Pre-Hospital Care Protocols

The State of Maine uses statewide EMS protocols for the care of patients in the pre-hospital environment. Protocols are developed by the Maine EMS Medical Direction & Practices Board (MDPB) and are reviewed/updated on a 2-year cycle.

Maine EMS protocols are available via a free app for smartphones.  It can be found in the App Store (iPhones/iPads) or Google Play (Android) as the "Maine EMS Protocol App" from Maine Emergency Medical Services.  Statewide protocols are no longer printed by Maine EMS but can be viewed, saved, and printed via the PDF link (below).

 

Maine EMS 2021 Statewide Protocols

Maine EMS and the Medical Direction & Practices Board (MDPB) developed updated statewide EMS protocols that were implemented on December 1, 2021.  

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 six statewide public protocol discussion forums. 

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The Education Committee, MDPB, and Maine EMS released the following information regarding protocol updates:

All EMS clinicians are required to attend a 2021 protocol update course and this can be accomplished through 2 options:

1. Complete the protocol update via MEMSEd (now available)

2. Or have attended one of the seven live, virtual, protocol update sessions listed below, 

• Region 1 was held on October 27, 2021
• Region 2 was held on October 12, 2021
• Region 3 was held on October 25, 2021
• Region 4 was held on October 19, 2021
• Region 5 was held on October 18, 2021
• Region 6 was held on October 28, 2021
• An additional session was held on November 15, 2021

EMS clinicians only need to do one of the above options.

Maine EMS 2021 Pre-Hospital Care Protocol Documents

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

  • Corrections:

    • Red 8: Under 13.a., the dose was hidden by the pediatric teddy bear logo.  It read "VF/VT: amiodarone 300 mg IV/IO; may consider additional mg IV/IO one time".  It has been corrected to read "VF/VT: amiodarone 300 mg IV/IO; may consider additional 150 mg IV/IO one time". This has been updated to the full protocol pdf and protocol app.  If you have printed the entire protocol pdf, you can print the single replacement Red 8 corrected page (PDF) (12/7/21).

    • Red 12: Under Amiodarone, the dose read "Can repeat in 3-5 minutes up to a total dose of".  This has been corrected to read "Can repeat in 3-5 minutes up to a total dose of 15 mg/kg".  This has been updated to the full protocol pdf and protocol app.  If you have printed the entire protocol pdf, you can print the single replacement Red 12 corrected page (PDF) (11/23/21).

    • Yellow 3: Under PEARLS, "MSDS" was changed to "SDS". This has been updated to the full protocol pdf and protocol app.  If you have printed the entire protocol pdf, you can print the single replacement Yellow 3 corrected page (PDF) (11/23/21).

  • Please note that for existing smartphone apps, users should manually update the apps on or after December 1, 2021.  Maine EMS does not print protocol books.  To download the free 2021 protocol app, visit the Apple store (iPhones/iPads) or Google Play store (Android devices) and search for the "Maine EMS Protocol App".  Please make sure you update regularly for any updates/changes/improvements in the app.

• 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 - Protocols/treatments where OLMC may be needed/required (based on 2021 protocols) (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 - Protocols/treatments where OLMC may be needed/required (based on 2021 protocols) (PDF) (10/20/21)

2021 White Papers

The MDPB has released several white papers surrounding decisions and changes that will go into effect with the next protocol change.  These white papers are:

• 2021 MEMS Protocols and the 2019 National EMS Scope of Practice (PDF) (June 4, 2021)
• Obstetric / Gynecological Emergencies (PDF) (June 4, 2021)
• EPIC Traumatic Brain Injury Protocol (PDF) (June 4, 2021)
• Acetaminophen (PDF) (June 4, 2021)
• Medical Shock (PDF) (June 4, 2021)
• Other White Papers from the MDPB

Interested in learning about and participating in the Maine EMS 2023 Statewide Protocols Development?

 

Interfacility Transports

• IFT Transport Page

Lifeflight of Maine Protocols

• Critical Care Transport Protocols (April 2019) (PDF)
• Trauma Triage Protocols (PDF) 
• Guidelines for Helicopter Transport (PDF)
• Clinical Launch Guidelines (PDF)

Emergency Shortage Protocols 

• Shortage Protocol - Fentanyl (PDF)
• Shortage Protocol - Fentanyl & Morphine (PDF)
• Shortage Protocol - Metoprolol (PDF)
• Shortage Protocol - Midazolam (PDF)

Archived Protocols

• 2019 Maine EMS Treatment Protocols (PDF)
• 2018 Maine EMS Treatment Protocols (PDF)
• 2015 Maine EMS Treatment Protocols (PDF)
• 2013 Maine EMS Treatment Protocols (PDF)
• 2011 Maine EMS Treatment Protocols (PDF)