JRCALC

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JRCALC

• Clinical Practice Guidelines
• for use by UK Ambulance Services

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Why?
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NW1 4LE

• Panarama
• Political
• Common standards of care
• CHI

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Pre-Hospital Clinical Guidelines

• Version 1
• October 2000

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JRCALC Guidelines sub-committee

• 50 members
• Ambulance Medical Directors
• Training Officers
• Others

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Development

• Feedback from Trusts
• Warwick University
• Consensus view
• Established National Guidelines
• Version 2 - 2002

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Local vs. National Guidelines

• LAPSC
• Training
• Resources
• Funding
• PGDs

• IHCD Training manuals
• Paramedic Registration
• CHI

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June 2004

• Evidence base
• BestBets
• Reformatting
• User-friendly
• A4
• Pocket books

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Whats changed

• Consent chapter revised
• Professional Standards - HPC
• IV fluids 250ml boluses
• NW Oxygen Guidelines
• Obs. Gynae
• Mental Health future risk table
• Burns consensus guidance

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Whats changed

• ROLE
• Start BLS whilst establish circumstances
• May then stop if ROLE criteria fulfilled
• Includes DNAR directives
• Extended to Children
• No need for doctor to confirm death

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Whats changed

• Morphine
• Maximum dose 20mg
• Paediatric doses
• Diazepam for Cocaine overdose
• Atropine in children only for bradycardia from
  vagal stimulation
• Aspirin GU/DU caution only

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Whats changed

• Thrombolytics
• Pain lasting at least 15 mins
• Onset less than 6 hours ago
• Diastolic less than 110mmHg
• RBBB permitted (must also have ST elevation)
• CPR not a contra-indication

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Whats New

• Sickle Cell crisis
• Hyperventilation
• Child Protection
• Dealing with death of a child
• CBRN
• Ipratropium

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Drug Codes

• Pre-Hospital Emergency Care
• Airport Codes
• Full name as well

• Department of Health
• National Patient Safety Agency

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Clinical Performance Indicators (CPI)

• ASA Clinical Effectiveness Dept.
• 10th December 2003
• Benchmarking
• Voluntary/Compulsory
• Outcome measures

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The Future

• 2006
• Evidence based review of all guidelines
• Hyperlinks to Evidence
• All Guidelines Group may comment
• Secure Web-based development site

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