The 2020 AHA guidelines say firm surface, and every EMS crew has been arguing about backboards and floor transfers ever since. A 2024 ILCOR meta-analysis and new June 2026 research quietly show the argument is aimed at the wrong variable — and the real fix has nothing to do with the mattress.

The 2023 AHA Focused Update said naloxone in cardiac arrest doesn’t improve outcomes. Two cohort studies (UCSF/UC Davis, JAMA Network Open 2024 and 2026) say otherwise. A Field Brief on what the evidence actually shows, the proposed non-opioid mechanism, dosing in arrest, and what to do on your next code — with an embedded 4-case Decision Engine.