When was the last time you worked a code? If you serve a busy, urban area, or a population heavy on retirees, you probably remain proficient in advanced cardiac life support (ACLS). Drug therapies and dosages, intubation procedures, and post-resuscitation care are part and parcel to busy EMS systems. But what if you work in a slow-paced, rural setting, where the calls are few and far between? What happens to your ACLS skills if you rarely use them? Most likely, you lose them.