appendix a facility codes for ems region 1 - nhtsa...appendix a facility codes for ems region 1 code...

Appendix A

Facility Codes for EMS Region 1

Code Facility City County Zip

100 Funeral Home101 Beckley ARH Beckley Raleigh 25801103 Bluefield Regional Med. Ctr. Bluefield Mercer 24701104 Heathsouth - Southern Hills Princeton Mercer 24740105 Princeton Community Princeton Mercer 24740106 Raleigh General Beckley Raleigh 25801107 St. Luke’s Bluefield Mercer 24701109 Summers County ARH Hinton Summers 25951110 Veterans Administration Beckley Welch 25801111 Welch Community Welch McDowell 24801113 Other114 Home115 Pinecrest Hospital Beckley Raleigh 25801116 Nursing Home117 Doctor’s Office/Clinic

830 No Patient Transported930 Patient Refused Transport

Revised 7/16/02

Appendix A



200 Funeral Home201 Cabell-Huntington Huntington Cabell 25701204 Guyan Valley Logan Logan 25601206 Mildred Mitchell-Bateman Hospital Huntington Cabell 25701207 Lakin Hospital Pt. Pleasant Mason 25550208 Logan General Logan Logan 25601210 Pleasant Valley Pt. Pleasant Mason 25550211 Region II Comm. Mental Health Center Huntington Cabell 25701213 St. Mary’s Huntington Cabell 25701214 Veteran’s Admin. Medical Center (VAMC) Huntington Wayne 25704215 Williamson ARH Williamson Mingo 25661216 Williamson Memorial Williamson Mingo 25661217 Other218 Home219 Nursing Home220 American Hospital for Rehab. Huntington Cabell 25705221 Logan Park Care Center222 HCA Riverpark Hospital Huntington Cabell 25701223 Pinnacle Care Huntington Cabell 25701224 Presbyterian Manor Huntington Cabell 25701225 Chateau Grove N.H. Barboursville Cabell 25504226 Fairhaven Rest Home Huntington Cabell 25704227 Mays Riverside Manor Huntington Cabell 25701228 Wayne Continuous Care Wayne Wayne 25570229 Lincoln Continuous Care Hamlin Lincoln 25523230 Chadwicks Personal Care Barboursville Cabell 25504231 Morris Memorial N.H. Milton Cabell 25541232 Logan Health Care Village


Revised 7/16/02

Appendix A

Facility Codes for EMS Region 3/4


300 Funeral Home301 Boone Memorial Madison Boone 25130302 CAMC - General Charleston Kanawha 25301303 CAMC - Memorial Charleston Kanawha 25301304 Greenbrier Valley Medical Center Fairlea Greenbrier 24902305 CAMC - Women’s and Children’s Charleston Kanawha 25301306 Montgomery General Montgomery Fayette 25136307 Plateau Medical Center Oak Hill Fayette 25901309 Pocahontas Memorial Marlinton Pocahontas 24954310 Richwood Area Community Hospital Richwood Nicholas 26651311 St. Francis Charleston Kanawha 25301313 Summersville Memorial Summersville Nicholas 26651314 Thomas Memorial S. Charleston Kanawha 25303315 Webster Memorial Webster Spngs Webster 26288316 Nursing Home317 Clinic/Doctors Office318 Highland Hospital Charleston Kanawha 25301319 Home320 The Eye & Ear Clinic Charleston Kanawha 25301321 Putnam General Hurricane Putnam 25526322 Medical Examiner’s Office S. Charleston Kanawha 25303325 Other


Revised 7/16/02

Appendix A



400 Funeral Home401 Camden-Clark Memorial Hospital Parkersburg Wood 26101402 Minnie Hamilton Health Care Center Grantsville Calhoun 26147404 Jackson General Hospital Ripley Jackson 25271405 Roane General Hospital Spencer Roane 25276406 St. Joseph’s Hospital Parkersburg Wood 26101407 Sistersville General Hospital Sistersville Tyler 26175408 Nursing Home409 Home410 Other411 Health South Western Hills Parkersburg Wood 26101412 Care Haven of Sistersville Sistersville Tyler 26175


Revised 7/16/02

Appendix A



500 Funeral Home501 Broaddus Hospital Philippi Barbour 26416502 Cortland Acres Thomas Tucker 26292503 Davis Memorial Hospital Elkins Randolph 26241505 Elkins Regional Convalescent Care Elkins Randolph 26241506 Fairmont Clinic Fairmont Marion 26554507 Marion Health Care Hospital Fairmont Marion 26554508 Fairmont General Hospital Fairmont Marion 26554509 Braxton County Memorial Hospital Gassaway Braxton 26624510 Good Samaritan Center Belington Barbour 26250511 Grafton City Hospital Grafton Taylor 26354512 Hopemont Hospital Terra Alta Preston 26764514 Monongalia General Hospital Morgantown Monongalia 26505515 Nella’s Nursing Home Elkins Randolph 26241516 Preston Memorial Hospital Kingwood Preston 26537517 St. Joseph’s Hospital Buckhannon Upshur 26201518 Stonewall Jackson Memorial Hospital Weston Lewis 26452519 Tucker Community Care Parsons Tucker 26287520 United Hospital Center Clarksburg Harrison 26301522 Veterans Administration Medical Center Clarksburg Harrison 26301523 Sharpe Hospital Weston Lewis 26452524 Ruby Memorial Hospital Morgantown Monongalia 26506525 Clinic Out-Patient526 Other527 Home528 Preston Nursing Home Kingwood Preston 26537529 Sunbridge Personal Care Home Salem Harrison 26426530 Americare Nursing Centers Morgantown Monongalia 26505531 Americare Nursing Centers Glenville Gilmer 26351532 Arbor’s Health Care Fairmon Marion 26554534 Clarksburg Continuous Care Center Clarksburg Harrison 26301536 Crestview Manor Nursing Home Clarksburg Harrison 26301538 Doris’s Nursing Home Enterprise Harrison 26568540 Gold Circle Nursing Home Stonewood Harrison 26301541 Harris Rest Home Philippi Barbour 26416542 Heartland of Clarksburg Clarksburg Harrison 26301543 Heartland of Preston County Kingwood Preston 26537544 Heritage Nursing Home Bridgeport Harrison 26330

Revised 7/16/02

Appendix A

Facility Codes for EMS Region 6/7 (Continued)


538 Doris’s Nursing Home Enterprise Harrison 26568540 Gold Circle Nursing Home Stonewood Harrison 26301541 Harris Rest Home Philippi Barbour 26416542 Heartland of Clarksburg Clarksburg Harrison 26301543 Heartland of Preston County Kingwood Preston 26537544 Heritage Nursing Home Bridgeport Harrison 26330545 Lee’s Home for the Elderly Buckhannon Upshur 26201546 Lida Clark Nursing Home Clarksburg Harrison 26301548 Madison House Nursing Home Morgantown Monongalia 26505549 Meadowview Manor Health Care Bridgeport Harrison 26330550 Medbrook Medical Center Bridgeport Harrison 26330551 Mullenax Personal Care Home Belington Barbour 26250552 Myers Clinic Philippi Barbour 26416553 Morgan Manor Nursing Home Morgantown Monongalia 26505554 Nella’s Inc. Crystal Springs Randolph 26241555 Rest Haven Nursing Home, Inc. Grafton Taylor 26354556 Rosewood Health Care Center Grafton Taylor 26354560 Sundale Nursing Home Morgantown Monongalia 26505561 Wishing Well Health Center Fairmont Marion 26554562 Country Comfort Personal Care Worthington Marion 26591563 Grafton Nursing Care Facility Grafton Taylor 26354565 Holbrook Nursing Home Buckhannon Upshur 26201566 Our Own Personal Care Clarksburg Harrison 26301567 St. Barbara’s Nursing Home Monongah Marion 26554568 Pinecrest Haven Personal Care Gore Harrison 26301570 MRI Clinic Morgantown Monongalia 26505571 Nursing Home572 Physician’s Office573 Health South Mountainview Hospital Morgantown Monongalia 26505


Revised 7/16/02

Appendix A



600 Funeral Home601 City Hospital Martinsburg Berkeley 25401602 Grant Memorial Petersburg Grant 26847603 Hampshire Memorial Romney Hamphsire 26757604 Jefferson Memorial Ranson Jefferson 25438606 Morgan County War Memorial Berkeley Sprgs Morgan 25411607 Potomac Valley Keyser Mineral 26726608 Veterans Administration Martinsburg Berkeley 25401609 Other610 Home611 Greenhaven Rest Home Fisher Hardy 26818612 Heartland of Keyser Keyser Mineral 26726613 Kidwell Nursing Home Romney Hamphsire 26757614 Knott Nursing Home Charles Town Jefferson 25414615 Jeffersonian Manor Charles Town Jefferson 25414616 Hartland of Martinsburg Martinsburg Berkeley 25401617 Pendleton Nursing Home Franklin Pendleton 26870618 Shenandoah Nursing Home Ranson Jefferson 25438619 Valley View Nursing Home Berkeley Sprgs Morgan 25411620 Dawn View Nursing Home Ft. Ashby Mineral 26719621 Grant County Nursing Home Petersburg Grant 26847622 E.A. Hawse Intermediate Facility Care Baker Hardy 26801623 Care Haven Martinsburg Berkeley 25401624 Canterbury of Shepherdstown Shepherdstown Jefferson 25443


Revised 7/16/02

Appendix A



700 Funeral Home701 Ohio Valley Medical Center Wheeling Ohio 26003703 Reynolds Memorial Glen Dale Marshall 26038704 Weirton Medical Center Weirton Brooke 26062706 Wetzel County N. Martinsville Wetzel 26155707 Wheeling Hospital Wheeling Ohio 26003708 Other709 Nursing Home710 Home711 Bishop Joseph Hodges Continuous Care Ctr. Wheeling Ohio 26003712 Brightwood Nursing Home Follansbee Brooke 26037713 Cameron Health Care Center Cameron Marshall 26033714 Fox Nursing Home Chester Hancock 26034715 Good Shepherd Nursing Home Wheeling Ohio 26003716 Mound View Health Care Moundsville Marshall 26041717 New Martinsville Health Care Center N. Martinsville Wetzel 26155718 Valley Haven Geriatric Center, Inc. Wellsburg Brooke 26070719 Weirton Geriatric Center Weirton Hancock 26062720 (Altenheim) The Home For the Aged Wheeling Ohio 26003721 Country Haven Rest Home Beech Bottom Brooke 26030722 Elmhurst - House of Friendship Wheeling Ohio 26003723 The Home For Men Wheeling Ohio 26003724 Icenhower Boarding Home, Inc. Wheeling Ohio 26003725 Lewis Wetzel Personal Care Home N. Martinsville Wetzel 26155726 Mound View Health Care, Inc. Moundsville Marshall 26041727 Serra Retirement Home Weirton Hancock 26062728 We Care Personal Care Home Chester Hancock 26034729 Welty Home for the Aged, Inc. Wheeling Ohio 26003


Revised 7/16/02

Appendix A

Codes for Out-of-State Facilities

State Code Facility City Zip

Kentucky 801 Kings Daughters Hospital Ashland 41101802 Louisa Community Hospital Louisa 41230803 University of Kentucky Med Center Lexington 40507804 University of Kentucky Med Center Moorehead 40351834 South Williamson ARH So. Williamson

Ohio 805 Belaire Hospital Belaire 43906806 Children’s Hospital Cincinnati 45202807 Cincinnati General Cincinnati 45202808 Cleveland Clinic Cleveland 44101809 Holzier Medical Center Gallipolis 45631810 Marietta Memorial Hospital Marietta 45750811 Martin’s Ferry Hospital Martin’s Ferry 43935812 Ohio State Univ. Med Center Columbus 43216813 Ohio Valley Hospital Steubenville 43952814 Selby General Hospital Marietta 45750815 St. John’s Hospital Steubenville 43952827 Pinecrest Gallipolis828 Heartland So. Point829 Pulley’s Nursing Home So. Point831 Pulley’s Care Center So. Point

Pennsylvania 816 Allegheny General Hospital Pittsburgh 15212817 Children’s Hospital Pittsburgh 15213818 Mercy Hospital Pittsburgh 15219819 Mountefire Hospital Pittsburgh 15213820 Presbyterian Hospital Pittsburgh 15213821 St. Francis Hospital Pittsburgh 15201822 Shady Side Hospital Pittsburgh 15232823 Washington Hospital Washington 15301824 West Allegheny Hospital Pittsburgh825 West Penn Pittsburgh 15224826 McGee’s Women’s Hospital Pittsburgh 15213832 Veteran Administration Hospital Pittsburgh 15206833 Greene County Memorial Waynesburg 15370

Tennessee 835 Holston Valley Kingsport

Revised 7/16/02

Appendix A

Codes for Out-of-State Facilities (Continued)

State Code Facility City Zip

Washington DC 901 Metro DC Hospital Washington DC 20000915 Veteran’s Administration Washington DC 20000

Maryland 902 Garrett Memorial Oakland 21550903 Memorial Cumberland 21502904 Sacred Heart Cumberland 21502905 Shock-Trauma Unit Baltimore 21233906 Washington County Hagerstown 21740

Virginia 907 Allegheny Regional Lowmoor 24426908 Carilion - Roanoke Community Roanoke 24001909 Carilion - Roanoke Memorial Roanoke 24001910 Rockingham Memorial Harrisburg 22801911 Medical College of Virginia Richmond 23219913 Winchester Memorial Winchester 22601916 University of Virginia Charlottesville 22902917 Bristol Regional Medical Center Bristol 24201918 Buchanan General Grundy 24614919 Clinch Valley Medical Center Richlands 24641920 Tazewell Community Hospital Tazwell 24651923 Giles County Hospital Pearisburg 24134924 Veteran’s Administration Salem 24153925 Augusta Medical Center Fishersville 22939926 Lewis Gale Medical Center Salem 24153

North Carolina 921 Bowman-Gray Baptist Hospital Winston-Salem 27103922 Duke University Hospital Durham 22710

General Use 830 No Patient Transported930 Patient Refused Service

Revised 7/16/02

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



Revised 7/16/02

Appendix C

Squad Codes for EMS Region 1

Region County Squad Code Code Code Squad Name 1 24 01 Widener’s Ambulance Services

55 03 Brenton Volunteer Fire and Rescue 24 04 Jan Care Ambulance - McDowell County 28 05 HealthNet V 55 06 STAT Ambulance Service - Wyoming 24 07 McDowell Co. Emergency Ambulance Authority 28 08 Bluefield WV Rescue Squad 55 09 Oceana Volunteer Fire Department 28 10 Princeton Rescue Squad 32 11 Union Rescue/Monroe Transport

12 Sweet Springs Rescue Squad 41 13 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

45 18 Green Sulphur District Volunteer Rescue Squad 55 19 Mullens Fire Department 45 20 Summers County EMS 24 21 Iaeger Ambulance Service 41 22 Beckley Fire Department 24 23 STAT - McDowell County 28 24 STAT - Mercer County 32 26 Peterstown Fire Department 41 27 Jan Care Ambulance Service - Raleigh Co. 55 29 Jan Care Ambulance Service - Wyoming Co. 36 Upper Laurel VFD

Revised 08/17/05

Appendix C

Squad Codes for EMS Region 2 Region County Squad Code Code Code Squad Name 2 06 01 Special Metals

02 Cabell County EMS 03 Cabell Huntington Hospital Pt. Transport Service

27 05 Mason County Emergency Amb. Service Authority 06 06 Jan Care - Cabell County 50 07 Medical Transportation Service

08 Portsmouth Ambulance Service 30 09 STAT Ambulance Service

10 MedFlight of East Kentucky 22 13 STAT - Lincoln County 14 Lincoln EMS 30 15 Appalachian First Response

16 Stafford EMS 50 22 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

23 31 LEASA (Logan Co. Emergency Amb. Svc. Authority) 06 38 Healthnet III 41 Lifeline Medical Transport - Cabell County

Revised 08/11/05

Appendix C

Squad Codes for EMS Region 3/4 Region County Squad Code Code Code Squad Name 3 03 01 Spruce River VFD

40 02 Duff Transport 03 03 Whitesville Ambulance Service 08 04 Clay County Emergency Ambulance Authority 10 05 K & B Behavioral Health Services

06 General Ambulance Service 07 Jan Care Ambulance Service (Fayette) 08 Fayette County OES 09 Sheltering Arms, Inc.

13 10 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

20 16 Charleston Fire Department 18 Cedar Grove VFD 20 Sky Hawk Traffic, Inc./dba Alert 1 21 Kanawha County Emerg. Amb. Authority

10 26 STAT - Fayette County 34 27 Redi-Care 38 31 Bartow-Frank-Durbin Fire & Rescue

32 Hillsboro Rescue Squad 33 Marlinton VFD

40 35 Putnam County EMS 13 41 Alderson Fire Department EMS 03 42 Boone County Ambulance Authority

43 Van VFD 13 44 Quinwood Ambulance Service

45 STAT - Greenbrier County 34 52 Jan Care Ambulance Service (Nicholas) 51 53 STAT - Webster County 20 54 Healthnet II 51 54 Webster Memorial EMS 20 55 Dow Chemical Company 38 56 Snowshoe Mountain Response Team 57 Cass Volunteer Fire & Rescue

58 Shavers Fork Fire/Rescue 59 STAT - Pocahontas County

20 63 Bayer Crop Science EMS Revised 08/11/05

Appendix C

Squad Codes for EMS Region 5

Region County Squad Code Code Code Squad Name 4 07 01 Calhoun County EMS

18 02 Jackson County EMS 37 03 Cytec Industries - Willow Island 04 Pleasants Co. Emergency Ambulance Authority 43 05 Ritchie County Ambulance Authority 44 07 Roane County Emergency Squad 48 08 Tyler Co. Emergency Squad - Alma

10 Tyler Co. Emergency Squad - Middlebourne 11 Sistersville General Hospital Ambulance Service

53 12 Wirt County Emergency Squad 54 13 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

18 19 Pechiney Rolled Products 54 20 Washington Bottom VFD 21 General Ambulance Service - Wood County 07 23 Minnie Hamilton Health Care Center ETS 48 24 GE Silicones WV LLC 54 25 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

37 33 St. Marys Volunteer Fire Department 34 Belmont Volunteer Fire Department

18 35 General Ambulance Service - Jackson County Revised 08/11/05

Appendix C

Squad Codes for EMS Region 6/7 Region County Squad Code Code Code Squad Name 5 01 01 Barbour County Emergency Squad

02 Belington Emergency Squad 04 03 Braxton Co. Emerg. Amb. Svc. Authority - Burnsville

05 Braxton Co. Emerg. Amb. Svc.. Authority - Sutton 09 06 Doddridge County Emergency Squad 11 07 Gilmer County Ambulance Service 17 08 Anmoore EMS (VFD)

09 Bridgeport Fire Department 10 Harrison Co. Emerg. Squad - Clarksburg 11 Salem VFD

21 12 Lewis County Emergency Amb. Svc. Authority 25 13 Fairview VFC

14 Grant Town VFD 15 MCRS/Fairmont - Station 20 16 MCRS/Mannington - Station 25 17 MCRS/Whitehall - Station 32

31 19 Monongalia EMS 39 20 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

42 28 Randolph Co. Emerg. Squad - Elkins 29 Randolph Co. Emerg. Squad - Harmon 30 Randolph Co. Emerg. Squad - Mill Creek

46 33 Taylor Co. Emergency Squad 47 34 Tucker County EMS - Davis - Station II

35 Tucker County EMS - Parsons - Station I

Revised 08/23/05

Appendix C

Squad Codes for EMS Region 6/7 (Continued)

Region County Squad Code Code Code Squad Name 5 49 36 Upshur County EMS

46 44 Flemington Area EMS, Inc. 31 46 HealthNet I 17 48 Lambert’s Ambulance Service - Harrison Co. 50 Harrison Co. Emergency Squad - Shinnston 47 51 Tucker Co. EMS - Canaan - Station III 17 52 Jan Care - Harrison County 25 53 Jan Care - Marion County 31 55 Jan Care - Monongalia County 25 56 Fairmont Fire Department 17 57 Clarksburg Fire Department 39 58 Masontown VFD 31 59 Crompton Med 25 60 Monongah VFD 39 62 Preston Memorial Hospital 49 63 Selbyville VFD 39 65 Terra Alta VFD 67 Tunnelton VFD

17 68 STAT Ambulance Service - Harrison County Revised 08/23/05

Appendix C

Squad Codes for EMS Region 8/9

Region County Squad Code Code Code Squad Name 6 02 01 Berkeley Co. EAA - Bedington VFD

02 Berkeley Co. EAA - Hedgesville VFD 03 Ryneal Fire Company 04 Berkeley Co. EAA - South Berkeley VFD & Rescue

12 05 Grant County Ambulance - Mt. Storm 06 Grant County Ambulance - Petersburg

19 07 PNGI Charles Town Gaming 14 08 Augusta Volunteer Rescue Squad

09 Capon Bridge Rescue Squad 10 Romney Volunteer Rescue Squad 11 Springfield Area Rescue Squad

16 12 Fraley Ambulance Service 13 Mathias/Baker Emergency Squad 14 Wardensville Volunteer Rescue Squad

19 15 Friendship Fire Company 16 Independent Fire Company 17 Shepherdstown VFD

29 18 Burlington VFD 19 Elk District Ambulance Service 20 Fort Ashby VFC 21 Keyser EMS 22 Ridgley VFC

33 23 Morgan County Rescue 24 Paw Paw VFC

36 25 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

02 29 Berkeley Co. Emergency Ambulance Authority 31 Berkeley Co. EAA - Baker Heights VFD

Revised 08/11/05

Appendix C

Squad Codes for EMS Region 8/9 (Continued) Region County Squad Code Code Code Squad Name 6 19 33 BSR, Inc.

02 35 Berkeley Co. EAA - Back Creek VFD 33 38 Morgan County - Great Cacapon 36 39 NSGA Fire Department 12 40 Valley Medical Transport - Grant 02 41 Valley Medical Transport - Berkeley 14 44 Lamberts Ambulance Service - Romney 29 45 Valley Medical Transport - Mineral 14 46 Valley Medical Transport - Hampshire

29 47 Lambert=s Ambulance Service - Keyser 48 Capon Springs Volunteer Fire & Rescue 49 Slanesville Volunteer Ambulance Service

19 50 Blue Ridge Mountain VFC 02 51 Lamberts Ambulance Service - Hedgesville 29 52 Fountain VFC

53 New Creek VFD 19 54 Jefferson County Ambulance Authority 29 55 Patterson Creek VFC

56 Short Gap VFC 57 Tri Towns Ambulance and Rescue

02 58 Martinsburg Fire Department 59 VA Medical Center - Martinsburg

Revised 08/29/05

Appendix C

Squad Codes for EMS Region 10/11

Region County Squad Code Code Code Squad Name 7 15 00 Weirton Steel Company

05 01 Brooke County Ambulance Service 02 Bethany VFD

35 03 Mozart Fire Department 04 West Liberty VFD 05 Emergency Medical Transport 06 Wheeling Island Gaming Inc.

15 07 New Manchester VFD 08 New Cumberland Ambulance 09 Weirton Area Ambulance & Rescue Squad

26 10 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

35 19 Bethlehem VFD 26 20 Dallas VFD 35 21 Clearview VFD

23 Stone Church VFD 24 Triadelphia EMS 25 Tri-State Ambulance 26 Valley Grove VFD 27 Wheeling Fire Department

52 28 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.

26 35 Moundsville Fire Department 36 PPG Industries

15 37 Life Team EMS 38 Tri County Ambulance Service 39 City of Weirton Fire Department 40 Newell Volunteer Fire Department

05 41 Beech Bottom Volunteer Fire Department 42 Lawrenceville Volunteer Fire Department

Revised 08/11/05

Appendix D

State Approved Drugs/Solutions

Code Drug/Solution

01 Atropine Sulfate 02 Calcium Chloride 03 Dexamethasone (Decadron) 04 Dextrose 5% in Water (D5W) 05 Dextroxe 50% (D50W) 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 (D10W) 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 (D25W) 69 Amiodorone (Cordarone) 70 Diastat 71 Atrovent (Ipratropium Bromide) 72 Toradol (Ketoralac Tromethamine)

Revised 08/30/04

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 (D5W) 04 Dextrose 10% in Water (D10W) 44 Dextrose 50% in Water (D50W) 05 Dextrose 25% in Water (D25W) 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

Appendix E

WV OEMS Patient Care RecordSubmission Form

Use a separate form for each month.

Directions:

1. Separate yellow copies by month, then Emergency ALS, Emergency BLS, Non-EmergencyTransports, 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 15th

of the month for the previous month. Example: January forms need to be in the office by the15th 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

WV EMSTSN Headquarters

WV EMS TSN, Inc.PO Box 100

Elkview, WV 25071-01--Joe E. Richards, MA, QMRP II

Chief Executive OfficerE-Mail address:

[email protected]

Office: (304) 965-0573(304)965-0542 (fax)

WV EMS TSNField Office for Region 3/4

PO Box 100Elkview, WV 25071-0100

304-965-6617 304-965-0542 (Fax)Program Director: Vacant

Interim Program Director: Pam CarteE-Mail addresses:

[email protected], Clay, Fayette, Greenbrier, Kanawha, Nicholas, Pocahontas,

Putnam, Webster


919 Mull CenterWheeling, WV 26003

304-233-4440 304-233-4402 (Fax)Program Director: Allisynne DunlapProgram Assistant: Sondra S. Nagle

E-Mail addresses:[email protected]@wvemstsn.net

Brooke, Hancock, Marshall, Ohio, Wetzel

WV EMS TSNField Office for Region 6/7200 Fairmont Ave. Suite 205Fairmont, WV 26554-2700

304-366-8764 304-366-5091 (Fax)Program Director: Gail Dragoo

Program Assistant: Marsha MyersE-Mail addresses:

[email protected]@wvemstsn.net

Barbour, Braxton, Doddridge, Gilmer, Harrison,Lewis, Marion, Monongalia, Preston, Randolph,

Taylor, Tucker, Upshur


82 Sue CourtMartinsburg, WV 25401-2911

304-263-4913 304-263-2302 (Fax)Program Director: Marianne Perry

Program Assistant: VacantE-Mail addresses:

[email protected], Grant, Hampshire, Hardy, Jefferson,

Mineral, Morgan, Pendleton

WV EMS TSNField Office for Region 5

603 29th St.Vienna, WV 26105

304-295-0111 304-295-0113 (Fax)Acting Program Director: Allisynne Dunlap

Program Assistant: Carol RobinsonE-Mail addresses:

[email protected]@wvemstsn.net

Calhoun, Jackson, Pleasants, Ritchie,Roane, Tyler, Wirt, Wood


PO Box 7005Huntington, WV 25774-7005

304-523-9102 304-523-7800 (Fax)Program Director: Jim DonathanProgram Assistant: Arisba Fink

E-Mail addresses:[email protected]

[email protected], Lincoln, Logan, Mason, Mingo, Wayne


PO Box 39Alderson, WV 24910

304-445-2022 304-445-2087 (Fax)Program Director: Jerry KyleProgram Assistant: Toni Hall

E-Mail addresses:[email protected]@wvemstsn.net

McDowell, Mercer, Monroe, Raleigh,Summers, Wyoming

TSN Regional EMS Field Offices

07/01/04

appendix a facility codes for ems region 1 - nhtsa...appendix a facility codes for ems region 1 code...

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