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Massachusetts EMS protocols,
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Offline, county-specific protocols for Massachusetts EMS providers — searchable, with a full medication reference, hospital finder, and study tools built in.
Covering 14 counties in Massachusetts · Protocols current as of June 17, 2026
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The protocol set serving Massachusetts right now.
Massachusetts Statewide Treatment Protocols
Version 2025.1 ↗
PDF document
660
Flashcards
331
Quiz questions
51
Medications
87
Resources
Study tools for Massachusetts Statewide Treatment Protocols
A few real flashcards and quiz questions from Massachusetts's own protocols — the full set, plus a spaced-review deck, is in the app.
Flashcards
Cricothyroid Membrane: Anatomical Location
The cricothyroid membrane is located anteriorly on the neck, between the thyroid cartilage (superiorly) and the cricoid cartilage (inferiorly). The needle is inserted through the lower half of this membrane at the midline (mid-sagittal).
Precordial lead placement: V1 and V2
V1 is placed at the 4th intercostal space at the right sternal border. V2 is placed at the 4th intercostal space at the left sternal border. Both are at the same intercostal level, on opposite sides of the sternum.
Mallampati Class IV — significance in airway management
A Mallampati Class IV airway grade indicates that conventional intubation is unlikely. When an EMT encounters a Mallampati IV airway, they are directed to use alternative equipment such as supraglottic airway devices, in accordance with their certification and training.
Precordial lead placement: V3, V4, V5, and V6
V3 is placed directly between V2 and V4. V4 is at the 5th intercostal space at the midclavicular line. V5 is level with V4 at the left anterior axillary line. V6 is level with V5 at the left midaxillary line.
Cormack & LeHane classification — purpose
The Cormack & LeHane system classifies laryngoscopy views (Grades I–IV) to describe what structures are visible during direct laryngoscopy. Higher grades indicate a more difficult or impossible glottic view, guiding the provider's decision to attempt or abandon intubation.
What type of vascular access site is used in home hemodialysis, and what is its significance during emergency disconnect?
Home hemodialysis patients use an AV fistula (arteriovenous fistula/shunt), which has dialysis needles inserted into it during treatment. Because it carries high blood flow, accidental needle dislodgement requires firm manual pressure for 20 minutes to control bleeding, and a pressure dressing must never be applied.
Adult CPR chest compression rate
Chest compressions in adult cardiac arrest must be performed at a rate of 100–120 per minute. Compressions should be uninterrupted for 2-minute cycles, with interruptions only occurring after each cycle.
Adult VT with Pulses: BP threshold for synchronized cardioversion vs. amiodarone
If the adult patient's systolic BP is unstable (less than 100 mmHg), perform synchronized cardioversion. If the systolic BP is stable (greater than or equal to 100 mmHg), administer amiodarone 150 mg slow IV/IO over 8–10 minutes.
Quiz questions
According to Protocol 1.1, a FR/EMT arrives on scene to an adult cardiac arrest. During the first 4 cycles (8 minutes) of resuscitation, which ventilation/oxygenation strategy is NOT an acceptable option?
- BVM ventilation during recoil without interrupting compressions
- High flow oxygen via NRB mask for passive insufflation
- ✓ Endotracheal intubation to secure a definitive airway
- Placement of an oral or nasal airway adjunct prior to ventilation
A paramedic is treating an adult patient with chronic renal failure whose 12-lead ECG shows peaked T waves, a QRS duration of 135 ms, and a prolonged PR interval. Which of the following treatment sequences is correct under standing orders?
- Administer nebulized albuterol first, then establish vascular access
- ✓ Establish vascular access, administer calcium chloride 1 gram IV over at least 5 minutes, and administer nebulized albuterol up to 20 mg
- Contact Medical Control before administering any medications
- Administer calcium chloride 1 gram IV push as rapidly as possible
You are an Advanced EMT treating an adult patient in cardiogenic shock. Which of the following fluid management actions is correct per Protocol 2.16A?
- Administer a normal saline bolus titrated to hemodynamic stability.
- ✓ Withhold all IV fluids; no fluid bolus is indicated.
- Administer 20 mL/kg normal saline bolus immediately.
- Administer 500 mL boluses up to 30 cc/kg as in the sepsis protocol.
A paramedic responds to a patient in atrial flutter with a systolic blood pressure of 82 mm Hg and signs of hypoperfusion. According to Protocol 3.2, what is the correct initial energy setting for synchronized cardioversion?
- ✓ 50 joules
- 100 joules
- 200 joules
- 360 joules
You are an EMT arriving on scene to a 58-year-old male with chest pain and a systolic BP of 130 mm Hg. He hands you his own nitroglycerin. Per protocol, what is the maximum number of nitroglycerin doses (including any self-administered prior to your arrival) you may administer under EMT standing orders?
- ✓ 3 total doses, including those self-administered prior to arrival
- 3 doses administered by the EMT only, not counting pre-arrival doses
- 5 total doses if symptoms persist
- Unlimited doses as long as SBP remains >120 mm Hg
A 45-year-old male achieves ROSC after a witnessed cardiac arrest. Five minutes later, he has a palpable carotid pulse, a stable rhythm, is intubated, and shows no purposeful movement to sternal rub or response to commands. His core temperature is 35 °C. Which of the following is a contraindication to initiating Targeted Temperature Management (TTM) for this patient?
- His core temperature is 35 °C
- He does not respond to commands
- ✓ The arrest was traumatic in origin
- He is intubated with a stable cardiac rhythm
Sourced from Massachusetts's EMS authority
Pocket Protocols brings Massachusetts's EMS protocols into a faster, fully offline app.
Massachusetts protocols — FAQ
Are Massachusetts's EMS protocols available offline?
Yes. Download Massachusetts's protocol set once and every protocol, medication, and hospital is available with no signal — built for basements, rural calls, and dead zones.
Are the protocols specific to my county in Massachusetts?
Yes. Massachusetts's protocols are scoped by county and region, so every provider sees exactly the set that governs where they respond. You can add more than one if you run in multiple areas.
Is Pocket Protocols official, or affiliated with Massachusetts?
No — Pocket Protocols is an independent app and isn't affiliated with or endorsed by any EMS authority. We bring Massachusetts's protocols into a faster, fully offline app and link the authority's own source for every set.
How do Massachusetts protocol updates reach the app?
When the EMS authority publishes a new version and it goes live in Pocket Protocols, the app refreshes automatically — crews are never working from a stale copy. We monitor official sources for changes every day.
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