New standalone guidelines regarding steroid-dependent patients have been issued by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), onto the JRCALC App and will be added into the print edition of JRCALC planned for later this year. These guidelines are available for ambulance clinicians to use immediately across the UK and are commonly used by all UK NHS ambulance services.

The Addison’s Clinical Advisory Panel, steered by our Chair Prof John Wass, are delighted to have worked with the Association of Ambulance Chief Executives (AACE) and National Ambulance Services Medical Directors (NASMeD) on the new steroid-dependent patient guidelines. At the ADSHG we have heard and experienced ourselves, both negative and positive ambulance experiences. To directly combat the negative we have worked hard on our free CPD session offered to paramedics and are delighted to now be working directly with the AACE and JRCALC teams to make these standalone steroid-dependent guidelines a reality, a fantastic step to improving patient safety.

We speak to Dr Alison Walker, ED Consultant, Medical Director West Midlands Ambulance Service and the JRCALC Chair to learn more about this vital addition. 



Why were these guidelines added?

We recognise the importance of treating patients that present to ambulance services with specific medical conditions, and felt that we needed a specific and standalone guideline for patients that may need steroid administration in emergency situation.


What did the process of bringing these guidelines to the latest edition of the JRCALC App and print edition involve?

We always involve paramedics and a range of specific topic experts, and of course our own JRCALC expert leads. We review the medical evidence to support the development of all our guidelines, to ensure the guidance is up to date, relevant, practical and helpful to all ambulance clinicians in their daily practice.


What do these guidelines mean for people who are steroid dependent?

We hope that patients will feel reassured that if they did need to call an ambulance, that they would be treated in the best possible way


What do these guidelines include?

The guidelines stress that adrenal crisis is a medical emergency and the importance of administrating hydrocortisone. Also covered is the assessment and management of glucocorticoid steroid dependant patients and adrenal crisis.


How will these guidelines be used by paramedics?

The guidelines are on an App, and can be easily accessed during a shift, if guidance is needed. This may for example be to check the dosages of hydrocortisone.


Calling an ambulance is a scary situation for any person – what’s your advice to someone with steroid dependency when calling 999?

As with any 999 call, try to stay calm and state where the help is needed. You will be asked a series of questions that will help the ambulance send the most appropriate response for your emergency.


Who is JRCALC and what is in the JRCALC guidelines?

The Joint Royal Colleges Ambulance Liaison Committee is a body of experts all of whom have experience and expertise in the delivery of emergency and urgent care. A core task for the committee is recommending to ambulance services standards of care by way of clinical guidelines.    


Thank you for speaking us and working with The Addison’s Clinical Advisory Panel! Is there anything else you would like to say?

"We are most grateful to be able to work collaboratively with yourselves, and to ensure we have the most up to date and practical guidelines for paramedics across the UK. We thank those individuals that gave their time to comment and contribute to this new guideline."


 ADSHG Clinical Panel | Professor John Wass

 Professor John Wass, Chair of the Addison’s Clinical Advisory Panel comments:

“We are delighted to continue our work with the ambulance service and with the JRCALC experts create these specific and standalone guidelines for steroid-dependent patients. Thank you to the ADSHG and members of our Addison’s Clinical Advisory Panel who gave their time and expertise to ensure that the JRCALC Guidelines remain the very best for paramedics and other clinicians - invaluable work for those living with Addison’s disease and steroid dependant patients.”

“In the guidelines we particularly emphasise the need for immediate treatment of anyone showing signs of adrenal crisis prior to transportation to hospital, the acknowledgment of the new NHS steroid emergency card and that it is always better to give injected hydrocortisone than to wait. These guidelines being standalone emphasis the urgency required and are another important safety advance reflecting the hard work of all involved.”

“We’ve come a long way from our medical awareness project back in 2005, which led to revisions in the 2006 JRCALC guidelines, allowing paramedics to give injected hydrocortisone for adrenal crisis for the first time. We look forward to these guidelines being rolled out to the print editions of the JRCALC and take us a step closer towards having a network of national ambulance services operating in the same way and with the same emergency response procedures towards patients with specific conditions such as Addison’s and adrenal insufficiency.”

The JRCALC clinical guidelines are available to purchase via the AACE website and can be obtained in both electronic and print formats.

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