There is no evidence that cooling patients post-ROSC is of benefit, but extremes of temperature are harmful. Some patients post-ROSC will have a mild hypothermia. Ensure that patients do not become colder by using no more clothing/blankets than is necessary. Vehicle heating is only required to provide a comfortable ambient temperature. In children where hypovolaemia is thought to be a contributory factor: give a fluid bolus of 10 ml/kg (N.saline (0.9%) or Hartmann’s solution), repeated once if indicated. Seek appropriate medical opinion if further boluses are thought to be indicated. It provides a dynamic, accessible and affordable learning platform for ambulance staff that is evidence-based, contextualised and in a question style that is in keeping with the challenges that arise in practice.

TXA not indicated In a woman who is bleeding PV more than 500mls following therapeutic abortion (termination) or miscarriage,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. If you work for a UK NHS Ambulance Service, you may be eligible for a JRCALC Plus account through your trust’s subscription.

Staff attending the arrest will need to be trained to provide support to the clinician that is performing the intubation, such as preparing and passing the equipment 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/ Once a tracheal tube is in place, continue continuous chest compressions with 10 gentle ventilations per minute. Avoid hyperventilation and high airway pressures during manual ventilation which adversely affect outcome. Alison Walker, Chair of JRCALC, lists the bundle 9 updates for the 2022 JRCALC Clinical Guidelines. 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.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. Reference list entry: Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives (2019) JRCALC clinical guidelines[app]. Version XX. Bridgwater: Class Publishing. Available from https://jrcalcplus.co.uk[accessed XX]. The contributors provide a breadth of experience and perspectives, working on the road, in primary care and healthcare education. 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.

Clopidogrel will be removed from JRCALC as part of the ACS update. Follow local policies/guidelines for P2Y12 inhibitor antiplatelet agents (e.g. ticagrelor, prasugrel).

How do I reference the JRCALC in APA (7th ed.) style?

Initial adult dose for oral morphine (not end of life) changed from 20mg, to 10-20mg, as it is now indicated for moderate pain. A full review and update. Includes new guidance and images on fracture reduction and management of patella dislocation. More detail on hip fractures. Quizzes are arranged in multiple ways, including broken down by JRCALC guideline, to facilitate specialised learning.

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. 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. Removal of wording in indications. The indication for TXA in women with post-partum hemorrhage if the patient continues to bleed remains. The following text has been removed: Reviewed and updated by NARU. Updated guidance on Conducted Energy Devices (Tasers) and for their assessment, management and removal, New wording around frailty scoring added: consider using the clinical frailty scale, as per local pathways. 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.