Naming Convention:
(Annual Revision) . (Significant Protocol Change) . (Formatting/Errata Change)

Contents:

1. Update V1.8.1 Jan. 2026
2. Update V1.7.1 Dec. 2025
3. Update V1.6.1 Dec. 2025
4. Notes prior to Dec. 2025:

Update V1.8.1 Jan. 2026

Added phone numbers for clinic desk and provider to reference list.

Numerous formatting edits to improve cohesiveness. Thanks Miranda!

MUSCULOSKELETAL INJURY:

Added clarifying language to the use of Slishman traction with concurrent injuries:

“Use of Slishman traction device for suspected mid-shaft femur fracture is appropriate if it improves patient comfort or splints patient for transport. Application is not required if pain is increased by application. Avoid use in patients with concurrent distal femoral, knee, lower leg, or hip injury.”

SPINAL MOTION RESTRICTION:

-Removed recommendation for use of short spine device when immobilizing pediatrics on LSB. Recommend use of vacuum mattress over LSB in pediatrics.
-Clarified language regarding use of LSB as an extrication tool.
-Added language regarding immobilizing the whole spine as well as use of towel roll/vacuum mattress as C-spine securement.

CARDIAC ARREST (ATRAUMATIC):

-Added AHA algorithm graphics for adults and pediatrics.

Update V1.7.1 Dec. 2025

Added recommendation to dilute ketamine when using IV. Dilution guidance is provided on the ketamine protocol page. The Pain Management protocol continues to use just mg/kg dosing ranges. This recommendation was added to avoid accidental overdosing of ketamine when using 50mg/ml concentration vials.

Update V1.6.1 Dec. 2025

Large update overall based on questions and comments that came out of the refresher.

• Albuterol med page and references -> Changed to DuoNeb
• Formatted agitated patient section.
• Added frozen patient to field death protocol, clarified that OLMC is recommended but not required for field termination of the obviously deceased patient.
• Removed voltage guidance from cardiac arrest protocols.
  • The AEDs currently in use dose automatically.
• Added IV/IO guidance to atraumatic arrest protocol.
  • IV should be the first 2 attempts, then move to I/O, based on AHA/ILCOR 2025 updates.
• Changed “spinal immobilization” to “spinal motion restriction”
  • Aligns with up to date understanding of the practice.
• Clarified that all patient placed in spinal motion restriction should be transferred to hospital.
  • Spinal precautions should not be removed or cleared in the field.
• Added femoral traction guidance to musculoskeletal injury.
  • Femoral traction to be used if comfortable as a splint, but not required.
  • Slishman can be used with pelvic binder, but shouldn’t interfere with the binder. The binder is more important.
• Added treat and release criteria for hypoglycemia.
• Added treat and release criteria for pain management with ibuprofen/acetaminophen.
• Added duoneb treat and release criteria for mild asthma.
• Added use of expired epi-pen
  • Generally safe, and studies indicate preserved potency out to 2-3 years of 80+%.
  • Don’t use if discolored, cloudy, or has particulates.

Notes prior to Dec. 2025:

12/28/25: V1.7.1 Added dosing guidance for IV ketamine.
12/1/25: V.1.6.1 Extensive multi-protocol revision following refresher. See further notes.
11/20/25: V1.5.1 Changed oxygen delivery and BP support tactics for TBI. Added transport to EMS/base between BLS and ALS care for avalanche victims.
11/19/24: V.1.4.2 Fixed formatting on Mountain Clinic Assistance Request, Death in Field
11/17/25: V1.4.1 Revised spinal immobilization protocol, added Sports Equipment Removal for Helmet, Boots. Fixed stroke heading.
11/12/25 V1.3.1 Added BLS epinephrine from vial for anaphylaxis, Amended epinephrine protocol to mirror changes.
11/11/25: V1.2.3 Added run review triggers, fixed page numbers.
11/10/25: V1.2.2 Fixed TBI heading and table of contents reference.