which drugs identified in section 7 could be applied.
Each of these chapters is then further split into subsections: an introduction, incidence, severity and outcome, pathophysiology and assessment and management. This provides a comprehensive overview of each medical emergency and how it should be managed by paramedics in practice. Paramedics should refer to this section to see whether a particular drug is used to treat a certain condition and where that drug fits into patient management.
Clinical consideration
Both hydrocortisone and adrenaline 1:100 have anaphylaxis listed as an indication in their chapters in the Medicines section (section 7). However, the Allergic Reactions Including Anaphylaxis chapter, in the Medical Emergencies section (section 3), should be referred to for more information about where these drugs fit into the management plan for such patients.
Table 2.1 Examples of emergency conditions covered in section 3.
| Acute coronary syndrome | Hyperventilation syndrome |
| Abdominal pain | Hypothermia |
| Allergic reactions (including anaphylaxis) | Implantable cardiovascular defibrillator |
| Altered levels of consciousness | Management of resuscitation of patients with left ventricular assist devices |
| Asthma in adults and children | Meningococcal meningitis and septicaemia |
| Cardiac rhythm disturbances | Mental health presentations |
| Chronic pulmonary disease | Mental Capacity Act |
| Convulsions in adults | Respiratory illness in children |
| Convulsions in children | Sickle cell crisis |
| Dyspnoea | Sepsis |
| Febrile illness in children | Stroke/transient ischaemic attack |
| Gastrointestinal bleeding | Traumatic chest pain |
| Glycaemic emergencies in adults and children | Overdose and poisoning in adults and children |
| Headache | Paediatric gastroenteritis |
| Heart failure | Pulmonary embolism |
| Heat‐related illness |
Paramedics need to be aware that just referring to the indications in the Medicines section (section 7) may not give full information about where a drug fits into an ambulance service protocol for management of a certain patient condition, and so the JRCALC guidance in the Medical Emergencies section (section 3) should always be referred to alongside the Medicines section in order to ensure best approach and correct patient management.
Trauma section (JRCALC Guidelines, section 4)
The Trauma section is laid out in a similar structure to the Medical Emergencies section. The initial two chapters give an overview of trauma emergencies in adults and children and the subsequent chapters each contain information about a specific trauma emergency and its paramedic management (see Table 2.2).
All the individual chapters follow a similar format, offering information about the incidence, severity and outcome, pathophysiology and assessment and management of each trauma emergency. In relation to drugs and their use in emergency situations, the Trauma chapter should be used similarly to the Medical Emergencies chapters. Each chapter can be used to find more information about drugs used in the treatment of a given emergency and, more specifically, exactly where a particular drug fits into the treatment and management plan for patients in practice. Paramedics should use this information in conjunction with the Medicines section (section 7) and specific drugs within it, in order to find not only information about when a drug should be used and how it fits into a particular management plan, but also information to ensure the drug is administered correctly, thus reducing the possibility of drug errors.
Maternity Care (JRCALC Guidelines, section 5)
The notion of two lives scenarios (i.e. mother and baby) presents the paramedic with numerous challenges specific to this area of care. This section begins with an overview of obstetric emergencies and contains chapters that guide the paramedic through the management of a range of maternity‐related presentations. Similarly to the previous sections, paramedics should refer to and check the protocols for each given maternity situation to confirm whether drug therapy is appropriate for a given maternal presentation. After checking the Maternity Care section, further information about dosage or specific drug actions should be sought in the Medicines section (section 7).
Special Situations (JRCALC Guidelines, section 6)
This section contains chapters about specific situations paramedics may encounter and includes information about major, high‐risk and complex incidents such as individuals requiring care interventions but who have been incapacitated by police or other security services. Within this section there are two chapters relating specifically to medicines.
Atropine for CBRNe (chemical, biological, radiological and nuclear explosives).
DuoDote® auto‐injector (atropine combined with pralidoxime).
These two chapters contain information about the presentation, indications, actions, contraindications, cautions and side‐effects of these drugs in relation to organophosphate and nerve agent poisoning.
Table 2.2 Examples of specific trauma emergency conditions and management covered in section 4.
| Abdominal trauma | Thoracic trauma |
| Head injury | Falls in older adults |
| Limb trauma | Burns and scalds |
| Spinal injury and spinal cord injury | Electrical injuries |
| Major pelvic trauma | Immersion and drowning |
Medicines (JRCALC Guidelines, section 7)
The Medicines section begins with an overview of medicines and goes on to present more detailed information and particular characteristics about medications which can be administered by registered
