Massachusetts Statewide Treatment Protocols Version 2026.2
Massachusetts Office of Emergency Medical Services
The Massachusetts Department of Public Health, Office of Emergency Medical Services has released Version 2026.2 of the Massachusetts Statewide Treatment Protocols.
This update includes changes to medication administration, provider scope of practice, allergic reaction and anaphylaxis treatment, respiratory care, cardiac arrest management, trauma care, obstetrical emergencies, blood administration, pediatric transport, refusal of medical care, and required ambulance medications.
Important Protocol Changes
Allergic Reaction and Anaphylaxis
First Responders may administer an epinephrine/surfactant nasal preparation. If the first dose is given by nasal spray and symptoms do not significantly improve within five minutes, all subsequent epinephrine doses must be administered by IM injection.
Antihistamines
Cetirizine has been added for mild allergic reactions. Diphenhydramine, also known as Benadryl, has been removed from Protocol 2.2.
Respiratory Distress
Adult indications and contraindications for BiPAP and CPAP have been added. BiPAP and CPAP are no longer indicated for pediatric patients of any age.
Obstetrical Emergencies
The paramedic TXA dose has been changed to 2 grams IV push. The second TXA dose has been removed.
Pain Management
Advanced EMTs may administer acetaminophen 650–1,000 mg IV.
Cardiac Arrest
Advanced EMT standing orders now include epinephrine 1 mg IV/IO, using 10 mL of a 0.1 mg/mL solution, every three to five minutes.
Vasopressin
Vasopressin has been removed from the optional medication list for paramedic-level ambulances.
Burn Management
Fluid administration language for Advanced EMTs treating adult and pediatric patients with 20% body-surface-area burns now specifies administration per hour.
Multisystem Trauma
The adult paramedic TXA dose has been changed to 2 grams IV push. A pediatric TXA dose has also been added to the traumatic cardiac arrest protocol.
Ultrasound
Properly authorized and trained paramedics may perform abdominal and pulmonary ultrasound scans. These scans must not delay transportation or other diagnostic or therapeutic care.
Buprenorphine
The Clinical Opiate Withdrawal Scale requirement has been updated to COWS greater than or equal to eight.
Pediatric Transport
The protocol contains updated terminology, definitions, and guidance for approved neonatal and infant transport devices attached directly to the ambulance stretcher.
Refusal of Medical Care
Medical Control should be contacted when EMS personnel have concerns about whether a refusal is appropriate.
Required Ambulance Medications
Oral liquid or tablet diphenhydramine is now optional for basic-level ambulances. IV diphenhydramine is no longer required or optional. Cetirizine has been added as an optional replacement.
Advanced-Level Ambulances
Epinephrine 1 mg in 10 mL is now a required medication.
Training Requirement
Ambulance and Emergency First Response services must train their EMS personnel on the updated protocols and ensure that their services are appropriately equipped before implementing the changes.
Review the Complete Protocols
EMS providers should review the complete official protocol document and follow their service-level training and implementation requirements.
Download the 2026.2 Statewide Treatment Protocols