Many, although not all, of the sixteen regional ambulance services/trusts distributed across Britain and Ireland allow registration, also known as “red-flagging”, of patients with particular medical conditions, including Addison’s disease.

Registering with your local ambulance service will mean that when a call by you or about you from your home address is made too 999/111, this will alert the call handler that you have Addison’s and are therefore steroid-dependent. The call handler can then alert the ambulance crew of this and the possible need for an emergency injection of hydrocortisone.

Find and contact your local ambulance trust

In most areas, it is your responsibility to get yourself registered with your local ambulance trust.  As a first step, you can identify your local ambulance trust/service for England and Wales. In the case of Ireland, Northern Ireland and parts of Yorkshire registration is currently not possible. Due to changes in registration practice and procedure across ambulance service regions, you are also recommended to search for the latest information in the relevant ADSHG Ambulance and A&E sub-forum for your region. These are in the members-only area.  In these sub-forums, members are encouraged to share useful information and their most recent experiences of registering in their particular region. Members’ personal stories of calling out an ambulance can also help you find out more about practice in a particular region so do look out for these when they are published in our magazine and on our website. In some regions, endocrinologists have established hospital-initiated registration of steroid-dependent patients.

Understand the process followed in your area

Ambulance services that operate a patient registration system may use one of several procedures: Some require registration through a GP (e.g. Scotland); some allow you to contact them directly to register, and some require completion of a form. The details that you need to provide will also vary.  In some cases, renewal of registration may be required annually; in others it is a lifetime registration. Also, be aware that some ambulance trusts are no longer registering steroid-dependent adult patients as their ambulances routinely carry emergency hydrocortisone injections and their crews are trained in how to administer them. They may only register those under 16 or adults with additional complicating medical conditions.

Useful tips for getting the help you need from ambulance services

When registering with an ambulance service or calling 999 for an ambulance, key phrases to use are:

  • Steroid-dependent, risk of adrenal crisis, adrenal insufficiency crisis, Addison’s/ Addisonian emergency 

AND describe symptoms (vomiting, diarrhoea, dehydration, injury/shock).

You are advised to carry documentation and/or evidence of steroid-dependency with you at all times (Medic Alert jewellery, Emergency card for wallet or purse or GP/hospital letter concerning your condition). Carry a copy of the NHS Steroid Emergency Card. The weblink and QR code printed on the card takes you and health teams straight to the Society for Endocrinology Adrenal Crisis page which has all the relevant guidance on how to manage an adrenal crisis, patient information links as well as a National Patient Safety Alert. 

As not all first response crews carry injectable hydrocortisone or are permitted to administer the emergency injection, it is also especially important to carry your own emergency hydrocortisone injection kit and to know how to use it. If you do not have one already, you are strongly advised to contact your GP or consultant about getting the necessary medication for the emergency injection kit.

If you live in the Republic of Ireland

Within the Republic of Ireland, all ambulances now carry injectable hydrocortisone and home address registration is not offered.

We're working hard to improve the emergency care provided to people with Addison's

The ambulance services in United Kingdom & Ireland are continually improving their support of people with Addison's, thanks to the lobbying and advocacy of the ADSHG and its members.

Article written by Julie Watson with contributions from Professor Simon Pearce and Vick Smith. December 2019.