JRCALC Overdose & Poisoning in Adults & Children (version/date not stated in source) + NWAS Non-Fatal Overdose Pathway
⚠ TIME CRITICAL
History
1 / 7
Safety first
Do not put yourself in danger — dynamic risk assessment. Consider PPE. Request specialist support early. Avoid mouth-to-mouth ventilation.
Adult
Child
JRCALC — Specific Considerations
Questions to Ask
Ingestion
Inhalation
Topical
Injection
Substance/container/packet available to bring to hospitalunassessed
Bring the substance(s)/containers for inspection at hospital if safe to do so. Also take the patient's normal medications (incl. inhalers).
Exploratory ingestion — child
May raise safeguarding concerns (inadequate supervision, or nature of substance) even with no toxic effect. If suspected, must be reported.
Time-Critical Screen
2 / 7
JRCALC — Table 3.100
Assess <C>ABCDE
Most poisoned patients are managed by addressing these time-critical features. Tap any present.
Major <C>ABCDE problemunassessed
Cardiac / respiratory arrestunassessed
Decreased level of consciousnessunassessed
Respiratory depressionunassessed
Arrhythmia / brady-tachycardiaunassessed
Hypotension (SBP <90mmHg)unassessed
Convulsionsunassessed
Hypothermiaunassessed
Hyperthermiaunassessed
Time-critical transfer indicated
Start correcting <C>ABCDE problems. Consider specialist/enhanced critical care teams. Time-critical transfer to nearest appropriate receiving hospital. Provide an ATMIST pre-alert call. Continue management en-route.
Agitation
Can be challenging — options include safe-holding techniques or appropriate medications per local procedures. External guideline — Acute Behavioural Disturbance / Agitated Patients and Delirium not built into this tool.
Assessment
3 / 7
JRCALC — Table 3.100
Vitals
Measure BM especially with alcohol intoxication (common cause of hypoglycaemia) or altered LOC. Correct hypoglycaemia — Glycaemic Emergencies / Glucagon / Glucose 10% guidelines not built into this tool. Glucagon is not suitable for beta-blocker overdose.
12-lead ECG/rhythm strip may be diagnostic — review and hand over to ED. Do not delay on scene if time-critical.
JRCALC
Carbon Monoxide Exposure
Consider CO in non-specific presentations. Acute: headache, dizziness, nausea/vomiting, lethargy, ataxia, chest pain, confusion, SOB, drowsiness, coma. Chronic: as above + flu-like symptoms, memory/visual issues.
Screening questions
Others/pets also unwell?
Feels better outdoors?
Heating not maintained?
No/activated CO alarm?
CO exposure suspected — actions
Remove crew/patient/others from exposure to a safer environment. Apply high-flow oxygen regardless of SpO₂ reading. Ventilate area if safe. Call fire service and/or HART to measure CO levels. Consider contacting/advising contact with gas services.
Management
4 / 7
JRCALC — Table 3.101
Oxygen
Apply pulse oximeter. Give O₂ if impaired respiratory effort/rate, hypoxia, CO poisoning, or after irritant gas inhalation.
Opioids (morphine, heroin, methadone) can cause respiratory depression — consider naloxone and/or ventilation, monitor vital signs closely. Repeated doses may be needed — if so, consider ventilation + time-critical transfer.
End of Life patientsNaloxone only where opioid-induced toxicity (intentional or unintentional) is suspected — aim is to reverse life-threatening respiratory depression only, i.e. RR <8/min AND unconscious and/or cyanosed. External guideline — End of Life Care not built into this tool.
Dosing — see Naloxone Hydrochloride guideline (not built into this tool)
Activated Charcoal
External reference — TOXBASE can advise on potentially toxic doses where charcoal may be appropriate. Not built into this tool.
CBRN suspected?External guideline — CBRN not built into this tool. Consider requesting specialist support per local procedures (e.g. HART, SORT, MERIT).
Thermoregulation
Hypo/hyperthermia can occur. Consider active cooling if temp >39°C or features of heat stroke. Hypothermia / Heat Related Illness guidelines not built into this tool.
TOXBASE® / NPIS
Consult TOXBASE (website or app — works offline) for substance-specific advice. 24hr NPIS phone advice: 0344 892 0111.
Non-Fatal OD Pathway
5 / 7
NWAS Additional Guidance
Non-Fatal Overdose Pathway
For illicit opiate-related overdoses. Consent is not required — advise the patient a referral will be made.
Inclusion (either)
Overdose followed illicit drug use, opiates suspected
Responded to Naloxone after illicit use
Exclusion (any)
Accidental OD of prescribed opiates — vulnerable patient
Clear suicide attempt, no substance misuse history
Carlisle Support Centre — state it's a non-fatal overdose referral.
Under 18Also complete a safeguarding referral.
Services will contact the patient with harm reduction advice and an option to opt out.
MH & Non-Conveyance
6 / 7
JRCALC
Self-Harm — Mental Health Assessment
Undertake a rapid mental health assessment. Where appropriate, speak to the patient alone initially (confidentiality/trust).
Psychological assessmentAll cases of self-harm require a psychological assessment — even if the substance/amount isn't significantly toxic — unless the patient declines and has capacity to do so. Mental Health Presentations guideline not built into this tool.
Capacity & Refusal
JRCALC
Patient has capacity to refuseunassessed
Consider whether the substance(s) impair functional decision-making (physiological/cognitive), or whether psychological distress/underlying MH condition impairs ability to weigh information. Full capacity assessment — see Mental Capacity Act 2005 tool (mca-assessment.html).
If capacity present and refuses after full information given — seek clinical advice/support per local procedures. Police and/or local MH services may be needed if safety of patient/others at risk. Duty of Care guideline not built into this tool.
JRCALC
Non-Conveyance Criteria
Following unintentional/accidental exposure — ALL must apply:
Ingestion reviewed on TOXBASE/NPIS, patient well, no significant concerns
History given is credible
Incident is/was accidental or unintentional
Responsible adult present (if applicable) and no safeguarding concerns
Patient appropriately safety-netted
Paediatric exposuresA safeguarding referral MUST be made regardless of the above.
Seek clinical advice/support per local procedures if any doubt. Deliberate toxic or multi-substance overdoses should always be transferred to hospital.
Summary / PRF
7 / 7
Event Log
No events logged yet
Documentation Checklist
Substance/quantity/route/time documented
Container/substance brought to hospital (or reason not)
TOXBASE/NPIS consulted where non-conveyance considered
ATMIST pre-alert given (if time-critical)
Safeguarding referral completed (if indicated)
Mental health / psychological assessment outcome documented