2026 NYS Collaborative Protocol Update

[Virtual Presenter] Welcome. Today we review only the 2026 changes that affect EMT practice, taking effect September 1, 2026. Everything is drawn from the official NYS DOH Collaborative Protocol Change Log 26-03 and agency implementation guidance, approved at the May 2026 SEMAC and SEMSCO meetings. Our goal: leave confident about what you'll do differently tomorrow..

[Audio] Zoom out before the details. Four forces drive nearly every change this year: evidence — much of it mirrors the 2025 AHA guidelines; simplification — clearer language and fewer contradictory bullets; standardization — the same care statewide; and patient safety — the throughline for all of it. Keep these in mind and the specifics make sense..

[Audio] Three new tools at the EMT level. Oral acetaminophen and ibuprofen moved to EMT or higher for pain and fever, and are new carried medications for our agency. And the isopropyl-alcohol pad for nausea, self-administered by inhalation, is now available at all levels. These are low-risk, high-comfort interventions. This slide is just the summary — the next two slides review acetaminophen and ibuprofen individually, with full doses and contraindications. Only give them if your agency is trained and equipped and the patient qualifies..

[Audio] Acetaminophen is a new medication that EMTs may be carrying. Keep the teaching simple: this is for eligible pain or fever patients who can tolerate PO medication. The adult dose is up to 1000 mg PO. Pediatric dosing is weight based at 15 mg/kg PO using the protocol's listed concentration (325 mg / 10.15 mL) and volume table. The most important safety screening points are recent acetaminophen use, liver disease, hepatitis-related liver inflammation, shock, and overdose. Pediatric acetaminophen volume table (325 mg / 10.15 mL): <2.7 kg — Medical Control 2.7–5.0 kg — 1.25 mL 5.1–7.7 kg — 2.5 mL 7.8–10.9 kg — 3.75 mL 11.0–22.3 kg — 5 mL ≥22.3 kg — 10.15 mL What You Do Tomorrow: Screen for recent acetaminophen use and liver contraindications before giving the medication. Use the weight-based table for pediatrics..

[Audio] Ibuprofen is also a new EMT-carried medication. It is useful for eligible pain and fever patients, but it has more contraindications than acetaminophen, so this slide emphasizes safety screening. The adult dose is up to 400 mg PO. Pediatric dosing is 10 mg/kg PO only if the child is older than 6 months, using the protocol's listed concentration (100 mg / 5 mL) and volume table. Ask about recent ibuprofen use, kidney disease or dialysis, blood thinners, NSAID or aspirin allergy, pregnancy, shock, and overdose. Pediatric ibuprofen volume table (100 mg / 5 mL): 5.1–7.7 kg — 2.5 mL 7.8–10.9 kg — 3.75 mL 11.0–22.3 kg — 5 mL ≥22.3 kg — 10 mL What You Do Tomorrow: Screen carefully for kidney disease, anticoagulant use, NSAID/aspirin allergy, late pregnancy, shock, overdose, and recent ibuprofen use..

[Audio] The biggest practical shift this year. For a patient with elevated skin temperature and altered mental status, you begin active, whole-body cooling immediately and continue until their mental status returns to normal — then stop. Transport may be delayed while you cool, and you can continue cooling en route, for example ice and water in a body bag. Order of preference: ice-water immersion, then cold-water immersion, TACO, cold-water dousing, and ice-water-soaked towels with ice packs to the groin, axilla, and neck..

[Audio] Two clarifications, not new treatments. Pediatric asthma epinephrine dosing was reworded to mirror the anaphylaxis dose — one less thing to second-guess. And pediatric fluid guidance was tightened so a 20 mL/kg bolus may be repeated once, consistent across protocols. The practical takeaway: trust the updated wording and always reassess after each intervention..

[Audio] Two brand-new protocols. Pre-eclampsia and eclampsia: think severe headache, visual changes, high blood pressure, and seizures in a pregnant or recently pregnant patient — keep the scene calm and quiet, support the airway during seizures, and transport rapidly. Obstetric hemorrhagic shock covers postpartum hemorrhage — control bleeding, treat for shock, keep the patient warm, and get ALS moving early. Your role is recognition, supportive care, and speed..

[Audio] The childbirth and neonatal protocols were renamed and placed side by side, and the guidance now mirrors the 2025 AHA and NRP updates. After delivery, dry the baby, and wait at least one minute before clamping and cutting the cord. Place the infant immediately on the mother's bare chest — skin-to-skin — and only wrap once you're packaging for safe transport. One awareness note: neonatal SGA remains an ALS-level item; you don't need the dose, just know it exists..

[Audio] A cluster of trauma refinements. Tourniquet conversion guidance was clarified — know your agency's criteria. Pediatric burn care was updated. And there's an awareness item: antibiotics are now emphasized for amputations and open fractures, which is an ALS intervention — your job is to recognize the injury and request ALS early. Follow the updated trauma priorities and escalate when indicated..

[Audio] This one is mostly awareness. At the ALS level, sepsis perfusion goals were updated and there are whole-blood and calcium changes — you don't administer these, but you should know they're coming so you can paint the picture for your ALS partners. Your EMT role is unchanged and vital: recognize sepsis and shock early — signs of infection plus poor perfusion — support the ABCs, and transport rapidly while requesting ALS..

[Audio] Here's the whole day on one screen — the top eight changes that touch EMT practice. Acetaminophen, ibuprofen, and alcohol inhalation expand what you can do. Cool heat-stroke patients first. Pediatric asthma epi mirrors anaphylaxis. Two new OB protocols. Delayed cord clamping and skin-to-skin. And sharper trauma priorities. Screenshot this slide — it's your field reference until the changes are second nature..

[Audio] That's the EMT-relevant slice of the 2026 updates. Please read the full Collaborative and BLS protocols version 26.0 before the September 1 effective date — the change logs 26-03 and 26-04 summarize every revision. Talk with your medical director about implementation, especially for the new medications. Thank you — happy to take questions..