Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives (2017) JRCALC Clinical Practice Supplementary Guidelines 2017. Bridgwater: Class Professional Publishing. Alison Walker, Chair of JRCALC, lists the bundle 9 updates for the 2022 JRCALC Clinical Guidelines. Amended dosage for children ages 6 and 9 months to be in line with BNF, and wording amended to emphasise that it is indicated for trauma.

New indication for oral morphine: ‘Oral morphine can be used as a component of managing moderate pain’. Guidance on the assessment and management of this common presentation. Includes differential diagnosis, red flags, serious pathologies for hospital conveyance and guidance on those patients that may be suitable for community management or referral to primary care, pharmacological and non-pharmacological pain management, advise on simple exercises and safety netting. This video from Class Professional Publishing details all the updates made to iCPG and JRCALC Plus in September 2021. 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. 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.

ENDORSEMENTS

The contributors provide a breadth of experience and perspectives, working on the road, in primary care and healthcare education. Reviewed and updated by NARU. Updated guidance on Conducted Energy Devices (Tasers) and for their assessment, management and removal,

The Joint Royal Colleges Ambulance Liaison Committee has representatives nominated by their respective organisation/specialties/colleges. The committee formally convene three times a year, with the majority of the guidance review and development transpiring between meetings.New caution added: Current evidence does not support the use of TXA for gastrointestinal haemorrhage If you work for a UK NHS Ambulance Service, you may be eligible for a JRCALC Plus account through your trust’s subscription.

Adult patients with a cardiac arrest of presumed primary cardiac aetiology should be transported directly to a hospital with 24/7 coronary angiography capability (Both STEMI and Non-STEMI patients). Although 250 – 500ml of IV (or IO) fluid may support the circulation, it may take several minutes to administer. If hypotension is present during or after this fluid administration, provide additional circulatory support using careful administration of an adrenaline bolus, repeated as required, every 3-5 mins to maintain the systolic BP > 100 mmHg. First In-text citation: (Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (JRCALC and AACE), 2019) 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.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. Women who are pregnant and/or breastfeeding should have tranexamic acid administered in life threatening haemorrhage.