Our manual was written in 2009. It has a major revision every two years. Our latest additions were fentanyl for ACS and pain management on SO. We already have things like permissive hypotension, Kings for BLS, a crush syndrome protocol, doubling up of ntg until therapeutic endpoint is reached in cardiac APE, induced post arrest hypothermia, EZ-IO stuff, standing order epi for anaphylaxis or asthma, VAD protocols, racemic epi for croup/epiglottitis, various poisining/OD therapies, ETCO2 capnography with nasal prongs which helps guide tx, and so on. Our arrest protocols will change with the new guidelines.