JRCALCJRCALC

Clinical Practice Clinical Practice GuidelinesGuidelines

for use by UK Ambulance Servicesfor use by UK Ambulance Services

June 2004June 2004

• Evidence baseEvidence base– BestBetsBestBets

• ReformattingReformatting

• User-friendlyUser-friendly– A4A4– Pocket booksPocket books

What’s changedWhat’s changed

• Consent chapter revisedConsent chapter revised

• Professional Standards - HPCProfessional Standards - HPC

• IV fluids – 250ml bolusesIV fluids – 250ml boluses

• NW Oxygen GuidelinesNW Oxygen Guidelines

• Obs. & GynaeObs. & Gynae

• Mental Health – future risk tableMental Health – future risk table

• Burns consensus guidanceBurns consensus guidance

What’s changedWhat’s changed

• ROLEROLE– Start BLS whilst establish Start BLS whilst establish

circumstancescircumstances– May then stop if ROLE criteria May then stop if ROLE criteria

fulfilledfulfilled– Includes DNAR directivesIncludes DNAR directives– Extended to ChildrenExtended to Children– No need for doctor to confirm deathNo need for doctor to confirm death

What’s changedWhat’s changed

• MorphineMorphine– Maximum dose 20mgMaximum dose 20mg– Paediatric dosesPaediatric doses

• Diazepam for Cocaine overdoseDiazepam for Cocaine overdose

• Atropine in children only for Atropine in children only for bradycardia from vagal bradycardia from vagal stimulationstimulation

• Aspirin GU/DU caution only Aspirin GU/DU caution only

What’s changedWhat’s changed

• ThrombolyticsThrombolytics– Pain lasting at least 15 minsPain lasting at least 15 mins– Onset less than 6 hours agoOnset less than 6 hours ago– Diastolic less than 110mmHgDiastolic less than 110mmHg– RBBB permitted (must also have ST RBBB permitted (must also have ST

elevation)elevation)– CPR not a contra-indicationCPR not a contra-indication

What’s NewWhat’s New

• Sickle Cell crisisSickle Cell crisis

• HyperventilationHyperventilation

• Child ProtectionChild Protection

• Dealing with death of a childDealing with death of a child

• CBRNCBRN

• IpratropiumIpratropium

Drug CodesDrug Codes

• Department of Department of HealthHealth

• National Patient National Patient Safety AgencySafety Agency

• Pre-Hospital Pre-Hospital Emergency CareEmergency Care

• Airport CodesAirport Codes

• Full name as wellFull name as well

FUROSEMIDE FRM FUROSEMIDE

GLUCOSE GEL GLG GLUCOSE GEL

GLUCOSE 50% GLL GLUCOSE 50% (Latin suffix 'L' used to indicate '50'%)

GLUCAGON GLU GLUCAGON

GLUCOSE 10% GLX GLUCOSE 10% (Latin suffix 'X' used to indicate '10'%)

GLYCERYL TRINITRATE (GTN) GTN GLYCERYL TRINITRATE

HEPARIN (STANDARD UNFRACTIONATED) HEP HEPARIN

The FutureThe Future

• 20062006

• Evidence based review of all Evidence based review of all guidelinesguidelines

• Hyperlinks to EvidenceHyperlinks to Evidence

• All Guidelines Group may All Guidelines Group may commentcomment

• Secure Web-based development Secure Web-based development sitesite