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.
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