Pre-Hospital Care Protocols

Maine EMS and the Medical Direction & Practices Board (MDPB) developed updated statewide EMS protocols that went into effect on January 31, 2024.  

• Maine EMS Protocol App: The protocol app is available free for all users for smartphones and tablets on the Apple Play Store (iOS Users) and Google Play Store (Android Users).  Current users will need to perform a manual update by users within their app on or after January 31, 2024.
• The MDPB has spent countless hours researching, drafting, and revising these EMS protocols.  In addition to monthly public meetings and volunteering many work hours, the MDPB held statewide public protocol discussion forums as well as protocol suggestion forms for submission directly to the MDPB.  We encourage you to be involved and meeting information can be found at the MDPB web page. 

View the Maine EMS 2023 Protocols (PDF) (2/27/25) Note - this is an updated version with the following corrections:

• Annex - OD Green: Updated K9 protocols
• Grey 30-32: Updated regional Maine EMS, and MDPB information
• Purple 5: The MAP formula was corrected from 1/2(systolic pressure minus diastolic pressure) to 1/3(systolic pressure minus diastolic pressure)
• Red 15: #9.ii was corrected from mg/kg/min to mcg/kg/min
• Minor punctuation and grammar changes that do not affect clinical care.
• Please note: The page numbers on the bottom left of each page are accurate to the section color, but NOT to the document as a whole - this was a limitation of time and programming. 

• 2023 EMS Protocols FAQ (PDF) (2/29/24) Note: This document will be updated from time to time if additional info is needed

2023 Additional Protocol Resource Documents

• 2023 Change Summary Document (PDF) (12/7/23)
• 2023 EMS Protocols FAQ (PDF) (2/29/24) Note: This document will be updated from time to time if additional info is needed
• 2023 Formulary Update (Requested from MDPB)
• New Definitions - Purple Section (PDF) (12/7/23)
• Maine Child Safe Haven Law (PDF) (12/7/23)
• Maine Stroke Alliance Plavix Statement (PDF) (12/7/23)
• Suggested Additional CEH Topics for Training (PDF) (11/21/23)

2024 Operational K9 Protocols & Documents

• Operational Bulletin Operational K9 Protocols (PDF) (11/19/24)
• Maine EMS OpK9 2024 Protocols (PDF) (11/19/24)
• Vet After hours and 24 hour 7 day clinics (PDF) (11/19/24)

2023 White Papers

• Other New 2023 Protocol (Trauma Triage, Strangulation & Fever (PDF) (12/7/23)
• Bougie Use (PDF) (11/16/23)
• Dexamethasone Update (PDF) (11/16/23)
• Magnesium Sulfate and the Treatment of Eclampsia (PDF) (11/16/23)
• Naloxone Dispensation (PDF) (11/16/23)
• New England Donor Services Reporting (PDF) (11/16/23)
• Newborn Warmth Maintenance (PDF) (11/16/23)
• Out of Hospital Cardiac Arrest (PDF) (11/16/23)
• Oxytocin (PDF) (11/16/23)
• Pediatric Cardiac Arrest and Pediatric Post Cardiac Arrest (PDF) (11/16/23)
• Posterior Circulation Stroke (PDF) (11/16/23)

All current and previous MDPB white papers can be found on the MDPB Resources page 

• 2021 Maine EMS Protocols (PDF) (12/7/21)

• 2021 Protocol Change Summary (PDF)

• 2021 Protocol FAQs v1.4 (PDF) (11/30/21)

• Maine EMS Protocol Formulary (Excel) (4/20/2022)

  • If you wish to print this Excel file out, we recommend that within Excel, after choosing print, you select "Narrow margins" and change "Scaling" to "Fit all columns on one page".  This will result in a 5 page document (otherwise printing may result in many pages and poor results).

• Maine EMS Protocol Formulary (PDF) (4/20/2022)

  • This is the same document as above but in PDF format and prints as a 5 page document but is smaller font.

• Epinephrine Infusion Dosing Reference Chart (PDF) (1/12/23)

• Norepinephrine Infusion Dosing Reference Chart (PDF) (1/12/23)

2021 Pandemic Protocols & Resources

Many additional resources can be found on the COVID Resource Page

• Maine EMS 2020 Pandemic Statewide Protocol Update (PDF) (7/28/2020)
• Printable "Leave Behind Sheets" (PDF) (updated 7/28/2020)
• Physician OLMC Quick Sheet (PDF) (4/8/2020)
• Guidance for Follow Up & Documentation for Home Care (PDF) (4/15/2020)
• Out of Hospital Cardiac Arrest during Pandemic White Paper (PDF) (4/30/2020)
• Pandemic Protocol FAQ (PDF) (4/10/2020)
  • Please note the following protocols are replaced by the July 28, 2020 protocol update as directed in Maine EMS Clinical Bulletin 2020-07-28-01
    • Pandemic Protocol for Out of Hospital Cardiac Arrest (PDF) (updated 5/12/2020)

2021 Protocol Resources

• EMT Scope of Practice Changes Overview & Guidelines 2021 (PDF) (updated 11/23/21)
  • Note: Although the Maine EMS protocols go into effect on December 1, 2021, EMTs and services have until March 1, 2022, to complete the mandatory training of "Nebulizer Use by EMTs Module".  The CPAP and 12-Lead Acquisition Modules are optional skills for EMT Level Services and can be instituted at any time after December 1, 2021.
  • Maine EMS is in the process of developing didactic education for these three modules for MEMSEd.  EMTs must complete either these modules or paramedic ICs may develop their own lecture in place of the MEMSEd course.  Once the overall 2021 protocol course (via MEMSEd or one of the previously offered webinars) and the expanded scope didactic lecture (via MEMSEd or in-person by a paramedic IC) are completed, EMTs must complete in-person skills education (using the required skill sheets below) with a paramedic IC.  In-person lecture and skills sessions must be submitted to an EMS regional office or training center for approval. Please review the Overview & Guidelines document (above) for specifics.
• Lesson Plan Template for EMT Scope of Practice Expansion (DOC) (12/7/21)
• Nebulizer Use by EMTs Module
  • This is a required skill for EMTs & EMT Level Services.
  • Instructors MUST refer to the EMT Scope of Practices Overview & Guidelines 2021 (above) for educational requirements.
  • Nebulizer Use By EMTs Powerpoint (PPT) (11/24/21)
    • Paramedic ICs may use this for the didactic education portion OR develop their own, approved by a regional office or training center.
  • Medication Rights Administration Skill Sheet (PDF) (11/16/21)
  • Medication Cross-Check Skill Sheet (PDF) (11/16/21) 
  • Small Volume Nebulizer Lab Sheet (PDF) (11/16/21)
  • Small Volume Nebulizer Skill Sheet (PDF) (11/16/21)
  • Nebulizer with CPAP Skill Sheet (PDF) (11/16/21)
• CPAP Use by EMTs Module
  • This is an optional skill for EMT Level Services.
  • Instructors MUST refer to the EMT Scope of Practices Overview & Guidelines 2021 (above) for educational requirements.
  • CPAP Lab Sheet (PDF) (11/16/21)
  • CPAP Skill Sheet (PDF) (11/16/21)
• 12-Lead Acquisition by EMTs Module
  • This is an optional skill for EMT Level Services.
  • Instructors MUST refer to the EMT Scope of Practices Overview & Guidelines 2021 (above) for educational requirements.
  • 12-Lead ECG Placement Job Aid (PDF) (11/16/21)
  • 12-Lead Acquisition Lab Sheet (PDF) (11/16/21)
  • 12-Lead Acquisition Skill Sheet (PDF) (11/16/21)
     
• Maine POLST Form (PDF)
• Infant Warming Mattress Specifications (PDF)
• Hospital Protocol Education Powerpoint PPT) (10/20/21)
  • This is aimed at hospital clinicians who provide online medical control and is a high-level overview only
• Hospital OLMC Reference - 2021 Protocols/treatments where OLMC may be needed/required (PDF) (10/20/21)

2021 Protocol Resources for Hospitals

• Hospital Protocol Education Powerpoint (PPT) (10/20/21)
  • This is aimed at hospital clinicians who provide online medical control and is a high-level overview only
• Hospital OLMC Reference - 2021 Protocols/treatments where OLMC may be needed/required (PDF) (10/20/21)