December 1, 2025

The 2026 Protocol Rollout brings a major shift in how EMS providers access clinical guidance, beginning with the transition to OneDoseTM as the primary—and only—hyperlinked digital protocol source. While a PDF version will still be published for printing needs, only OneDose will feature live links and interactive navigation going forward. Providers will also notice that the platform is significantly more streamlined than previous years, including color-coding across sections (Adult, Peds, OB, Admin, Procedures/Appendix) to mirror the PDF layout and support rapid visual recognition in the field.

The OneDose app has also received important safety enhancements. The “Remember Me” function now reduces login delays, and protocols with strict age or weight limitations will automatically lock out access when a patient falls outside the appropriate range—a safeguard designed to minimize dosing or protocol-selection errors. Additionally, hospital contacts inside the app now include searchable tags, allowing crews to quickly identify Trauma Centers, STEMI Centers, SANE programs, Burn Centers, Pediatric Trauma facilities, and more.

Communication is another major area of improvement. System-wide correspondence will now be distributed through in-app notifications, flagged by an on-screen bell icon, with optional device push notifications for those who enable them. This ensures that protocol updates, medication shortages, and urgent advisories reach crews in real time.

Finally, providers should be aware of a short-term hydromorphone shortage affecting the specific concentration carried in the field. Boxes will be stickered to indicate supply disruption, and fentanyl should be used instead. Since this shortage is anticipated to resolve early next year, morphine is not being added to the formulary at this time.

Thank you, 

Scott Wildenheim, Paramedic, EMSI

Operations Manager

University Hospitals

Critical Care Transport LLC.

December 8, 2025

Several high-impact clinical protocols have been modernized and expanded in 2026. The Adult Respiratory/Breathing protocol now features a unified mild-to-severe column emphasizing progressive escalation rather than fragmented decision paths. The moderate-to-severe section encourages coordinated therapy with CPAP, magnesium, and methylprednisolone simultaneously to prevent deterioration. A new peri-arrest column removes asthma-specific language and instead focuses on aggressive bronchodilation with epinephrine, albuterol, magnesium, and steroids when the patient is critically compromised, regardless of the underlying cause.

The Adult Seizure protocol introduces ketamine as an evidence-supported option when benzodiazepines fail. Prolonged seizures down-regulate GABA receptors—making benzos less effective—and simultaneously up-regulate NMDA receptors, creating a “self-fueling” cycle of glutamate-driven excitation. Ketamine’s ability to block NMDA activity interrupts that cycle. Due to the small risk of laryngospasm or apnea, ketamine should be administered IM or diluted slow IV.

The Burns protocol has been re-framed to emphasize clinical findings over outdated triggers such as soot alone. Airway intervention is now based on distress, stridor, or swelling rather than prophylactic intubation. Fluid resuscitation has been standardized across adults and pediatrics, with initiation thresholds set at 20% TBSA and volumes expressed both in drops (no pump) and mL/hr (with pump). These updates help prevent over-resuscitation, which is a major risk in burn care.

Pediatric protocols also see major refinement. The Pediatric Bradycardia protocol now recognizes that chest compressions for heart rates below 60 are not appropriate for all ages and body sizes. For children over eight years old, crews may address bradycardia with pacing and medications instead of moving immediately to compressions, while children eight years old and under should still follow the classic PALS rule. Meanwhile, the Pediatric Behavioral Emergencies protocol, supported by Rainbow providers, removes age restrictions for ketamine in violent situations, instead basing dosing on >50 kg weight while preserving benzodiazepine pathways for lower-risk patients. Continuous monitoring—including capnography—is required for any sedated pediatric patient.

Thank you, 

Scott Wildenheim, Paramedic, EMSI

Operations Manager

University Hospitals

Critical Care Transport LLC.