Alert Medic 1 Discussing the 2025 Maryland EMS Protocol Updates w/ Tim Chizmar, MD
Jun 13, 2025
Tim Chizmar, MD, oversees EMS protocols in Maryland and focuses on educating EMS providers. In this discussion, he delves into the 2025 protocol updates, highlighting major changes in trauma care and sepsis management. He emphasizes the introduction of pre-hospital antibiotics and the new guidelines for managing hypertensive disorders in pregnancy. Chizmar also addresses advancements like video laryngoscopy and high-performance CPR, stressing the need for continuous training and timely interventions to improve patient outcomes.
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Give TXA Over 3–5 Minutes And Early
- Administer TXA over three to five minutes in most prehospital trauma cases; rapid infusion beyond that is unnecessary.
- Prioritize early TXA within the first hour for best effect, as effectiveness declines with time post-injury.
Start Pressors Early In Severe Sepsis
- For septic shock with SBP <70 or MAP <50 and AMS, start vasopressors early while giving fluids concurrently and secure dual access.
- Titrate fluids in volume-sensitive patients with 250 mL aliquots and add pressors sooner rather than waiting for large fluid volumes.
Evidence Supports Restrictive Fluids + Early Pressors
- The CLOVERS trial supports earlier pressors or restrictive fluids as non-inferior to liberal fluids, shifting practice toward earlier vasopressors.
- Peripheral vasopressors are safe short-term via robust IV or IO access and enable earlier hemodynamic control.