Pediatric Protocols and Guidelines

Protocols and guidelines for providing emergency care to children are especially important to pre-hospital and hospital clinicians who treat children infrequently yet need to keep their knowledge and skills up to date. Massachusetts EMSC aims to have in place statewide standards of care at every level of the EMS system so that all practitioners will be able to respond appropriately when caring for an injured or very sick child.

Effective March 1 2010, certain MA EMS Statewide Treatment Protocols include pre-hospital treatment for adrenal insufficiency/adrenal crisis. Paramedic ambulances in the state must stock either Solu-Cortef or Solu-Medrol. Massachusetts is only the second state in the nation to fully implement these standards.

Pre-hospital Protocols

Pediatric protocols are embedded within the latest version of the OEMS Statewide Treatment Protocols ( Look for the ‘Benny the Bear’ image for pediatric-specific care guidelines.

Protocol 5.3 Tracheostomy Tube Obstruction Management describes procedures for both adult and pediatric trach tube management.

Also be sure to check Appendix A2 for pediatric medications and Appendix A3 for inter-facility transfer guidelines (Parts B1 and D5 provide guidance on pediatric and pregnancy-related transfers)

Guidelines for Safe Pediatric Transport in Ground Ambulances

In Massachusetts, there is no exemption from the child passenger restraint law for ambulances (C 90 Sec. 7AA):

Children must be properly restrained during transport, based on their level of injury or illness. Section 7.4 of the Statewide Treatment Protocols ( provides detailed guidance on appropriate restraint of children. Protocol 7.4 is derived from the National Highway Traffic Safety Administration’s Recommendations for the Safe Transport of Children in Ground Ambulances document

Under no circumstances is a child to be transported while being held in the arms of an adult, either on the stretcher or on the bench seat.

If in doubt as to optimal transport decisions, be sure to consult your supervisor and/or agency policy.

For general questions about pediatric ambulance transport please contact the Program Manager

A pediatric transport training class is in development and will be available in Spring 2015.

This information is provided by the Injury Prevention and Control Program within the Department of Public Health.