Mitchell-Bateman Hospital Huntington Cabell Lakin Hospital Pt. Pleasant Mason Logan General Logan Logan Pleasant Valley Pt. Pleasant Mason Region II Comm. Mental Health Center Huntington Cabell St. Mary s Huntington Cabell Veteran s Admin. Medical Center (VAMC) Huntington Wayne Williamson ARH Williamson Mingo Williamson Memorial Williamson Mingo Other 218 Home 219 Nursing Home 220 American Hospital for Rehab. Huntington Cabell Logan Park Care Center 222 HCA Riverpark Hospital Huntington Cabell Pinnacle Care Huntington Cabell Presbyterian Manor Huntington Cabell Chateau Grove N.H. Barboursville Cabell Fairhaven Rest Home Huntington Cabell Mays Riverside Manor Huntington Cabell Wayne Continuous Care Wayne Wayne Lincoln Continuous Care Hamlin Lincoln Chadwicks Personal Care Barboursville Cabell Morris Memorial N.H. Milton Cabell Logan Health Care Village 830 No Patient Transported 930 Patient Refused Transport Revised 7/16/02

3 Appendix A Facility Codes for EMS Region 3/4 Code Facility City County Zip 300 Funeral Home 301 Boone Memorial Madison Boone CAMC - General Charleston Kanawha CAMC - Memorial Charleston Kanawha Greenbrier Valley Medical Center Fairlea Greenbrier CAMC - Women s and Children s Charleston Kanawha Montgomery General Montgomery Fayette Plateau Medical Center Oak Hill Fayette Pocahontas Memorial Marlinton Pocahontas Richwood Area Community Hospital Richwood Nicholas St. Francis Charleston Kanawha Summersville Memorial Summersville Nicholas Thomas Memorial S. Charleston Kanawha Webster Memorial Webster Spngs Webster Nursing Home 317 Clinic/Doctors Office 318 Highland Hospital Charleston Kanawha Home 320 The Eye & Ear Clinic Charleston Kanawha Putnam General Hurricane Putnam Medical Examiner s Office S. Charleston Kanawha Other 830 No Patient Transported 930 Patient Refused Transport Revised 7/16/02

4 Appendix A Facility Codes for EMS Region 5 Code Facility City County Zip 400 Funeral Home 401 Camden-Clark Memorial Hospital Parkersburg Wood Minnie Hamilton Health Care Center Grantsville Calhoun Jackson General Hospital Ripley Jackson Roane General Hospital Spencer Roane St. Joseph s Hospital Parkersburg Wood Sistersville General Hospital Sistersville Tyler Nursing Home 409 Home 410 Other 411 Health South Western Hills Parkersburg Wood Care Haven of Sistersville Sistersville Tyler No Patient Transported 930 Patient Refused Transport Revised 7/16/02

5 Appendix A Facility Codes for EMS Region 6/7 Code Facility City County Zip 500 Funeral Home 501 Broaddus Hospital Philippi Barbour Cortland Acres Thomas Tucker Davis Memorial Hospital Elkins Randolph Elkins Regional Convalescent Care Elkins Randolph Fairmont Clinic Fairmont Marion Marion Health Care Hospital Fairmont Marion Fairmont General Hospital Fairmont Marion Braxton County Memorial Hospital Gassaway Braxton Good Samaritan Center Belington Barbour Grafton City Hospital Grafton Taylor Hopemont Hospital Terra Alta Preston Monongalia General Hospital Morgantown Monongalia Nella s Nursing Home Elkins Randolph Preston Memorial Hospital Kingwood Preston St. Joseph s Hospital Buckhannon Upshur Stonewall Jackson Memorial Hospital Weston Lewis Tucker Community Care Parsons Tucker United Hospital Center Clarksburg Harrison Veterans Administration Medical Center Clarksburg Harrison Sharpe Hospital Weston Lewis Ruby Memorial Hospital Morgantown Monongalia Clinic Out-Patient 526 Other 527 Home 528 Preston Nursing Home Kingwood Preston Sunbridge Personal Care Home Salem Harrison Americare Nursing Centers Morgantown Monongalia Americare Nursing Centers Glenville Gilmer Arbor s Health Care Fairmon Marion Clarksburg Continuous Care Center Clarksburg Harrison Crestview Manor Nursing Home Clarksburg Harrison Doris s Nursing Home Enterprise Harrison Gold Circle Nursing Home Stonewood Harrison Harris Rest Home Philippi Barbour Heartland of Clarksburg Clarksburg Harrison Heartland of Preston County Kingwood Preston Heritage Nursing Home Bridgeport Harrison Revised 7/16/02

6 Appendix A Facility Codes for EMS Region 6/7 (Continued) Code Facility City County Zip 538 Doris s Nursing Home Enterprise Harrison Gold Circle Nursing Home Stonewood Harrison Harris Rest Home Philippi Barbour Heartland of Clarksburg Clarksburg Harrison Heartland of Preston County Kingwood Preston Heritage Nursing Home Bridgeport Harrison Lee s Home for the Elderly Buckhannon Upshur Lida Clark Nursing Home Clarksburg Harrison Madison House Nursing Home Morgantown Monongalia Meadowview Manor Health Care Bridgeport Harrison Medbrook Medical Center Bridgeport Harrison Mullenax Personal Care Home Belington Barbour Myers Clinic Philippi Barbour Morgan Manor Nursing Home Morgantown Monongalia Nella s Inc. Crystal Springs Randolph Rest Haven Nursing Home, Inc. Grafton Taylor Rosewood Health Care Center Grafton Taylor Sundale Nursing Home Morgantown Monongalia Wishing Well Health Center Fairmont Marion Country Comfort Personal Care Worthington Marion Grafton Nursing Care Facility Grafton Taylor Holbrook Nursing Home Buckhannon Upshur Our Own Personal Care Clarksburg Harrison St. Barbara s Nursing Home Monongah Marion Pinecrest Haven Personal Care Gore Harrison MRI Clinic Morgantown Monongalia Nursing Home 572 Physician s Office 573 Health South Mountainview Hospital Morgantown Monongalia No Patient Transported 930 Patient Refused Transport Revised 7/16/02

7 Appendix A Facility Codes for EMS Region 8/9 Code Facility City County Zip 600 Funeral Home 601 City Hospital Martinsburg Berkeley Grant Memorial Petersburg Grant Hampshire Memorial Romney Hamphsire Jefferson Memorial Ranson Jefferson Morgan County War Memorial Berkeley Sprgs Morgan Potomac Valley Keyser Mineral Veterans Administration Martinsburg Berkeley Other 610 Home 611 Greenhaven Rest Home Fisher Hardy Heartland of Keyser Keyser Mineral Kidwell Nursing Home Romney Hamphsire Knott Nursing Home Charles Town Jefferson Jeffersonian Manor Charles Town Jefferson Hartland of Martinsburg Martinsburg Berkeley Pendleton Nursing Home Franklin Pendleton Shenandoah Nursing Home Ranson Jefferson Valley View Nursing Home Berkeley Sprgs Morgan Dawn View Nursing Home Ft. Ashby Mineral Grant County Nursing Home Petersburg Grant E.A. Hawse Intermediate Facility Care Baker Hardy Care Haven Martinsburg Berkeley Canterbury of Shepherdstown Shepherdstown Jefferson No Patient Transported 930 Patient Refused Transport Revised 7/16/02

8 Appendix A Facility Codes for EMS Region 10/11 Code Facility City County Zip 700 Funeral Home 701 Ohio Valley Medical Center Wheeling Ohio Reynolds Memorial Glen Dale Marshall Weirton Medical Center Weirton Brooke Wetzel County N. Martinsville Wetzel Wheeling Hospital Wheeling Ohio Other 709 Nursing Home 710 Home 711 Bishop Joseph Hodges Continuous Care Ctr. Wheeling Ohio Brightwood Nursing Home Follansbee Brooke Cameron Health Care Center Cameron Marshall Fox Nursing Home Chester Hancock Good Shepherd Nursing Home Wheeling Ohio Mound View Health Care Moundsville Marshall New Martinsville Health Care Center N. Martinsville Wetzel Valley Haven Geriatric Center, Inc. Wellsburg Brooke Weirton Geriatric Center Weirton Hancock (Altenheim) The Home For the Aged Wheeling Ohio Country Haven Rest Home Beech Bottom Brooke Elmhurst - House of Friendship Wheeling Ohio The Home For Men Wheeling Ohio Icenhower Boarding Home, Inc. Wheeling Ohio Lewis Wetzel Personal Care Home N. Martinsville Wetzel Mound View Health Care, Inc. Moundsville Marshall Serra Retirement Home Weirton Hancock We Care Personal Care Home Chester Hancock Welty Home for the Aged, Inc. Wheeling Ohio No Patient Transported 930 Patient Refused Transport Revised 7/16/02

9 Appendix A Codes for Out-of-State Facilities State Code Facility City Zip Kentucky 801 Kings Daughters Hospital Ashland Louisa Community Hospital Louisa University of Kentucky Med Center Lexington University of Kentucky Med Center Moorehead South Williamson ARH So. Williamson Ohio 805 Belaire Hospital Belaire Children s Hospital Cincinnati Cincinnati General Cincinnati Cleveland Clinic Cleveland Holzier Medical Center Gallipolis Marietta Memorial Hospital Marietta Martin s Ferry Hospital Martin s Ferry Ohio State Univ. Med Center Columbus Ohio Valley Hospital Steubenville Selby General Hospital Marietta St. John s Hospital Steubenville Pinecrest Gallipolis 828 Heartland So. Point 829 Pulley s Nursing Home So. Point 831 Pulley s Care Center So. Point Pennsylvania 816 Allegheny General Hospital Pittsburgh Children s Hospital Pittsburgh Mercy Hospital Pittsburgh Mountefire Hospital Pittsburgh Presbyterian Hospital Pittsburgh St. Francis Hospital Pittsburgh Shady Side Hospital Pittsburgh Washington Hospital Washington West Allegheny Hospital Pittsburgh 825 West Penn Pittsburgh McGee s Women s Hospital Pittsburgh Veteran Administration Hospital Pittsburgh Greene County Memorial Waynesburg Tennessee 835 Holston Valley Kingsport Revised 7/16/02

10 Appendix A Codes for Out-of-State Facilities (Continued) State Code Facility City Zip Washington DC 901 Metro DC Hospital Washington DC Veteran s Administration Washington DC Maryland 902 Garrett Memorial Oakland Memorial Cumberland Sacred Heart Cumberland Shock-Trauma Unit Baltimore Washington County Hagerstown Virginia 907 Allegheny Regional Lowmoor Carilion - Roanoke Community Roanoke Carilion - Roanoke Memorial Roanoke Rockingham Memorial Harrisburg Medical College of Virginia Richmond Winchester Memorial Winchester University of Virginia Charlottesville Bristol Regional Medical Center Bristol Buchanan General Grundy Clinch Valley Medical Center Richlands Tazewell Community Hospital Tazwell Giles County Hospital Pearisburg Veteran s Administration Salem Augusta Medical Center Fishersville Lewis Gale Medical Center Salem North Carolina 921 Bowman-Gray Baptist Hospital Winston-Salem Duke University Hospital Durham General Use 830 No Patient Transported 930 Patient Refused Service Revised 7/16/02

11 Appendix B Codes for Regional Medical Command Centers Code # Region Medical Command Center Name 01 Region 1 Regional Command (Beckley) 02 Region 2 Huntington Medical Command 03 Region 3/4 Charleston MedBase 04 Region 5 West Central Medical Command Center (WESTCOM) 05 Region 6/7 WVU Medical Command 06 Region 8/9 WVU Medical Command 07 Region 10/11 WVU Medical Command Revised 7/16/02

12 Appendix C Squad Codes for EMS Region 1 Region County Squad Code Code Code Squad Name Widener s Ambulance Services Brenton Volunteer Fire and Rescue Jan Care Ambulance - McDowell County HealthNet V STAT Ambulance Service - Wyoming McDowell Co. Emergency Ambulance Authority Bluefield WV Rescue Squad Oceana Volunteer Fire Department Princeton Rescue Squad Union Rescue/Monroe Transport 12 Sweet Springs Rescue Squad US Dept. of Interior - National Park Service 14 Ghent Area VFD & Ambulance 15 General Ambulance 16 Best Transport Ambulance 17 Trap Hill Volunteer Fire & Rescue Green Sulphur District Volunteer Rescue Squad Mullens Fire Department Summers County EMS Iaeger Ambulance Service Beckley Fire Department STAT - McDowell County STAT - Mercer County Peterstown Fire Department Jan Care Ambulance Service - Raleigh Co Jan Care Ambulance Service - Wyoming Co. 36 Upper Laurel VFD Revised 08/17/05

13 Appendix C Squad Codes for EMS Region 2 Region County Squad Code Code Code Squad Name Special Metals 02 Cabell County EMS 03 Cabell Huntington Hospital Pt. Transport Service Mason County Emergency Amb. Service Authority Jan Care - Cabell County Medical Transportation Service 08 Portsmouth Ambulance Service STAT Ambulance Service 10 MedFlight of East Kentucky STAT - Lincoln County 14 Lincoln EMS Appalachian First Response 16 Stafford EMS STAT - Wayne County 23 Ceredo VFD 24 Fort Gay VFD 25 Sunoco Chemical - Neal Plant 26 Kenova VFD 27 Lavalette VFD 28 Prichard VFD 29 Wayne VFD 30 Dunlow VFD and Rescue LEASA (Logan Co. Emergency Amb. Svc. Authority) Healthnet III 41 Lifeline Medical Transport - Cabell County Revised 08/11/05

14 Appendix C Squad Codes for EMS Region 3/4 Region County Squad Code Code Code Squad Name Spruce River VFD Duff Transport Whitesville Ambulance Service Clay County Emergency Ambulance Authority K & B Behavioral Health Services 06 General Ambulance Service 07 Jan Care Ambulance Service (Fayette) 08 Fayette County OES 09 Sheltering Arms, Inc Anthony Creek VFD & Rescue Squad 11 Greenbrier County Emergency Amb. Service 12 Northern Greenbrier Ambulance Service 13 White Sulphur Springs Rescue Squad 14 Williamsburg Volunteer Rescue Squad 15 Peacemaker Medical Response Charleston Fire Department 18 Cedar Grove VFD 20 Sky Hawk Traffic, Inc./dba Alert 1 21 Kanawha County Emerg. Amb. Authority STAT - Fayette County Redi-Care Bartow-Frank-Durbin Fire & Rescue 32 Hillsboro Rescue Squad 33 Marlinton VFD Putnam County EMS Alderson Fire Department EMS Boone County Ambulance Authority 43 Van VFD Quinwood Ambulance Service 45 STAT - Greenbrier County Jan Care Ambulance Service (Nicholas) STAT - Webster County Healthnet II Webster Memorial EMS Dow Chemical Company Snowshoe Mountain Response Team 57 Cass Volunteer Fire & Rescue 58 Shavers Fork Fire/Rescue 59 STAT - Pocahontas County Bayer Crop Science EMS Revised 08/11/05

15 Appendix C Squad Codes for EMS Region 5 Region County Squad Code Code Code Squad Name Calhoun County EMS Jackson County EMS Cytec Industries - Willow Island 04 Pleasants Co. Emergency Ambulance Authority Ritchie County Ambulance Authority Roane County Emergency Squad Tyler Co. Emergency Squad - Alma 10 Tyler Co. Emergency Squad - Middlebourne 11 Sistersville General Hospital Ambulance Service Wirt County Emergency Squad Camden-Clark Ambulance Service 14 Wood County Emergency Services 15 Pond Creek Volunteer Fire Department 16 MJS Enterprises/dba St. Joseph=s Ambulance Services 18 G. E. Plastics Pechiney Rolled Products Washington Bottom VFD 21 General Ambulance Service - Wood County Minnie Hamilton Health Care Center ETS GE Silicones WV LLC Blennerhassett Volunteer Fire Department 26 Deerwalk Volunteer Fire Department 27 Eastwood Volunteer Fire Department 28 Lubeck Volunteer Fire Department 29 Parkersburg Fire Department 30 Mineral Wells Volunteer Fire Department 31 Waverly Volunteer Fire Company 32 Williamstown Volunteer Fire Company St. Marys Volunteer Fire Department 34 Belmont Volunteer Fire Department General Ambulance Service - Jackson County Revised 08/11/05

16 Appendix C Squad Codes for EMS Region 6/7 Region County Squad Code Code Code Squad Name Barbour County Emergency Squad 02 Belington Emergency Squad Braxton Co. Emerg. Amb. Svc. Authority - Burnsville 05 Braxton Co. Emerg. Amb. Svc.. Authority - Sutton Doddridge County Emergency Squad Gilmer County Ambulance Service Anmoore EMS (VFD) 09 Bridgeport Fire Department 10 Harrison Co. Emerg. Squad - Clarksburg 11 Salem VFD Lewis County Emergency Amb. Svc. Authority Fairview VFC 14 Grant Town VFD 15 MCRS/Fairmont - Station MCRS/Mannington - Station MCRS/Whitehall - Station Monongalia EMS KAMP Central Ambulance Service 21 Bruceton Community Ambulance Service 22 Mountaineer Ambulance Service 23 Rowlesburg Volunteer Ambulance Service 24 Terra Alta Community Ambulance Squad 25 Tunnelton Community Ambulance Service 26 Union Ambulance Service 27 Valley District Ambulance Service Randolph Co. Emerg. Squad - Elkins 29 Randolph Co. Emerg. Squad - Harmon 30 Randolph Co. Emerg. Squad - Mill Creek Taylor Co. Emergency Squad Tucker County EMS - Davis - Station II 35 Tucker County EMS - Parsons - Station I Revised 08/23/05

17 Appendix C Squad Codes for EMS Region 6/7 (Continued) Region County Squad Code Code Code Squad Name Upshur County EMS Flemington Area EMS, Inc HealthNet I Lambert s Ambulance Service - Harrison Co. 50 Harrison Co. Emergency Squad - Shinnston Tucker Co. EMS - Canaan - Station III Jan Care - Harrison County Jan Care - Marion County Jan Care - Monongalia County Fairmont Fire Department Clarksburg Fire Department Masontown VFD Crompton Med Monongah VFD Preston Memorial Hospital Selbyville VFD Terra Alta VFD 67 Tunnelton VFD STAT Ambulance Service - Harrison County Revised 08/23/05

18 Appendix C Squad Codes for EMS Region 8/9 Region County Squad Code Code Code Squad Name Berkeley Co. EAA - Bedington VFD 02 Berkeley Co. EAA - Hedgesville VFD 03 Ryneal Fire Company 04 Berkeley Co. EAA - South Berkeley VFD & Rescue Grant County Ambulance - Mt. Storm 06 Grant County Ambulance - Petersburg PNGI Charles Town Gaming Augusta Volunteer Rescue Squad 09 Capon Bridge Rescue Squad 10 Romney Volunteer Rescue Squad 11 Springfield Area Rescue Squad Fraley Ambulance Service 13 Mathias/Baker Emergency Squad 14 Wardensville Volunteer Rescue Squad Friendship Fire Company 16 Independent Fire Company 17 Shepherdstown VFD Burlington VFD 19 Elk District Ambulance Service 20 Fort Ashby VFC 21 Keyser EMS 22 Ridgley VFC Morgan County Rescue 24 Paw Paw VFC Pendleton Co. Emerg. Rescue - Franklin 26 Pendleton Co. Emerg. Rescue - North Fork 27 Pendleton Co Emerg. Rescue. - Sugar Grove 28 Pendleton Co. Emerg. Rescue - Upper Tract Berkeley Co. Emergency Ambulance Authority 31 Berkeley Co. EAA - Baker Heights VFD Revised 08/11/05

19 Appendix C Squad Codes for EMS Region 8/9 (Continued) Region County Squad Code Code Code Squad Name BSR, Inc Berkeley Co. EAA - Back Creek VFD Morgan County - Great Cacapon NSGA Fire Department Valley Medical Transport - Grant Valley Medical Transport - Berkeley Lamberts Ambulance Service - Romney Valley Medical Transport - Mineral Valley Medical Transport - Hampshire Lambert=s Ambulance Service - Keyser 48 Capon Springs Volunteer Fire & Rescue 49 Slanesville Volunteer Ambulance Service Blue Ridge Mountain VFC Lamberts Ambulance Service - Hedgesville Fountain VFC 53 New Creek VFD Jefferson County Ambulance Authority Patterson Creek VFC 56 Short Gap VFC 57 Tri Towns Ambulance and Rescue Martinsburg Fire Department 59 VA Medical Center - Martinsburg Revised 08/29/05

20 Appendix C Squad Codes for EMS Region 10/11 Region County Squad Code Code Code Squad Name Weirton Steel Company Brooke County Ambulance Service 02 Bethany VFD Mozart Fire Department 04 West Liberty VFD 05 Emergency Medical Transport 06 Wheeling Island Gaming Inc New Manchester VFD 08 New Cumberland Ambulance 09 Weirton Area Ambulance & Rescue Squad Bayer Corporation 11 Marshall County Sheriff=s Office 12 Benwood VFD 13 Cameron Volunteer Emergency Squad 14 Glen Dale VFD 15 Limestone Regional EMS 16 McMechen VFD 17 Tri-State - Marshall County 18 Fork Ridge Community VFD & EMS Bethlehem VFD Dallas VFD Clearview VFD 23 Stone Church VFD 24 Triadelphia EMS 25 Tri-State Ambulance 26 Valley Grove VFD 27 Wheeling Fire Department New Martinsville Fire Department 29 Grandview Unit - WCEAA 30 New Martinsville Unit - WCEAA 31 Folsom Volunteer Fire Department 32 Shortline Unit - WCEAA 33 United Unit - WCEAA 34 Med Assist Ambulance Service, Inc Moundsville Fire Department 36 PPG Industries Life Team EMS 38 Tri County Ambulance Service 39 City of Weirton Fire Department 40 Newell Volunteer Fire Department Beech Bottom Volunteer Fire Department 42 Lawrenceville Volunteer Fire Department Revised 08/11/05

21 Appendix D State Approved Drugs/Solutions Code Drug/Solution 01 Atropine Sulfate 02 Calcium Chloride 03 Dexamethasone (Decadron) 04 Dextrose 5% in Water (D 5 W) 05 Dextroxe 50% (D 50 W) 06 Diazepam (Valium) 07 Digoxin (Lanoxin) 08 Diphenhydramine HCL (Benadryl) 09 Dopamine HCL (Intropin) 10 Epinephrine (1:1,000) 11 Furosemide (Lasix) 13 Isoproterenol HCL (Isuprel) 14 Lactated Ringer=s 15 Lidocaine (Xylocaine) 16 Meperidine HCL (Demerol) 18 Morphine Sulfate 19 Naloxone HCL (Narcan) 20 Nitroglycerin (Nitrostat) 21 Pentazocine Lactate (Talwin) 22 Promethazine HCL (Phenergan) 23 Sodium Bicarbonate 24 Sodium Chloride 0.9% (Normal Saline) 25 Bretylium Tosylate (Bretylol) 26 Epinephrine (1:10,000) 27 Activated Charcoal 28 Aminophylline 30 Glucagon 31 Haloperidol (Haldol) 33 Propanolol HCL (Inderal) 34 Mannitol (Osmitrol) 35 Phenobarbital 36 Plasma Protein Fraction 37 Procainamide HCL (Pronestyl) 38 Steroids (Solu-Cortef) 39 Steroids (Solu-Medrol) 41 Tetanus Toxoid 43 Nalbuphine HCL (Nubain) 44 Dextrose 10% in Water (D 10 W) 50 Verapamil HCL (Isoptin) 51 Oxytocin (Pitocin) 52 Terbutaline (Brethine) 53 Thiamine HCL 54 Nitroglycerine Spray 55 Nitrous Oxide 56 Procardia 57 Albuterol 58 Heparin 59 Adenosine 60 Magnesium Sulphate 61 Nitroglycerine Infusion 62 Tagamet 63 Aspirin 64 Oral Glucose Gel 65 Ibuprofen 66 Tylenol 67 Integrilin 68 Dextrose 25% in Water (D 25 W) 69 Amiodorone (Cordarone) 70 Diastat 71 Atrovent (Ipratropium Bromide) 72 Toradol (Ketoralac Tromethamine) Revised 08/30/04

22 Appendix D State Approved Drugs/Solutions Drug/Solution Code Activated Charcoal 27 Adenosine 59 Albuterol 57 Amiodorone (Cordarone) 69 Aminophylline 28 Aspirin 63 Atropine Sulfate 01 Atrovent (Ipratropium Bromide) 71 Bretylium Tosylate (Bretylol) 25 Calcium Chloride 02 Dexamethasone (Decadron) 03 Dextrose 5% in Water (D 5 W) 04 Dextrose 10% in Water (D 10 W) 44 Dextrose 50% in Water (D 50 W) 05 Dextrose 25% in Water (D 25 W) 68 Diastat 70 Diazepam (Valium) 06 Digoxin (Lanoxin) 07 Diphenhydramine HCL (Benadryl) 08 Dopamine HCL (Intropin) 09 Epinephrine (1:1,000) 10 Epinephrine (1:10,000) 26 Furosemide (Lasix) 11 Glucagon 30 Haloperidol (Haldol) 31 Heparin 58 Ibuprofen 65 Integrilin 67 Isoproterenol HCL (Isuprel) 13 Lactated Ringer=s 14 Lidocaine (Xylocaine) 15 Magnesium Sulphate 60 Mannitol (Osmitrol) 34 Meperidine HCL (Demerol) 16 Morphine Sulfate 18 Nalbuphine HCL (Nubain) 43 Naloxone HCL (Narcan) 19 Nitroglycerine Infusion 61 Nitroglycerine (Nitrostat) 20 Nitroglycerine Spray 54 Nitrous Oxide 55 Oral Glucose Gel 64 Oxytocin (Pitocin) 51 Pentazocine Lactate (Talwin) 21 Phenobarbital 35 Plasma Protein Fraction 36 Procainamide HCL (Pronestyl) 37 Procardia 56 Promethazine HCL (Phenergan) 22 Propanolol HCL (Inderal) 33 Sodium Bicarbonate 23 Sodium Chloride 0.9% (Normal Saline) 24 Steroids (Solu-Cortef) 38 Steroids (Solu-Medrol) 39 Tagamet 62 Terbutaline (Brethine) 52 Tetanus Toxoid 41 Thiamine HCL 53 Toradol (Ketralac Tromethamine) 72 Tylenol 66 Verapamil HCL (Isoptin) 50 Revised 08/30/04

23 Appendix E WV OEMS Patient Care Record Submission Form Use a separate form for each month. Directions: 1. Separate yellow copies by month, then Emergency ALS, Emergency BLS, Non-Emergency Transports, and No Transports. 2. Complete the information below. 3. Please do not submit partial months. All records are to be in the TSN Field Office by the 15 th of the month for the previous month. Example: January forms need to be in the office by the 15 th of February. 4. Attach this from as a cover sheet to your yellow copies. 5. Send to the appropriate WV EMS TSN Field Office. ************************************************************************************************************************ ****** Squad Name: Squad Number: Month: Year: Date Sent to TSN: Total Runs: Emergency ALS Runs: Emergency BLS Runs: Non-Emergency Transports: No Transports: Prepared for Submission By: ************************************************************************************************************************ * FOR TSN FIELD OFFICE USE ONLY Dave Received: Date Entered: Entered By: File Date and Name: Revised 7/16/02

24 TSN Regional EMS Field Offices WV EMSTSN Headquarters WV EMS TSN, Inc. PO Box 100 Elkview, WV Joe E. Richards, MA, QMRP II Chief Executive Officer address: Office: (304) (304) (fax) WV EMS TSN Field Office for Region 1 PO Box 39 Alderson, WV (Fax) Program Director: Jerry Kyle Program Assistant: Toni Hall addresses: jkyle@wvemstsn.net thall@wvemstsn.net McDowell, Mercer, Monroe, Raleigh, Summers, Wyoming WV EMS TSN Field Office for Region 2 PO Box 7005 Huntington, WV (Fax) Program Director: Jim Donathan Program Assistant: Arisba Fink addresses: jdonathan@wvemstsn.net afink@wvemstsn.net Cabell, Lincoln, Logan, Mason, Mingo, Wayne WV EMS TSN Field Office for Region 3/4 PO Box 100 Elkview, WV (Fax) Program Director: Vacant Interim Program Director: Pam Carte addresses: pcarte@wvemstsn.net Boone, Clay, Fayette, Greenbrier, Kanawha, Nicholas, Pocahontas, Putnam, Webster WV EMS TSN Field Office for Region th St. Vienna, WV (Fax) Acting Program Director: Allisynne Dunlap Program Assistant: Carol Robinson addresses: adunlap@wvemstsn.net crobinson@wvemstsn.net Calhoun, Jackson, Pleasants, Ritchie, Roane, Tyler, Wirt, Wood WV EMS TSN Field Office for Region 6/7 200 Fairmont Ave. Suite 205 Fairmont, WV (Fax) Program Director: Gail Dragoo Program Assistant: Marsha Myers addresses: gdragoo@wvemstsn.net mmyers@wvemstsn.net Barbour, Braxton, Doddridge, Gilmer, Harrison, Lewis, Marion, Monongalia, Preston, Randolph, Taylor, Tucker, Upshur WV EMS TSN Field Office for Region 8/9 82 Sue Court Martinsburg, WV (Fax) Program Director: Marianne Perry Program Assistant: Vacant addresses: mperry@wvemstsn.net Berkeley, Grant, Hampshire, Hardy, Jefferson, Mineral, Morgan, Pendleton WV EMS TSN Field Office for Region 10/ Mull Center Wheeling, WV (Fax) Program Director: Allisynne Dunlap Program Assistant: Sondra S. Nagle addresses: adunlap@wvemstsn.net snagle@wvemstsn.net Brooke, Hancock, Marshall, Ohio, Wetzel 07/01/04