Clinical update: Clinical guidance for the use of intramuscular Hydrocortisone

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The below guidance is for associate ambulance practitioners, emergency medical technicians and student ambulance paramedics 2.

The Trust has taken the decision to introduce additional medications into the EMT scope of practice and provide additional guidance in relation to the AAP scope of practice. This is in relation to the use of intramuscular Hydrocortisone.

Regulation 238 of the Human Medicines Regulations 2012 makes the provision for certain medications to be administered by anyone for the purpose of saving a life in an emergency. The presentation that we often see is adrenal insufficiency (addisionian crisis). It is also true that on occasion, immediate paramedic support is not available. Despite this these patients require emergency treatment using this medication.

For indications and contraindications clinicians should refer to the Clinical Practice Guidelines and familiarise themselves with medication regimes below:

Adrenal insufficiency:
Hydrocortisone 100mg (where required reconstituted in 1ml of normal saline or water of injection)
(Paediatric dose as per weight requirement JRCALC).

*It should be noted that the above guidance is only for use in an emergency life threatening situation where paramedic support is not immediately available. It does not give non-paramedic clinicians authority to use hydrocortisone in any circumstances other than in adrenal
insufficiency for a patient with a known history of such a condition.

*Where paramedic support is available immediately the preferred route is intra venous and should be used unless it is not possible for access to be gained. 

If you require any further support please discuss with a paramedic colleague or local management team. Also feel free to contact the area clinical lead team on or contact your local ACL directly.

The clinical update is available on East24. Please print it off and circulate it round stations.

Published 11th September, 2017


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