The publishers, Class Professional Publishing, will continue to provide additional updates to the 2019 Guidelines here. We will endeavour to answer your question promptly having consulted with JRCALC experts as necessary. Of the questions we receive there are often common themes; below is a searchable facility to review the questions and answers given.

JRCALC receives no central funding or government support and consequently the committee are unable to host free access to the guidelines. The Intellectual Property Rights to the guidelines are held by AACE on behalf of the NHS ambulance services, and royalties from the publishing of guidelines are used to help support the functioning of JRCALC and the development of future guidance. Dexamethasone is now indicated for children with croup; regardless of whether it is mild, moderate, or severe.

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Also, a study around use of TXA in major trauma has concluded that administration of TXA to patients with bleeding trauma reduces mortality to a similar extent in women and men, but women are substantially less likely to be treated with TXA and if they are treated, it is at a later stage than for men. This will now be highlighted in the text and in the key points in ‘Trauma emergencies in adults-overview’ >> https://pubmed.ncbi.nlm.nih.gov/35597623/ Initial adult dose for oral morphine (not end of life) changed from 20mg, to 10-20mg, as it is now indicated for moderate pain. Initiate the delivery of good quality BLS on scene, prioritising oxygen delivery, ventilation and chest compressions. ALS procedures including defibrillation if indicated, airway management and establishing IV/IO access to deliver therapies for reversal of hypovolaemia/hypoglycaemia should be considered where resources, training and skillset permit, but should not inappropriately delay transfer to definitive care. Reference list entry:Brown, S.N., Kumar, D.S., James, C. andMark, J. (eds.)(2019) JRCALCclinical guidelines 2019.Bridgwater: Class Professional Publishing.

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. 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/ Updated and inclusion of guidance for preterm babies, in line with the British Association of Perinatal Medicine (BAPM) framework for practice: A full review and update. Includes new guidance and images on fracture reduction and management of patella dislocation. More detail on hip fractures.The JRCALC Clinical Guidelines 2022 Reference Book is the comprehensive guide to emergency care for busy healthcare professionals on the road. 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. Initial dose: 50 mcg (0.05 mg) IV/IO. (0.5 ml from a 1:10,000 pre-filled 10 ml adrenaline syringe). 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. The amount of fluids for children with medical causes of hypovolaemia has changed from 20ml/kg to 10ml/kg for the initial dose which is repeated according to response. For children with heart or renal failure the initial dose is reduced to 5ml/kg and no repeat dose without seeking clinical advice.

New caution added: Current evidence does not support the use of TXA for gastrointestinal haemorrhage JRCALC combines expert advice with practical guidance to help paramedics in their challenging roles and supports them in providing patient care. The guidelines cover an extensive range of topics, from resuscitation, medical emergencies, trauma, obstetrics and medicines, to major incidents and staff wellbeing. Additional wording for clarity has been added to Table 7.5 – High levels of supplemental oxygen for adults with critical illnesses: During the prehospital phase of care vital signs may not normalise and therefore patients with abnormal vital signs should continue to be administered high flow oxygen until hospital arrival. A consistency change has been made. Pelvic binders – clarity added on entrapped patients for pelvic binders to be applied when this can safely be done with minimal handling. This will often be after extrication. In October 2022, a new edition of the JRCALC reference book was published with the latest updates to guidance.

Standby CPD: evidence-based discussions on a wealth of anatomy, physiology, pathology and pharmacology topics. Recently published articles include CPR-induced consciousness, accidental hypothermia and falls in older people. A new issue is published every month. Updated indications: COPD and pregnant women with known Addison’s Disease who are in established labour (regular painful contractions) The information highlighted here will also inform future updates and changes to JRCALC Clinical Practice Guidelines.

The IV route is re-included as a route for anaphylaxis for alleviating distressing cutaneous symptoms, only after emergency treatment with adrenaline and the patient is stable and oral anti-histamine administration is not possible. The most recent reference edition of the JRCALC clinical guidelines was published in 2019. Following a three-year cycle, it is likely that the next reference edition will be published in 2022. 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. New indication for oral morphine: ‘Oral morphine can be used as a component of managing moderate pain’. TXA not indicated In a woman who is bleeding PV more than 500mls following therapeutic abortion (termination) or miscarriage,

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Updates, Corrections, and Additional Guidance to Existing JRCALC Guidelines (Sept 2023) Guideline/medicine: Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives (2017) JRCALC Clinical Practice Supplementary Guidelines 2017. Bridgwater: Class Professional Publishing.