Maryland Medical Protocols for Emergency Medical Services - 2026 New and Revised Protocols

Sep 8, 2026

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Maryland Medical Protocols for Emergency Medical Services compiles EMS treatment guidance for 2026, including new and revised protocols approved by the EMS Board and reviewed with state advisory and expert input. Prior to July 1, 2026, EMS clinicians complete the Maryland EMS Update: 2026 to highlight updates and qualify for continuing education credit. Revisions cover topics such as abuse/neglect reporting, angioedema medication management, chest pain guidance related to aortic syndrome, airway obstruction care, and standardized protocols for critically unstable patients, trauma, seizures, and stroke.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages514

Reading Time21 h 35 min

AccessFree to download

I. General Information

General Provisions

Important Numbers

Maryland Trauma and Specialty Referral Centers

Protocol Key

Protocol Usage Flow Diagram

Protocol Variation Procedure

Inability to Carry Out Physician Order

Physician Orders for Extraordinary Care Not Covered by Maryland Protocol

II. General Patient Care

General Patient Care (GPC)

History and Examination & Detailed / Ongoing Assessments

START and JumpSTART Triage Algorithms

Critically Unstable Patient

The complete “Maryland Medical Protocols for Emergency Medical Services” is also available on the Internet at [www.MIEMSS.org](www.MIEMSS.org). Protocols are occasionally amended during the year. Please check the MIEMSS website to be sure you have the most up-to-date version. The edition date appears on the lower portion of the page. This text was produced from materials from the Division of State Documents (DSD), Office of the Secretary of State, State of Maryland. Only text obtained directly from the DSD is enforceable under Maryland law. For copies of the official text, call the DSD at 1-800-633-9657. Cover Photo: Maryland Institute for Emergency Medical Services Systems Media Services Thank you to the Baltimore City Fire Department. Release Date July 1, 2026 ii [www.miemss.org](www.miemss.org) Back to Contents Welcome Letter Maryland Medical Protocols for Emergency Medical Services New and Revised Protocols for 2026 We are pleased to present the Maryland EMS community with several new and revised EMS treatment protocols for 2026. The protocols have been approved by the EMS Board with the advice of the Statewide EMS Advisory Council, Protocol Review Committee, and a multi-disciplined group of subject matter experts from around the state. Prior to July 1, 2026, all EMS clinicians must complete the Maryland EMS Update: 2026, which will highlight the new material. The protocol update will be available for continuing education credit on the MIEMSS Online Training Center ([www.emsonlinetraining.org](www.emsonlinetraining.org)) in the spring of 2026. • Abuse / Neglect: This revision adds the new statewide hotline for child and vulnerable adult abuse and neglect reporting, 1-800-91PREVENT, pursuant to a recent change in Maryland law. • Angioedema: This new protocol addresses an adverse reaction associated with ACE inhibitor medications. Patients may experience isolated, but severe swelling of the lips, tongue or throat. The protocol defines treatment with epinephrine and tranexamic acid (TXA) after medical consultation. • Chest Pain: This protocol revision includes guidance for the treatment of suspected aortic syndrome (aortic dissection) . Labetalol may be given with medical consultation. • Choking / Foreign Body Airway Obstruction: This addition to the GPC incorporates new American Heart Association guidelines for the treatment of choking in patients of all ages. • Critically Unstable Patient: This revision adds a pediatric section that describes immediate interventions for critically ill pediatric patients prior to initiating transport. • Crush Syndrome (Hyperkalemia): This protocol modification simplifies the dosing of sodium bicarbonate (bolus only) and removes the consult for high-dose albuterol. The timing of medication administration for patients with hyperkalemia due to crush syndrome is further defined (e.g. , pre-and post-extrication) . • MODEL-T (Buprenorphine): This protocol revision enables Cardiac Rescue Technicians (CRTs) who have additional training to administer buprenorphine. • Newly Born Protocol: The ALS and BLS protocols have been consolidated into a single protocol. A Newly Born resuscitation checklist has been added. • Patient-Initiated Refusal of Care: The protocol has been revised to focus on the assessment of a patient’s capacity to make an informed medical decision. The checklist has been reconfigured for clarity, so that any “no” answers lead to transport or medical consultation. Welcome Letter [www.miemss.org](www.miemss.org) iii Release Date July 1, 2026 Back to Contents Welcome Letter (continued) Welcome Letter • Seizure – Adult and Pediatric: This protocol modification increases the maximum patient dose of midazolam for adults to 10 mg IM/IN. For adult patients with IV or IO access, ALS clinicians may now administer up to two doses of midazolam 5 mg IV/IO. The medical consult for the second IV/IO dose of midazolam has been removed. Ke

FAQs

What changes are included in the 2026 Maryland EMS protocols?

The 2026 edition includes multiple new and revised EMS treatment protocols. Updates address areas such as reporting for abuse/neglect, angioedema management, chest pain guidance for suspected aortic syndrome, and additions to airway obstruction care and critically unstable pediatric interventions.

When must EMS clinicians complete the 2026 update training?

All EMS clinicians must complete the Maryland EMS Update: 2026 prior to July 1, 2026. The protocol update is available for continuing education credit on the MIEMSS Online Training Center in spring 2026.

Where can the most up-to-date protocol version be verified?

Protocols are occasionally amended during the year. Checking the MIEMSS website ensures access to the most up-to-date version, and the edition date is shown on the lower portion of the page.

Sep 8, 2026

Upload by Mason