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.

December 15, 2025

The 2026 rollout introduces several brand-new protocols, including Hypothermic Arrest, OB Hemorrhage Emergencies, OB Hypertensive Emergencies, BVM Procedure, OG Procedure, and an updated Transport Destination Protocol. Each address high-risk, low-frequency situations in which clear stepwise guidance is crucial. The Hypothermic Arrest protocol formally consolidates long-standing best practices into one location: limited shocks, reduced ventilation rate, active rewarming, withholding cardioactive medications until the patient is rewarmed, and early ECMO consideration when appropriate.

OB care received substantial updates this year, now guided by new ACOG EMS-specific recommendations. OB Emergencies have been separated into two dedicated protocols—OB Hemorrhage and OB Hypertensive Emergencies—to better reflect modern management. Post-partum hemorrhage guidance now acknowledges bleeding risks up to 12 weeks and adopts a revised TXA approach: 1 g over 10 minutes, with a repeat dose after 30 minutes if needed. Oxytocin administration has also been clarified: in active hemorrhaging after birth, it may be given prior to placental delivery—except in multiple gestations.

Procedural updates emphasize safety and technique standardization across the system. A formal BVM procedure now outlines expectations, including appropriate PEEP valve use to improve oxygenation. The new OG tube procedure provides gastro-decompression guidance for airway management, though its adoption will depend on medical director approval and agency-level training. Needle decompression has been narrowed strictly to true tension pneumothorax presentations, removing the 5th intercostal option and retaining only anterior/anterior-axillary sites while adding ultrasound considerations for future equipment upgrades.

Other technical revisions include enhancements to the Restraint procedure, clarifying EMS obligations when managing handcuffed patients and reinforcing the medical risks associated with custody-related situations. The IO procedure now warns against using sites over joint replacements, which may fail or cause hardware damage. Updates to the Taser protocol define when EMS must transport, clarify removal techniques for new Taser 7 probes, and emphasize the requirement for diagnostic EKG evaluation in high-risk patients. Finally, the revised Crush protocol aligns with new national recommendations by reducing the pre-release timeframe to one hour and adding calcium and albuterol after extended entrapment.

Thank you, 

Scott Wildenheim, Paramedic, EMSI

Operations Manager

University Hospitals

Critical Care Transport LLC.

December 29, 2025

Dear Prehospital Heroes, 

It has been another year of lifesaving, compassion, and realizing how every one of you helps to make this a better place to live. Your professionalism and empathy bring a measure of reassurance and care to so many life-threatening events. We know that the prehospital providers are the ones who can make a difference in the following critical events. Reminding all of you, those who perish from anaphylaxis do so rapidly. The adage that, if they make it to the emergency department alive, they won’t die, still holds true. You folks are the ones who provide immediate lifesaving care for these critical patients. It is you who makes the difference with emergent respiratory emergencies. EMS is counted on for STEMI and stroke care, both with prior notification, prior treatment, and getting the right patient to the right place for the right care. EMS is a critical link to our chain of survival for our trauma patients, too. Additionally, when you follow our sign-off protocol, you acknowledge those who may require further evaluation in the emergency department. Thank you for making a difference in so many of our patients’ lives. 

Things are getting exciting throughout our system. Our Main campus has continued to save many lives that would have previously perished through the extracorporeal membrane oxygenation (ECMO) CPR, also known as extracorporeal cardiopulmonary resuscitation (ECPR). Dr. Colin McCloskey, Dr. Yasir Abu-Omar (cardiac surgery), Dr. Mahdi Shishehbor (chair of HHVI), and our very own Dr. Frank Forde, our prehospital liaison, have put this program together, allowing a second chance for out-of-hospital cardiac arrest patients, who can get to the main campus within 30 minutes of their cardiac arrest. The initial survivability numbers were so impressive that Dr. Jordan Singer, our amazing EMS medical director for Lorain and Elyria counties, has taken his main campus ECMO experience and started the program at UH Elyria Hospital. The future is hopeful for these ECMO candidates.  

Dr. Singer has also moved forward with providing our narcotic overdose community with lifesaving pre-hospital suboxone therapy. We have agreed with the AHA recommendation to provide DAWN kits to more of our at-risk patients. We also have Dr. Singer, Dr. Hill, and Falon Steiner to thank for upgrading our educational offerings and ensuring excellent procedural skills, with an annual skills check-off going out to all our departments for 2026. 

Dr. Hill, paramedics Scott Wildenheim, Wes Green, Caleb Ferroni, AJ Joseph, and Tony Crino, have brought our Prehospital Paradigm podcast to thousands of prehospital providers in eight countries. Hot topics from exciting specialists throughout our system have joined the podcast monthly. Thanks to these providers from trauma, neurology, cardiology, pediatrics, and disaster preparedness, as well as our fantastic tactical specialists. 

We have had another great year for our Event Medicine team led by Dr. Jeff Luk, which included medical coverage with physicians, medics, and nurses at the Browns games, the Cleveland Marathon, the Triathlons, and many other community events throughout Northeast Ohio. Some notable events included the Cuyahoga River Rowing Regatta, the Norwalk Racetrack, the D-Day in Conneaut, Morgan Wallen and AC/DC concerts, and stadium soccer games. Many of our outreach programs train our students at dozens of local schools in CPR and Stop the Bleed® programs. 

I have left off so many names, but we are grateful for everyone’s contributions in one of the University Hospitals' major missions, to build lifesaving communities. Our administration has never wavered in its constant outstanding support for our EMS Institute. I joined this team in 2014 and nearly 12 years later, the mission continues. With Danny Ellenberger at the helm pushing our mission further, we are excited to spread the words: To Heal, To Teach and To Discover. None of us could have done any of this without our prehospital providers, who provide compassionate, professional, and outstanding prehospital care. You all dedicate your lives to saving lives. During this special time of year, please spend some time with yourselves, enjoying family and friends.  

Happy Holidays to all and sincere gratitude to you.  

Sincerely, 

Don Spaner, MD