UK Ambulance Service Clinical Practice Guidelines

428 Pages·2006·8.95 MB·English

by  Brad Foster

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
Section 1: Cardiac Arrest and Arrhythmias
Copyright
Guidelines
Acknowledgements
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
(ROLE)
Consent
Traumatic cardiac arrest
Patient confidentiality
Section 2: Medical Emergencies in Adults
Section 2: Pain Management Guidelines
Medical emergencies in adults – overview
Management of pain in adults
Abdominal pain
Management of pain in children
Decreased level of consciousness
Dyspnoea
Section 3: Drug Protocols
Headache
Drug introduction Mental disorder
Drug codes Non-traumatic chest pain / discomfort
Adrenaline (Epinephrine)
Amiodarone Section 3: Specific Treatment Options
Aspirin
Acute coronary syndrome
Atropine
Anaphylaxis / allergic reactions in adults
Benzylpenicillin (Penicillin g)
Asthma in adults
Chlorphenamine (Chlorpheniramine, Piriton)
Chemical, biological, radiological & nuclear
Dextrose 40% gel
incidents (CBRN)
Diazepam (as Diazemuls and Stesolid)
Chronic obstructive pulmonary disease (COPD)
Entonox/Nitronox
Convulsions in adults
Furosemide (Frusemide, Lasix)
Gastrointestinal bleeds (GI bleeds)
Glucagon (GlucaGen)
Glycaemic emergencies in adults
Glucose 10%
Heat exhaustion and heat stroke
Glyceryl Trinitrate (GTN and Suscard)
Hyperventilation syndrome
Hydrocortisone
Hypothermia
Ibuprofen
Meningococcal septicaemia
Ipratropium Bromide (Atrovent)
Overdose and poisoning in adults
Lidocaine (Lignocaine)
Pulmonary embolism
Metoclopramide (Maxolon)
Pulmonary oedema
Morphine Sulphate
Sickle cell crisis
Morphine Sulphate Oral Solution
Stroke / Transient Ischaemic Attack (TIA)
Naloxone Hydrochloride (Narcan)
Oxygen
Section 4: Trauma Emergencies
Paracetamol solution or oral suspension (Calpol)
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 s
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Effects of pregnancy on maternal resuscitation h es s
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Section 6: Treatment and Management of E u e
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Assault and Abuse a r P
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Safeguarding children ar
Sexual assault C
Suspected abuse of vulnerable adults and
recognition of abuse
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PART 3 – PAEDIATRIC GUIDELINES i
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Section 1: Emergencies in Children lt e
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PART 4 – METHODOLOGY n A
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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
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Practice Guidelines are designed to support staff both during training and in
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“Up-to-date, professional FFF
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,
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the committee will periodically issue updates to the e
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content and users should ensure they are using the
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most up-to-date version of the guidelines;
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http://www.jrcalc.org.uk s
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Although some modification of the guidelines may be
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 [phone]
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 Medical School, The University of Warwick, Coventry, CV4 7AL.
Name:
Contact details:
Please comment in the box below
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Copyright October 2006 Page 1 of 1
Acknowledgements
The Joint Royal Colleges Ambulance Liaison Committee is indebted to the following who have contributed to the
development of the UK Ambulance Service Clinical Practice Guidelines 2006.
Stephen Barnard Greater Manchester Ambulance Service NHS Trust
Neil Barnes Greater Manchester Ambulance Service NHS Trust s
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Robin Beal Isle of Wight Ambulance Service NHS Trust
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Sarah Black Westcountry Ambulance Services NHS Trust
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Tony Bleetman Birmingham Heartlands and Solihull NHS Trust g
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Graham Brown Westcountry Ambulance Services NHS Trust e
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Richard Brown University Hospitals Leicester
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Simon Brown Royal Berkshire Ambulance Service NHS Trust n
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Gillian Bryce Westcountry Ambulance Service NHS Trust c
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John Burnham Lincolnshire Ambulance Service NHS Trust
Colin Cessford North East Ambulance Service NHS Trust
Kirsty Challen South Manchester University Hospital
Ravi Chauhan Warwick Emergency Care and Rehabilitation
Thomas Clarke Newcastle Upon Tyne Hospitals NHS Trust
David Coates Avon Ambulance Service NHS Trust
Michael Colquhoun Welsh Ambulance Services NHS Trust / Resuscitation Council (UK)
Mark Cooke Ambulance Service Association
Matthew Cooke Warwick Medical School
Andrew Currie Warwick Medical School
Charles Deakin Royal College of Anaesthetists
Richard Diment Ambulance Service Association
Ben Disney University Hospitals Coventry and Warwickshire
Sarah Docherty North East Ambulance Service NHS Trust
Darren Earley Mersey Regional Ambulance Service NHS Trust
Jon Ellis East Midlands Ambulance Service NHS Trust
Chris Evans Welsh Ambulance Services NHS Trust
Gary Evans Lincolnshire Ambulance Service NHS Trust
Kevin Errington Staffordshire Ambulance Service NHS Trust
Yaish Firas University Hospitals Birmingham
Joanne Fisher Warwick Medical School
James Gray South Yorkshire Ambulance Service NHS Trust
Dave Greggs East Anglia Ambulance Service NHS Trust
Henry Guly Plymouth Hospitals NHS Trust
David Haigh Lincolnshire Ambulance Service NHS Trust
Glyn Harding Westcountry Ambulance Services NHS Trust
Pam Hardy East Midlands Ambulance Service NHS Trust
Stephen Hines London Ambulance Service NHS Trust
Kim Hinshaw Royal College of Obstetricians and Gynaecologists
Mike Jackson Mersey Regional Ambulance Service NHS Trust
David Janes Sussex Ambulance Service NHS Trust
Rose Jarvis Warwick Medical School
Fiona Jewkes Wiltshire Ambulance Service NHS Trust
Graham Johnson Leeds Teaching Hospitals NHS Trust
Acknowledgements October 2006 Page 1 of 3
Acknowledgements
Sue Jones St George’s Healthcare NHS Trust
Carl Keeble East Midlands Ambulance Service
Yvette LaFlamme-Williams Welsh Ambulance Services NHS Trust
Robin Lawrenson Scottish Ambulance Service NHS Trust
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c Bill Lord Monash University, Melbourne, Australia
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n Andrew Marsden Medical Director Scottish Ambulance Service
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w Jeremy Mayhew Kent Ambulance Service NHS Trust
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e Janet McComb Newcastle Upon Tyne Hospitals NHS Trust
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g Iain McNeil Royal College of General Practitioners
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m Ken Morgan Merseyside Ambulance Service NHS Trust
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n Fionna Moore London Ambulance Service NHS Trust
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s Steve Mortley East Anglian Ambulance Service NHS Trust
Adrian Noon Ambulance Service Association
Matthew O’Meara Warwick Emergency Care and Rehabilitation
Bill O’Neil London Ambulance Service NHS Trust
Rose Ann O’Shea Hinchingbrooke NHS Trust
Keith Porter University Hospitals Birmingham
Tom Quinn Staffordshire Ambulance Service/Coventry University
Iain Robertson-Steel West Midlands Ambulance Service NHS Trust
Julian Sandell University College Hospital London
Tina Sajjanhar Lewisham Hospital NHS Trust
John Scott East Anglian Ambulance Service NHS Trust
Dougie Shepard Scottish Ambulance Service
Mike Smyth Hereford and Worcester Ambulance Service NHS Trust
Richard Steyn Birmingham Heartlands and Solihull NHS Trust
Richard Taffler Westcountry Ambulance Services NHS Trust
Duncan Thomas Warwick Medical School
Andy Thurgood West Midlands CARE Team
Ian Todd London Ambulance Service NHS Trust
Dominic Tolley Coventry & Warwickshire Ambulance Service NHS Trust
Eddie Tunn Mersey Regional Ambulance Service NHS Trust
Paul Underwood Avon Ambulance Service NHS Trust
Anton van Dellen Staffordshire Ambulance Service NHS Trust
Darren Walter Greater Manchester Ambulance Service NHS Trust
Michael Ward Oxfordshire Ambulance Service NHS Trust
Jim Wardrope South Yorkshire Ambulance Service NHS Trust
Andy Weal Gloucestershire Ambulance Service NHS Trust
Mark Whitbread London Ambulance Service NHS Trust
Richard Whitfield Welsh Ambulance Services NHS Trust
David Wilmot Wiltshire Ambulance Service NHS Trust
Richard Williams Royal College of Psychiatrists
John Wood Avon Ambulance NHS Trust
Malcolm Woollard Faculty of Pre-hospital Care Research Unit, James Cook
University Hospital
Matthew Wyse Coventry & Warwickshire Ambulance Service NHS Trust
Page 2 of 3 October 2006 Acknowledgements
Acknowledgements
Peak Flow Charts used with permission from Clement Clarke International.
The Foundation for the Study of Infant Deaths.
Meningitis Research Foundation.
The Wong-Baker FACES Pain Rating Scale used with permission from Mosby.
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The ICD image with permission from Medmovie.com. t
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The committee would also like to thank the following for allowing the reproduction of their guidance to be e
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published in the UK Ambulance Service Clinical Practice Guidelines 2006.
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Michael Colquhoun Recognition of Life Extinct by Ambulance Personnel o
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Andrew Marsden k
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Michael Ward A
Simon Brown Implantable Cardioverter Defibrillator
Thomas Clarke
Michael Colquhoun
Mark Cooke
Sue Jones
Janet McComb
Steven Bland Chemical, Biological, Radiological and Nuclear Incidents Sort Algorithm
Iain McNeil Chemical, Biological, Radiological and Nuclear Incidents (Special Agent)
Triage Algorithm
Graham Brown JRCALC Drug Codes – July 2006
Iain Robertson-Steel
Resuscitation Council (UK) Resuscitation Algorithms
Howard Swanton Thrombolytics Protocol
Tom Quinn
Mark Cooke
Sue Dodd
David Smith
Fionna Moore
Mark Whitbread
Liam Penny
Tom Evans
Michael Langman
Acknowledgements October 2006 Page 3 of 3
Update Analysis – Report of the Key Changes
Significant revisions have been made to the 2006-2008 edition of the clinical practice guidelines. Some sections
have been removed as these are now adequately covered in training manuals, and other important areas of clinical
practice have been included. Importantly, the paediatric section has been expanded recognising that the
management of children is frequently different from that of adults. The Resuscitation Council’s (UK) latest guidance
for cardiopulmonary resuscitation (CPR) is incorporated, including a new guideline for the management of patients
fitted with an implantable cardioverter defibrillator. All drug protocols now have administration tables including:
age, dose, concentration, and volume. Drug dosages are no longer detailed within the guidelines and clinicians are
referred to the specific drug protocol(s). In addition, standardised terminology relating to the administration of
oxygen and fluid has been included. Each guideline also includes a list of the key points.
This report indicates where key changes have been made, and is a signpost to changes within the guidelines but
is not a substitute for reading and assimilating the new guidance.
Ethical Issues
Consent The following aspects have been added to the existing guideline, each of which has
become more prominent since the initial guideline was written:
• An update on recent (2004, 2005) case law and good practice criteria.
• Further analysis of existing references, in particular, ‘Reference Guide to Consent
for Examination’ and ‘Good Practice in Consent Implementation (DH)’.
• The inclusion of a ‘definitions’ section, covering the major terms/phrases used in
the guideline (valid consent, informed consent, duration of consent).
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• The inclusion of a paragraph outlining the ‘three tests’ for consent. i
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• The inclusion of a paragraph explaining how to seek consent. al
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• A complete rewrite of consent for young people. A

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• The inclusion of a paragraph concerning consent versus duty of care versus t
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human rights. d
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• Inclusion of a paragraph concerning consent and research.
• All other paragraphs underwent major rewriting.
Patient The following aspects have been added to the existing guideline, each of which
confidentiality has become more prominent since the initial guideline was written:
• Definition of ‘identifiable information’.
• The relevance of the Data Protection Act (1998) to patient confidentiality.
• The NHS Code of Practice on patient confidentiality.
• Patient’s rights of access to their health records.
• Disclosure to non-NHS partners.
• Involvement of research.
Update Analysis October 2006 Page 1 of 18