A full review and update. Includes more information and images about devices such as insulin pumps. Now includes guidance on pre-hospital ketone testing which should be performed when indicated and where ketone meters are available. New section on diabetes mental health and diabulimia. Updated and inclusion of guidance for preterm babies, in line with the British Association of Perinatal Medicine (BAPM) framework for practice: New guidance around assessment and management of hanging added, with reference also added to Trauma Emergencies in Children.

The contributors provide a breadth of experience and perspectives, working on the road, in primary care and healthcare education. Updated indications: COPD and pregnant women with known Addison’s Disease who are in established labour (regular painful contractions)

New wording around frailty scoring added: consider using the clinical frailty scale, as per local pathways. Consider the administration of honey in children over the age of 12 months provided it is immediately available, the child is able to swallow and it is less than 12 hours since ingestion. Dose: 10 mL (2 teaspoons) every 10 minutes for up to 6 doses. DO NOT DELAY HOSPITAL TRANSFER

Reviewed in line with RCUK. Includes new guidance to highlight there will be occasions when a patient who has a DNACPR form may have a cardiac arrest that is considered unnatural and not in the envisaged circumstances and has a potentially reversible cause such as choking. All reversible causes should be considered. In these circumstances, resuscitation and rapid conveyance to hospital should be considered as the cause of the arrest is unrelated to their main clinical problem(s) and could be reversible. The amount of fluids for children with medical causes of hypovolaemia has changed from 20ml/kg to 10ml/kg for the initial dose which is repeated according to response. For children with heart or renal failure the initial dose is reduced to 5ml/kg and no repeat dose without seeking clinical advice. Joint Royal Colleges Ambulance Liaison Committee, Association of Ambulance Chief Executives. (2019). JRCALC Clinical Guidelines. Cited from: iCPG (2016) (Version XX) [Mobile application software]. Bridgwater: Class Publishing Ltd. Accessed XX. 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. 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).

There have been a number of JRCALC Clinical Guidelines editions since the early 2000s, with the 2006 version being superseded in 2013, 2016 and 2019 – and then most recently in 2022 with the current edition. Most notable in this latest print edition is the removal of the medicines, that do however remain fully accessible on the JRCALC apps.

Medicine guidelines have been removed, but are available on the iCPG and JRCALC Plus apps, where they are regularly updated to ensure that the most up-to-date guidance is available to clinicians.Dexamethasone is now indicated for children with croup; regardless of whether it is mild, moderate, or severe. 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.

A learning and personal development resource for pre-hospital professionals. Offering a new format of learning on the move! JRCALC and AACE publish updates to the guidelines on our apps, iCPG and JRCALC Plus. The 2021 edition has been brought up to date with all the latest significant changes on the app. This includes updates to assessment tools and algorithms, such as: Following a three-year cycle, it is likely that the next reference edition will be published in 2025. As such, the JRCALC apps have become the defining source for clinical guidance for UK paramedics and should be used to inform clinical decision making.In the event of symptomatic bradycardia in children/infants, first ensure that hypoxia has been reversed (the commonest cause of bradycardia). The most recent reference edition of the JRCALC clinical guidelines was published in 2019. Following a three-year cycle, it is likely that the next reference edition will be published in 2022. The first update bundle of 2023 includes a new guideline for Agitated patients. This will sit alongside the existing guidance for acute behavioural disturbance (ABD). JRCALC are also in the process of developing new guidance on delirium. Agitation can have multiple causes and the clinical management can be challenging. The focus should be on identifying and treating, or arranging to treat the underlying cause. 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. 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].