Additional wording added in relation to women and TXA administration. Additional wording added around extrication, care during entrapment, self-extrication and time on scene. These changes are in relation to a Delphi study of rescue and clinical subject matter experts on the extrication of patients following a motor vehicle collision >> https://pubmed.ncbi.nlm.nih.gov/35725580/ These JRCALC guidelines are an important part of clinical risk management and ensure uniformity in the delivery of high-quality patient care. As such, they form the basis for UK paramedic training and education. A new paragraph is included on alcoholic ketoacidosis which can occur when a person who is alcohol dependent or has had a prolonged alcohol binge, abruptly stops drinking and at the same time stops eating. The production of guidelines involves a huge amount of goodwill from a wide range of professionals for which we are all very grateful. From the JRCALC representatives to the individuals that make up the various guideline development sub-groups, all time and knowledge is volunteered, without which the JRCALC guidelines would not be possible.

The College of Paramedics, in partnership with the Association of Ambulance Chief Executives (AACE) and JRCALC held an insightful and successful study day in November 2021, attended by over 450 delegates. Combining expert advice with practical guidance, the Joint Royal Colleges Ambulance Liaison Committee Clinical Guidelines are the essential resource for paramedics. The guidelines are written specifically for the ambulance paramedic role, providing a comprehensive overview of the principal areas they may encounter, and supporting them in providing excellent patient care. A completely new guideline. This guideline must be considered in conjunction with the Acute Behavioural Disturbance (ABD) and Agitated Patients guidelines. Delirium is often not recognised and is associated with poor outcomes. Details the numerous causes and suggests the need to consider delirium early in the assessment of the patient. Diazepam oil in water emulsion is now a discontinued medicine, so this presentation will be removed from JRCALC. Diazepam solution will remain.Consider the administration of honey in children over the age of 12 months provided it is immediately available, the child is able to swallow and it is less than 12 hours since ingestion. Dose: 10 mL (2 teaspoons) every 10 minutes for up to 6 doses. DO NOT DELAY HOSPITAL TRANSFER The decision to terminate resuscitation has been increased to 30 minutes from 20 minutes: If, following ALS interventions, the patient has been persistently and continuously asystolic for 30 minutes and all reversible causes have been identified and corrected, resuscitation may be discontinued except in cases listed below. Laryngoscopy remains an important skill for visually inspecting the oropharynx in choking and should be part of ongoing competency assessments. Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives. (2019). JRCALC Clinical Guidelines. Cited from: iCPG (2016) (Version XX) [Mobile application software]. Bridgwater: Class Publishing Ltd. Accessed XX. We are pleased to receive questions relating to the JRCALC Guidelines, however in the first instance we recommend that you liaise with appropriate senior clinicians within your organisation to clarify a guideline or area of practice.

Infants, children and adolescents (i.e. all those < 18 yrs age)-refer to termination of resuscitation and verification of death in children A look at the epidemiology, the effect of COVID and what can be done to enhance recovery from Out of Hospital Cardiac Arrest. If you have any questions about the guidelines, please visit https://aace.org.uk/jrcalc-qas/ , which publishes answers to commonly asked questions.In children where hypovolaemia is thought to be a contributory factor: give a fluid bolus of 10 ml/kg (N.saline (0.9%) or Hartmann’s solution), repeated once if indicated. Seek appropriate medical opinion if further boluses are thought to be indicated. iCPG is a digital version of the official JRCALC guidelines for ambulance service practitioners. It allows emergency services staff to access up-to-date guidance on medical conditions and drug dosages at all times and therefore helps to ensure best patient care.

The JRCALC administrative base is provided by the Association of Ambulance Chief Executives (AACE) . Initial adult dose for oral morphine (not end of life) changed from 20mg, to 10-20mg, as it is now indicated for moderate pain. New guidance on waterbirths included in 7. Special Considerations section. Emphasis on getting a woman in labour out of the water prior to giving birth. Adult patients with non-traumatic OHCA should be considered for transport to a recognised centre of care for appropriate specialist treatment, according to local protocols. There is no evidence to express a preference for a policy of primarily transporting via ambulance (using bypass protocols) or one of secondary inter-hospital transfer.Clopidogrel will be removed from JRCALC as part of the ACS update. Follow local policies/guidelines for P2Y12 inhibitor antiplatelet agents (e.g. ticagrelor, prasugrel). This video from Class Professional Publishing details all the updates made to iCPG and JRCALC Plus in September 2021. Changes made to be more in line with the manufacturers summary of product characteristics (SPC) and now includes an image of a finger over the diluter hole for stronger administration. There have been a number of JRCALC Clinical Guidelines editions since the early 2000s, with the 2006 version being superseded in 2013, 2016 and 2019 – and then most recently in 2022 with the current edition. Most notable in this latest print edition is the removal of the medicines, that do however remain fully accessible on the JRCALC apps.

updated assessment and management of irritant/incapacitant sprays, attenuating energy projectiles and batons. Indications for IV paracetamol amended to relief of moderate to severe pain. Updated text in IV dosage table, ‘IV paracetamol is only used when managing moderate and severe pain (use an oral preparation when managing fever with discomfort). Rigor is also distinct from trismus (spasm of the muscles around the jaw) which may occur in those with a reduced level of consciousness. It is distinct from the rigidity of rigor mortis which is not isolated to jaw muscles alone. Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives. (2019). JRCALC Clinical Guidelines. Cited from: JRCALC Plus (2017) (Version XX) [Mobile application software]. Bridgwater: Class Publishing Ltd. Accessed XX. Access all available content during your subscription period. New content will continue to be released and made available to anyone who has a current subscription.

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Updates, Corrections, and Additional Guidance to Existing JRCALC Guidelines (Sept 2023) Guideline/medicine: Following a three-year cycle, it is likely that the next reference edition will be published in 2025. This session looks at what will be in the new guideline and indicates how to spot red flags and serious pathologies – along with when and when not to convey – and what are the assessment, management & analgesic options available to paramedics. The publishers, Class Professional Publishing, will continue to provide additional updates to the 2019 Guidelines here.