ABOUT
Our mission
The quality of emergency care a citizen in Massachusetts receives should not depend on their town, city, or region. Yet the care paramedics and emergency medical technicians are permitted or equipped to provide varies widely from one jurisdiction to the next, leaving patients with unequal care for the same emergency. The Massachusetts Prehospital Coalition advocates for published, evidence-based standards of paramedic practice to help build a more consistent and equitable EMS system across the Commonwealth, improve public health outcomes, and foster healthier, more resilient communities.
Who we are
We are EMS providers, educators, and physicians at every stage of our careers, from new graduates to veterans. Our members work in both 911 emergency response and inter-facility transport, in public, fire-based, private, and hospital-based EMS agencies, in classrooms and clinical settings, and in emergency medicine and medical direction.
What we believe
Every community in the Commonwealth deserves the same standard of prehospital care.
Advanced capability should be governed by published requirements that any service and medical director can meet, not by unpublished exceptions.
Protocols should reflect current evidence and keep pace with neighboring states.
Stronger education, clear career pathways, and a sustainably funded EMS system serve patients first.
What we work on
Statewide Treatment Protocol reform for EMS providers at every level
Recognizing EMS as an essential service with stable funding.
Fair ambulance billing and reimbursement at the federal level
Increased paramedic education standards and a critical care paramedic tier.
Appropriate scope for every level of practice, including EMTs and AEMTs.
How we work
We bring evidence, data, and clinical and teaching experience to OEMS, medical directors, legislators, services, and fellow clinicians. We aim to be a partner at the table, not an opponent of the people running today's systems.
Origin
The Massachusetts Prehospital Coalition was formed in October 2026, after a group of seven concerned EMS providers came together before a problem they could no longer ignore.
Massachusetts calls itself the medical mecca of the United States. It has world-ranked hospitals, medical schools, and residencies, yet the care its pre-hospital healthcare providers are allowed to give has increasingly fallen behind neighboring states, national evidence, and the standard the public expects when they dial 911. Too often, the care a patient receives before reaching a hospital depends simply on which zip code they are dialing 911 from. We grew tired of watching good medicine stop at the ambulance doors.
A Massachusetts citizen with a medical emergency shouldn’t have to hope they’re in the right zip code.
Nothing showed the problem more clearly than the fight over prehospital blood transfusion.
Trauma research is clear: patients bleeding to death do better the sooner they get blood, ideally within 30 minutes of injury. Every minute a hemorrhaging patient goes without blood increases their odds of death by about 2%.
Military medicine had already brought whole blood back to the battlefield, and civilian EMS across the country has followed. In Connecticut, Saint Francis Hospital and AMR launched New England’s first prehospital whole blood program in August 2020, and more than 200 field transfusions followed. The blood those Connecticut ambulances carry comes from the Red Cross in Dedham, Massachusetts. Massachusetts blood was saving lives in Connecticut ambulances while Massachusetts paramedics weren’t allowed to give it.
At home, state regulation 105 CMR 135.410 allowed transfusions outside a hospital only in unusual circumstances, and only when a blood bank director judged them necessary. Massachusetts paramedics could continue a transfusion started before transport, but they couldn’t start one. In 2023, a Harvard Law School Petrie-Flom Center analysis called prehospital blood a priority for Massachusetts policymakers, and urged that politics be set aside to build a system fair to every patient.
The first services had to fight for every step. Getting a program running required a special project waiver from the Department of Public Health and an 18-month evaluation process. Canton Fire, working with Boston Medical Center, launched the state’s first prehospital whole blood pilot. In June 2024, it performed Massachusetts’ first field transfusion of whole blood, saving a Braintree crash victim who was in shock with internal bleeding. Lawrence General Hospital paramedics became the second service, with their program formally beginning in December 2024. Both programs started with trauma patients only.
Both programs then pushed for wider access. Lawrence General’s leadership argued to the state, on ethical grounds, that patients in hemorrhagic shock from medical causes deserved blood too, and won approval.
Pediatric transfusion took the longest of all. Bleeding is the leading cause of preventable death in injured children, and national trauma experts have reported that prehospital transfusion in children is feasible, safe, and in some studies associated with better survival. Yet when Massachusetts paramedics began transfusing in 2024, children under 15 were excluded entirely.
Pediatric blood was brought to the Medical Services Committee repeatedly for more than a year, was expected to be approved, and was then pulled from the agenda outright. Providers were told only that it was “under review.” It was not until 2026, nearly two years after the state’s first field transfusion, that Merrimack Valley paramedics finally received clearance to transfuse children under 15.
The first pediatric blood transfusion by ground-based paramedics in Massachusetts took place in August 2026, when Merrimack Health Paramedics transfused a child in life-threatening hemorrhagic shock from a gunshot wound. The patient survived.
For two years, a child bleeding to death in Massachusetts could not receive the same lifesaving treatment as an adult in the same ambulance.
Opponents raised objections at every stage. At a January 2025 Trauma Systems Committee meeting, members raised concerns about protecting blood as a limited resource, proposed a review program like the one used for prehospital intubation, and asked what would happen during shortages and mass casualty incidents. Critics also claimed that waiting for a blood unit would delay transport. The data said otherwise: program leaders reported Canton’s on-scene times under four minutes, with injury-to-transfusion times around 18 to 20 minutes. Some services were still told not to call for blood because the patient would get it at the ER.
The pressure worked. The Medical Services Committee took up the Field Blood Transfusion protocol for discussion and vote in June 2025. Low Titer Type O+ Whole Blood now appears as Protocol 6.13 in the Statewide Treatment Protocols. New programs followed. OEMS approved Worcester EMS to carry and give blood in July 2026. That same month, Mansfield Fire put Bristol County’s first whole blood transfusion truck into service. A month later, in September 2026, Hyannis Fire began providing regionalized prehospital blood transfusion for all of Cape Cod.
In the fall of 2025, the New England Whole Blood Summit drew more than 200 participants and national leaders in prehospital transfusion. It launched the Northeast Prehospital Blood Coalition and showed how much demand had been waiting for a path forward.
The blood fight also exposed how EMS policy is actually made in Massachusetts.
The Medical Services Committee was created to advise. Its own charter says it advises the Emergency Medical Care Advisory Board (EMCAB) and the Department of Public Health on clinical issues and protocol updates, and EMCAB is itself an advisory body to DPH. The intended path was this: proposals went to EMCAB, the committee commented, and DPH decided.
In practice, that path has collapsed. The Medical Services Committee meets on a regular schedule, but the most recent EMCAB meeting we could find on the public record was in July 2023. With the oversight board effectively dormant, the advisory committee has expanded its own role. It now decides what reaches DPH at all. No statute gives the Medical Services Committee that power. When an item is pulled from its agenda, as pediatric blood was, there is no other path forward.
The committee’s makeup compounds the problem. Its seats are held mostly by physicians, including every regional medical director, with only one paramedic and one EMT reported among its members. Members also include representatives of services and organizations directly affected by its decisions, from ground paramedic services to air medical transport. The same committee that reviews and recommends special project waivers includes members whose own services operate under those waivers, regardless of whether they are paid by those services as medical directors or administrators.
We make no allegation of wrongdoing by any individual, and many members of the committee have served Massachusetts patients with dedication for years. Our concern is structural. In our view, when clinicians whose own services are affected by OEMS policy also sit on the committee that advises on that policy, and when we have been unable to locate any published conflict-of-interest disclosures or recusal records, it becomes difficult for providers and the public to fully trust the process. We believe published disclosures and clear recusal standards would strengthen confidence in the committee and in the decisions it makes. We also believe the committee would be stronger with a more democratic selection process and greater representation of the EMS providers who carry out its protocols every day, including providers with full voting rights.
The blood fight proved something that many in Massachusetts EMS had stopped believing: when concerned EMS providers take a life-or-death issue to the top, they can win. Prehospital blood did not reach Massachusetts patients because the system moved on its own. It got there because frontline providers, program leaders, and physicians refused to accept “under review” as an answer. They also refused to let a study of questionable quality stand as the final word, one published in the midst of the debate by authors with institutional interests in its outcome. They brought the evidence to every meeting, made the case in public, and kept pushing when items were pulled from the agenda. In under three years, prehospital blood went from a regulatory barrier to a statewide protocol, and access expanded to medical patients and, finally, to children. Paramedics did that.
That fight also showed how much remains broken. Massachusetts too often regulates EMS capability through unpublished exceptions rather than published standards. The result is unequal care: some of the neighborhoods with the most penetrating trauma, such as Dorchester, Roxbury, Mattapan, and Chelsea, have been among the last to get access. And no single victory fixes a system in which an advisory committee decides what reaches the Department of Public Health and the providers who carry out its decisions have no elected voice.
The fight for pre-hospital blood was the beginning, not the end. And it is still ongoing.
We formed the Massachusetts Prehospital Coalition to make sure that momentum does not stop with blood. The same organized, evidence-based pressure that brought whole blood to Massachusetts ambulances can modernize everything else holding pre-hospital care in the State back.
Every paramedic in the Commonwealth deserves the tools to practice modern medicine, and every patient deserves to receive it, regardless of where they dial 911.
The public dials 911 on their worst days and trusts that the appropriate help is coming. Today, our system isn’t living up to that trust.
We are paramedics, EMS educators, and physicians. We believe every resident and visitor of the Commonwealth deserves equitable access to modern EMS care, and that we are all in this together.
TESTIMONIUM SUPRA OPINIONEM