In the January 2024 JRCALC Clinical Guidelines Update, Haemorrhage during Pregnancy has been removed and replaced with three new standalone guidelines for bleeding in pregnancy (up to 20 weeks; after 20 weeks and post-partum haemorrhage). Major, Complex and High Risk Incidents has been updated by NARU on behalf of JRCALC. Finally, medicine updates include a full review of Syntometrine and Misoprostol. 


Julian Mark, Interim Chair of JRCALC and Executive Medical Director at Yorkshire Ambulance Service, provides an overview below. Key updates include:

  • Pulmonary Embolism 
  • Cardiac Rhythm Disturbance 
  • Implantable Cardioverter Defibrillator 
  • GTN and heart failure
  • Hypothermia and cardiac arrest drugs 

Bleeding in Pregnancy and PPH

There are three new standalone guidelines on bleeding in pregnancy, which sit in the maternity section of JRCALC clinical guidance: 

  • Vaginal Bleeding during Pregnancy up to 20 weeks Gestation 
  • Vaginal Bleeding during Pregnancy after 20 weeks Gestation 
  • Management of Post-partum Haemorrhage (PPH) 

These new guidelines were developed in response to feedback from frontline staff that the current guidance was not clear enough. Camella Main, Lead Midwife in Pre Hospital Maternity Care at London Ambulance Service, was involved in the review of these new guidelines. Watch this video to find out more.   

Medicines update

The review of medicines for January 2024 update includes: 

  • Syntometrine 
  • Misoprostol 
  • Medicines overview 
  • Benzylpenicillin 
  • Hydrocortisone 
  • Rectal diazepam and diazepam 
  • Tranexamic acid (TXA) 

This clinical update includes changes to the style of Syntometrine and Misoprostol monographs. These are the first medicines to be updated using the new standardisation model that is being introduced to JRCALC. Louise Maunick, Chief Pharmacist at South Central Ambulance Service, shares further insight in this update video.  

Major, Complex and High Risk Incidents

Finally, NARU has led the review of Major, Complex and High Risk Incidents guideline, which sits in the special situations section of JRCALC clinical guidance. This guideline has been fully reviewed and updated. It includes the new Major Incident Triage Tool (MITT) algorithm and Ten Second Triage (TST), a new primary scene triage tool that has been developed for use by all first responders to any incident with multiple casualties.