Subsequent doses: 50-100 mcg (0.05-0.10 mg). (0.5 – 1.0 ml from a 1:10,000 pre-filled 10 ml adrenaline syringe). Updated guidance on mechanical chest compression devices and use of ultrasound. Other key changes include:

This session looks at the clinical challenges presented by frail and older people, along with the use of decision making support tools for the paramedic. A full review and update. Includes new guidance and images on fracture reduction and management of patella dislocation. More detail on hip fractures.Do not give nitrous oxide for patients with chest injuries and a clinically suspected pneumothorax. Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives (2016) UK Ambulance Services Clinical Practice Guidelines 2016. Bridgwater: Class Professional Publishing. Reference list entry:Brown, S.N., Kumar, D.S., James, C. andMark, J. (eds.)(2019) JRCALCclinical guidelines 2019 [ebook].Bridgwater: Class Professional Publishing. Available fromhttps://ebookcentral-proquest-com.proxy.library.lincoln.ac.uk/lib/ulinc/detail.action?docID=5976256 [accessed XX]. 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/ The JRCALC administrative base is provided by the Association of Ambulance Chief Executives (AACE) .

Laryngoscopy remains an important skill for visually inspecting the oropharynx in choking and should be part of ongoing competency assessments. New guideline covering assessment and management of steroid-dependent patients with emphasis on hydrocortisone administration. The existing wording in Medical Emergencies in Adults is removed as it is now superseded by this new guideline.

ParaPass Key Features

Reviewed and updated in line with RCUK. New section on advance care planning included and more guidance added to clarify decisions around ARDT, lasting power of attorney and DNACPR, expected and unexpected deaths.

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. Over 2,000 multiple choice questionson the JRCALC Guidelines, covering the full breadth of paramedic practice, from vulnerable patient groups to obstetrics to trauma. Reference list entry:Brown, S.N., Kumar, D.S., James, C. andMark, J. (eds.)(2019) JRCALCclinical guidelines 2019.Bridgwater: Class Professional Publishing. ALS procedures (e.g. establishing vascular access) must not delay the transfer of the child to hospital – start and continue good-quality BLS on scene as the priority. Attempt ALS procedures en-route, if practical; oxygenation, ventilation and chest compressions remain the priority.New guidance to go in the ‘Special Situations’ section. Includes Safety Triggers for Emergency Personnel (STEP) 1-2-3 Plus, CRESS tool (consciousness, respiration, eyes, secretion, skin), specific agents: nerve agents, cyanide, opiates, atropine toxicity, corrosive substances, Individual Chemical Exposure (ICE), ionising radiation and decontamination, illicit drugs labs. 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. 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.

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.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.