Massachusetts Pre-Hospital Statewide Treatment Protocols 2023.2

Table of Contents

SECTION 1 – General Patient Care

• Routine Patient Care 1.0

• High Quality CPR - Adult 1.1

SECTION 2 – Medical Protocols

• Adrenal Insufficiency - Adult/Pediatric 2.1

• Allergic Reaction/Anaphylaxis – Adult 2.2A

• Allergic Reaction/Anaphylaxis – Pediatric 2.2P

• Altered Mental/Neurological Status/Diabetic Emergencies/Coma-- Adult 2.3A

• Altered Mental/Neurological Status/Diabetic Emergencies/Coma – Pediatric 2.3P

• Behavioral Emergencies – Adult & Pediatric 2.4

• Behavioral Emergencies: Restraint - Adult & Pediatric 2.5

• Bronchospasm/Respiratory Distress – Adult 2.6A

• Bronchospasm/Respiratory Distress – Pediatric 2.6P

• Hyperthermia (Environmental) – Adult & Pediatric 2.7

• Hypothermia (Environmental) – Adult & Pediatric 2.8

• Nerve Agent/Organophosphate Poisoning – Adult & Pediatric 2.9

• Obstetrical Emergencies 2.10

• Newly Born Care 2.11

• Resuscitation of the Newly Born 2.12

• Pain and Nausea Management – Adult & Pediatric 2.13

• Poisoning/Substance Abuse/Overdose – Adult & Pediatric 2.14

• Seizures – Adult 2.15A

• Seizures – Pediatric 2.15P

• Shock – Adult 2.16A

• Shock – Pediatric 2.16P

• Sepsis – Adult 2.17A

• Sepsis – Pediatric 2.17P

• Stroke – Adult 2.18

• Hyperkalemia - Adult 2.19

• Home Hemodialysis Emergency Disconnect 2.20

SECTION 3 – Cardiac Emergencies

• Acute Coronary Syndrome – Adult 3.1

• Atrial Fibrillation/Flutter 3.2

• Bradycardia – Adult 3.3A

• Bradycardia – Pediatric 3.3P

• Cardiac Arrest (Adult)- Asystole/Pulseless Electrical Activity 3.4A

• Cardiac Arrest (Pediatric)- Asystole/Pulseless Electrical 3.4P

• Cardiac Arrest (Adult)-Ventricular Fibrillation/Pulseless Ventricular Tachycardia 3.5A

• Cardiac Arrest (Pediatric)-Ventricular Fibrillation/Pulseless Ventricular Tachycardia 3.5P

• Congestive Heart Failure (Pulmonary Edema) 3.6

• Targeted Temperature Management 3.7

• Post Resuscitative Care/ROSC-Adult & Pediatric 3.8

• Supraventricular Tachycardia - Adult 3.9A

• Supraventricular Tachycardia - Pediatric 3.9P

• Ventricular Tachycardia with Pulses – Adult & Pediatric 3.10

SECTION 4 – Trauma Protocols

• Burns/Inhalation/Lightning Strike/Electrocution Injuries – Adult & Pediatric 4.1

• Drowning/Submersion Injuries – Adult & Pediatric 4.2

• Eye Emergencies -- Adult & Pediatric 4.3

• Head Trauma/Injuries – Adult & Pediatric 4.4

• Multisystem Trauma -- Adult & Pediatric 4.5

• Musculoskeletal Injuries -- Adult & Pediatric 4.6

• Soft Tissue/Crush Injuries -- Adult & Pediatric 4.7

• Spinal Column/Cord Injuries -- Adult & Pediatric 4.8

• Thoracic Injuries -- Adult & Pediatric 4.9

• Traumatic Amputations -- Adult & Pediatric 4.10

• Traumatic Cardiopulmonary Arrest – Adult & Pediatric 4.11

SECTION 5 – Airway Protocols & Procedures

• Upper Airway Obstruction - Adult 5.1A

• Upper Airway Obstruction – Pediatric 5.1P

• Difficult Airway 5.2

• Tracheostomy Tube Obstruction Management 5.3

• Sedation for an Intubated Patient 5.4

SECTION 6 – Medical Director Options

• Requirements for Medical Director Options6.0

• BLS Bronchodilators Adult & Pediatric6.1

• Needle Cricothyrotomy6.2

• Urban Search and Rescue (USAR) Medical Specialist6.3

• Tranexamic Acid6.4

• Check and Inject Epinephrine by EMT-Basics6.5

• Acetaminophen IV6.6

• Surgical Cricothyrotomy6.7

• Bilevel Positive Airway Pressure (BiPAP)/Continuous Positive Airway Pressure (CPAP) by EMT-Basic and/or AEMT6.8

• Glucagon for Hypoglycemia by EMT Basic6.9

• Withholding and Cessation of Resuscitation by Paramedic as a Medical 

• Control Option6.10

• 12 Lead ECG Acquisition and Transmission by EMT-Basic and/or Advanced EMTs. 6.11

• Leave-Behind Naloxone6.12

• Ultrasound Device Use by Paramedics 6.13

• Automated Transport Ventilators6.14 

• Oral Antipsychotics6.15

• Supraglottic Airway by BLS6.16

• Bolus IV/IO Nitroglycerin and Infusion for Acute Pulmonary Edema6.17

SECTION 7 – Medical Policies & Procedures

• Air Medical Transport7.1

• Electrical Control Weapons7.2

• Medical Orders for Life Sustaining Treatment (MOLST) and Comfort Care/DNR7.3

• Pediatric Transportation7.4

• Refusal of Medical Care and Transportation7.5

• Sedation and Analgesia for Electrical Therapy7.6

• Withholding and Cessation of Resuscitation7.7

• Ventricular Assist Devices (VADs)7.8

• Process for Changes to the Statewide Treatment Protocols7.9

SECTION 8 – Special Operations Principles

• Fire and Tactical EMS Rehabilitation8.1

• Mass/Multiple Casualty Triage8.2

Appendices

• Interfacility Transfer Guidelines and Protocols A1

• Scope of Practice A2

• Department-Approved Point of Entry Plans A3

• Assessment Tool for the Deaf and Hard of Hearing A4