UK Ambulance Service Clinical Practice Guidelines (2006) Editors: Dr Joanne D Fisher, Dr Simon N Brown and Professor Matthew W Cooke Issued October 2006 ISBN 1 84690 060 3 Contents Foreword PART 2 – ADULT GUIDELINES Disclaimer Copyright Section 1: Cardiac Arrest and Arrhythmias Acknowledgements Guidelines Update analysis Adult basic life support (BLS) Glossary of terms Adult advanced life support (ALS) Adult foreign body airway obstruction PART 1: GENERAL GUIDELINES Cardiac rhythm disturbance Implantable cardioverter defibrillators (ICDs) Section 1: Ethical Issues Recognition of life extinct by Ambulance Clinicians Consent (ROLE) Patient confidentiality Traumatic cardiac arrest Section 2: Pain Management Guidelines Section 2: Medical Emergencies in Adults Management of pain in adults Medical emergencies in adults – overview Management of pain in children Abdominal pain Decreased level of consciousness Section 3: Drug Protocols Dyspnoea Headache Drug introduction Mental disorder Drug codes Non-traumatic chest pain / discomfort Adrenaline (Epinephrine) Amiodarone Section 3: Specific Treatment Options Aspirin Atropine Acute coronary syndrome Benzylpenicillin (Penicillin g) Anaphylaxis / allergic reactions in adults Chlorphenamine (Chlorpheniramine, Piriton) Asthma in adults Dextrose 40% gel Chemical, biological, radiological & nuclear Diazepam (as Diazemuls and Stesolid) incidents (CBRN) Entonox/Nitronox Chronic obstructive pulmonary disease (COPD) Furosemide (Frusemide, Lasix) Convulsions in adults Glucagon (GlucaGen) Gastrointestinal bleeds (GI bleeds) Glucose 10% Glycaemic emergencies in adults Glyceryl Trinitrate (GTN and Suscard) Heat exhaustion and heat stroke Hydrocortisone Hyperventilation syndrome Ibuprofen Hypothermia Ipratropium Bromide (Atrovent) Meningococcal septicaemia Lidocaine (Lignocaine) Overdose and poisoning in adults Metoclopramide (Maxolon) Pulmonary embolism Morphine Sulphate Pulmonary oedema Morphine Sulphate Oral Solution Sickle cell crisis Naloxone Hydrochloride (Narcan) Stroke / Transient Ischaemic Attack (TIA) Oxygen Paracetamol solution or oral suspension (Calpol) Section 4: Trauma Emergencies Salbutamol (Ventolin) Trauma emergencies in adults – overview Sodium chloride 0.9% Abdominal trauma Sodium lactate, compound (Ringers lactate / Burns and scalds in adults Hartmann's solution) Electrocution Syntometrine Head trauma Tetracaine (AMETOP) The immersion incident Thrombolytics (Reteplase, Tenecteplase) Limb trauma Neck and back trauma Thoracic trauma Trauma in pregnancy Page 1 of 2 October 2006 Contents Section 5: Obstetric and Gynaecological Emergencies Birth imminent (normal delivery and delivery complications) Effects of pregnancy on maternal resuscitation Haemorrhage during pregnancy (including miscarriage and ectopic pregnancy) Pregnancy induced hypertension (including eclampsia) Vaginal bleeding: gynaecological causes (including abortion) Section 6: Treatment and Management of Ethical Issues Assault and Abuse Guidelines Paediatric Trauma Emergencies Trauma Safeguarding children Sexual assault & Arrhythmias Arrest Cardiac Suspected abuse of vulnerable adults and recognition of abuse PART 3 – PAEDIATRIC GUIDELINES Section 1: Emergencies in Children Medical emergencies in children – overview Trauma emergencies in children – overview Anaphylaxis and allergic reactions in children Asthma in children Burns and scalds in children Convulsions in children Dealing with the Death of a Child (Including Sudden Unexpected Death in Infancy (SUDI) Methodology Glycaemic emergencies in children Guidelines Pain Overdose and poisoning in children Child basic life support (BLS) Child advanced life support (ALS) Child foreign body airway obstruction in Adults Medical Emergencies Newborn life support Page for age charts Obstetrics & Gynaecological Emergencies (resuscitation and other emergencies in children) PART 4 – METHODOLOGY Guideline development methodology Drugs Specific Treatment Options Specific Treatment Treatment & Management of Assault Treatment October 2006 Page 2 of 2 Foreword Dr Thomas Clarke The modernisation of the UK ambulance services heralds a new model for healthcare delivery with a much wider remit that has seen a shift away from the traditional role of simply transferring patients to further care. Today, the dedicated staff of the UK ambulance services work together, from the outset, to provide high quality, immediate, up-to-date, professional clinical care on which best patient outcome depends. Such care is reliant on clinical knowledge and expertise, and the Joint Royal Colleges Ambulance Liaison Committee Clinical Practice Guidelines are designed to support staff both during training and in the field. “Up-to-date, professional Foreword clinical care for best patient outcome” Dr Thomas Clarke Chairman Joint Royal Colleges Ambulance Liaison Committee Dr Simon Brown The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Practice Guidelines set the standard of care for ambulance practice in the UK. It is vitally important, given the rapidly changing nature of healthcare delivery in the ambulance service, that such changes are reflected in these guidelines. Importantly, the 2006 edition sees the introduction of a paediatric section, recognising that the management of children is frequently different from that of adults. In addition, the new guidance for cardiopulmonary resuscitation is incorporated, including the management of patients fitted with an implantable cardioverter defibrillator. Some sections included in previous editions have been “Important new changes” removed, as they are now adequately covered in training manuals. The multidisciplinary approach to the development of these guidelines not only enhances ownership but provides a ‘powerhouse’ of experience and expertise Professor Matthew which feeds directly into the guidelines. Cooke JRCALC is indebted to those who were responsible for previous editions and those who have produced guidelines, or have allowed their work to be directly reproduced, for this current edition. “Powerhouse of experience and expertise” Dr Simon Brown Professor Matthew Cooke Chairman, JRCALC Clinical Practice Guidelines Committee Project Director, University of Warwick To the UK ambulance service’s best resource…its staff Foreword October 2006 Page 1 of 1 Disclaimer The Joint Royal Colleges Ambulance Liaison Committee has made every effort to ensure that the information, tables, drawings and diagrams contained in Clinical Practice Guidelines issued July 2006 is accurate at the time of publication. However, the JRCALC guidance is advisory and has been developed to assist healthcare professionals, together with patients, to make decisions about the management of the patient’s health, including treatments. It is intended to support the decision- making process and is not a substitute for sound clinical judgement. Guidelines cannot always contain all the information necessary for determining appropriate care and cannot address all individual situations; therefore individuals using these guidelines must ensure they have the appropriate knowledge and skills to enable appropriate interpretation. The committee does not guarantee, and accepts no legal liability of whatever nature arising from or connected to, the accuracy, reliability, currency or completeness of the content of these guidelines. Users of the guidelines must always be aware that such innovations or alterations after the date of publication may not be incorporated in the content. As part of its commitment to defining national standards, the committee will periodically issue updates to the content and users should ensure they are using the most up-to-date version of the guidelines; http://www.jrcalc.org.uk Although some modification of the guidelines may be Disclaimer required by individual ambulance services, and approved by relevant local clinical committees, to ensure they respond to the health requirements of the local community, the majority of the guidance is universally applicable to NHS ambulance services. Modification of the guidelines may also occur when undertaking research sanctioned by a research ethics committee. Whilst these guidelines cover the full range of paramedic treatments available across the UK they will also provide a valuable tool for ambulance technicians and other pre-hospital care providers. Many of the assessment skills and general principles will remain the same. Those not qualified to Paramedic level must practise only within their level of training and competence. Disclaimer October 2006 Page 1 of 1 Copyright COPYRIGHT Anyone wishing to reproduce the UK Ambulance Service Clinical Practice Guidelines 2006, either in whole or in part, in printed form, electronically or any other medium, and regardless of purpose, must consult with and gain the permission of: The Chief Executive Ambulance Service Association 7th Floor Capital Tower 91 Waterloo Road LONDON SE1 8XP Telephone +44 (0)20 7928 9620 TYPESETTING AND PUBLISHING Typesetting by DL Graphics Ltd, London; printed by Page Bros Ltd, Norwich designed and published by IHCD (part of Edexcel, a Pearson Company) on behalf of the Joint Royal Colleges Ambulance Liaison Committee and the Ambulance Service Association. ERRORS, OMISSIONS AND COMMENTS Considerable effort has been taken to ensure the accuracy and consistency of these guidelines. If you find an error, omission, or would like to comment then contact us using the form below or on our website at www.warwick.ac.uk/go/jrcalcguidelines. ✄ To: Dr Joanne D Fisher Warwick