2026 Clinical Practice Updates for EMS

EMS science and guidelines are constantly changing. The science changes more frequently than textbooks are updated, and many practitioners don’t even find out about changes right away.

Are you aware of what’s changed in EMS recently? To keep up to date, one of the best places you can look for new research is the National Association of EMS Physicians (NAEMSP).

Here we’ll review the American Heart Association (AHA) updates, along with shifting trauma care guidelines from NAEMSP.

For educators: The Emergency Care, 15th Edition textbook is regularly updated and all of these updates have already been added to the text.

This pdf provides a summary of these changes.

What are some of these recent clinical changes in EMS?

The American Heart Association’s (AHA) 2025 update introduces four updates that are critical for EMT and paramedic instruction.

1. Back Blows Return to Foreign Body Airway Obstruction Care

Back blows (also known as back slaps) are reinstated for responsive adults and children with severe or complete foreign body airway obstruction (FBAO). The updated sequence is five back blows followed by five abdominal thrusts, repeated until the object is dislodged or the patient becomes unresponsive. This sequence aligns more closely with long-standing ILCOR and Red Cross guidance.

For educators: Update exams and reinforce the full sequence in skills practice. This change simplifies inconsistencies students might have already encountered.

2. Naloxone in Cardiac Arrest

Naloxone might now be considered in suspected opioid-related cardiac arrests but only after high-quality CPR is underway and without interrupting compressions or ventilations. Routine use of naloxone in all codes is not recommended.

For educators: Consider adding questions that involve prioritizing steps in a code and include naloxone. A build-a-list TEI question would be ideal here, as it would give students additional exposure to that type of question.

3. Emphasis on Death Notification and Debriefing

The AHA is placing more importance on post-resuscitation communication and team debriefing.

For educators: Practice how to communicate effectively after a code. Tie it in to the introductory and resuscitation chapters, including cardiac arrest lab stations.

4. Neonatal Resuscitation Updates

Several minor changes were introduced or reinforced:

• Delayed cord clamping (≥ 60 seconds) remains recommended.

• Ventilation rate adjusted to 30-60/minute.

• Two-thumb compression method preferred universally. If a patient’s size prohibits this, compress with the heel of one hand.

• Supraglottic airways are indicated in neonatal resuscitation if EMTs are allowed to use them and have access to neonatal sizes.

For educators: Consider expanding time spent on neonatal care, which often gets less attention late in the course.

Are there any trends in trauma care EMS providers need to know?

Five recent position papers from the NAEMSP offer insight into where trauma care may be heading.

1. Pelvic Injuries

The paper: Prehospital Trauma Compendium: Evaluation and Management of Suspected Pelvis Fractures - An NAEMSP Position Statement and Resource Document

Accuracy of pelvic trauma identification and effectiveness of binders is experiencing growing skepticism. If binders are used, they should be placed over the trochanters and the legs should be internally rotated by securing the feet together.

For educators: Focus on anatomy, especially differentiating “hip” from “pelvis.” Make sure students understand proper application of binders.

2. Femoral Shaft Fractures

The paper: Prehospital Trauma Compendium: Management of Suspected Femoral Shaft Fractures - A Position Statement and Resource Document of NAEMSP

Traction splinting might be on its way out, with increasing support for simpler fixation methods. Isolated mid-shaft femur fractures are rare–so use of the traction splint is also rare. We aren’t as good at skills we use infrequently.

For educators: Continue teaching traction splints where required but introduce students to other perspectives and alternatives.

3. Open Pneumothorax Management

The paper: Prehospital Trauma Compendium: Traumatic Pneumothorax Care: Position Statement and Resource Document of NAEMSP

Chest seals are no longer recommended when we ventilate a patient with an open chest wound. If an occlusive dressing is used, a vented seal is preferred over an unvented one.

An interesting note about this paper is that it says that 3-sided dressings aren’t recommended, but continues on to recommend “a thin, dry, adherent dressing” with no further explanation. We believe the 3-sided dressing is more in the spirit of the vented dressing than the 4-sided alternative. Vented commercial chest seals may be preferred, but we know that enough blood will clog any seal. Being observant for developing tension pneumothorax is the best medicine.

For educators: Reinforce pathophysiology and make sure students can identify a developing tension pneumothorax. When students understand the “why,” they can make better decisions on the exam and in the field.

4. Traumatic Cardiac Arrest

The paper: Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEPs

Epinephrine is no longer recommended in traumatic out-of-hospital cardiac arrest, and future discussions might even remove compressions.

For educators: Teaching foundational physiology is necessary, especially the role of the sympathetic nervous system.

5. Spinal Care Evolution

The paper: Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature

Traditional longboard immobilization is definitively out, and even spinal motion restriction is being re-evaluated. Some agencies are switching to soft collars, or (GASP!) no collars.

For educators: Prioritize thorough spinal assessment and decision-making. Expect continued movement toward less restrictive approaches.

When will EMT textbooks be updated for science changes?

We can tell you that the e-text and subsequent paper printings of Emergency Care, 15th Edition, have been updated to include these changes. From integrated clinical updates such as the above to enhanced decision-making tools that include new flowcharts and scenario-based learning, both the e-text and paper textbook are designed to help educators stay current without constantly reinventing their course.

This pdf provides a further summary of these changes.

In addition, Limmer Education provides classroom solutions and educator resources as a value-add to your course.