External Guidance

Included below is a list of clinical guidelines produced by external organisations that are relevant to Emergency Medicine. This page is regularly reviewed and updated by the QEC Best Practice subcommittee. If you would like to recommend guidelines for publication here or have any other queries in regards to the external organisation clinical guidelines, please email alison.ives@rcem.ac.uk

Shown below are the topics listed in alphabetical order within this section.

Abdominal	Acute Coronary Syndrome	Acutely ill patients
Advance care planning	Alcohol	Ambulatory Care
Anthrax	Arrhythmia	Asthma/Respiratory Disease
Atrial fibrillation	Bleeding	Breathlessness
Carbon Monoxide	Cardiopulmonary Resuscitation (CPR)	Cellulitis
Chest pain	Complex regional pain syndrome	Confidentiality
Coronavirus	Domestic Violence	ED care and general service design (inc CQC, GMC +)
Ebola	End of life	Endocrinology
Falls	Feverish children	Fit notes
Fitness to drive	GI	Handover
Head injury	Headache	Hip Fracture
Hospital Discharge	Hypertension	Infectious diseases
Intravenous Fluid Therapy	Low back pain	Meningitis
Mental Health	Older people	Organ Donation
Paediatric EM	Parkinson’s	Pneumonia
Police Liaison	Post traumatic stress disorder	Pregnancy
Pre-hospital	Pulmonary embolism	Radiology
Rheumatology	Safeguarding children	Safety
Sedation	Seizure	Self-harm
Sepsis	Sickle cell	Stroke/TIA
Toxicity	Transient loss of consciousness	Urinary tract infection
Venous thrombosis	Violent/challenging behaviour	Then: Additional resources

Arrhythmia

Supraventricular Arrhythmias (Guidelines for the Management of Patients with) (American Heart Association, 2003)

Asthma/Respiratory Disease

Quality Standards for the acute non-invasive ventilation in adults (British Thoracic Society, Apr 2018)
Asthma: diagnosis, monitoring and chronic asthma management (NICE NG80, Nov 2017)
Guidelines for the Ventilatory Management of Acute Hypercapnic Respiratory Failure in Adults (British Thoracic Society/Intensive Care Society, March 2016)
Appendix 1 : Search Strategy and Clinical Questions
Appendix 2: Evidence Tables
Report on inquiry into respiratory deaths (All Party Parliamentary Group on Respiratory Health, June 2014)
National Review of Asthma Deaths (RCP, May 2014)
British Guideline on the Management of Asthma (The British Thoracic Society / Scottish Intercollegiate Guidelines Network, 2012)

Atrial fibrillation

Atrial fibrillation: the management of atrial fibrillation (NICE CG180, June 2014) PLEASE NOTE: THERE HAS BEEN AN AMENDMENT SINCE PUBLICATION – See recommendation 1.7.2 in the NICE version and recommendation 64 in the full version (August 2014).
Atrial Fibrillation (Management of) (European Society of Cardiology, 2010)

Bleeding

Breathlessness

Emergency Oxygen Use in Adult Patients (The British Thoracic Society, 2008) Last reviewed 2011. Update due 2014

Carbon Monoxide

Carbon Monoxide Poisoning Diagnosis Algorithm (PHE, Nov 2013)
Resource: Carbon Monoxide Poisoning Awareness Poster for EDs (August 2012) – see accompanying statement from Dr Ed Walker, RCEM Toxicology Group. With thanks to HPA for use of COMA acronym.
Leaflet – CO awareness
Poster: Free gas checks
Poster: CO detectors
Poster: Camping Safety
Poster: Keeping children safe
Poster: Keeping Babies safe
Further resources including posters and information leaflets are available from the charity CO awareness

Cardiopulmonary Resuscitation (CPR)

Resuscitation Guidelines (Resus Council, 2021)
In Hospital Care of Out-of-Hospital Cardiac Arrests: Time Matters (NCEPOD, Feb 2021)
RCEM summary of key recommendations (RCEM, Feb 2021)
Resuscitation to Recovery: A National Framework to improve care of people with out-of-hospital cardiac arrest (OHCA) in England (NHS England, March 2017)
Cardiovascular implanted electronic devices (CIEDs) in people towards the end of life, during cardiopulmonary resuscitation and after death (Resus Council 2015)
Quality standards for cardiopulmonary resuscitation practice and training (Resus Council, 2013)
Bridging the Gap: The financial case for a reasonable rebalancing of health and care resources (RCPsych, Dec 2013)

Cellulitis

Guidelines on the management of cellulitis in adults (CREST, 2005)

Chest pain

Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin (NICE CG95, March 2010)

Chronic obstructive pulmonary disease (COPD)

Acute Non-Invasive Ventilation: Inspiring Change (NCEPOD, July 2017)
Management of chronic obstructive pulmonary disease in adults in primary and secondary care (NICE CG101, June 2010)
NICE CG101 Evidence Update (Jan 2012)

Complex regional pain syndrome

Complex regional pain syndrome in adults (RCP, updated July 2018)
CRPS concise guidance

Confidentiality

Confidentiality – GMC guidance (GMC, 2009)

Coronavirus COVID-19

Clinical practice guide for improving the management of adult COVID-19 patients in secondary care (GIRFT, Dec 2020)
Developing professional identity in multi-professional teams (AoMRC, May 2020)
Principles for reintroducing healthcare services COVID-19 (AoMRC, May 2020)
Positions on medicines use and development relating to COVID-19 (BPS, May 2020)
Safety and Wellbeing Advice for Survivors (Women’s Aid and Collaborators, April 2020)
Rolling updates on coronavirus disease (WHO, Feb 2020)
Coronavirus information including assessment and management of suspected UK cases (PHE, Jan 2020)
Blog – what you need to know (PHE, Jan 2020)
Information for the public (Department if Health and Social Care, Jan 2020)
Advice for travel to China (PHE, Jan 2020)
Statement on the coronavirus situation in Wuhan, China (DoH, Jan 2019)
Statement by Secretary of State for Health and Social Care video and transcript(UK Parliament, Jan 2019)

Domestic Violence

Domestic abuse during COVID-19: Guidance for mental health practitioners (Ava Project, 2020)
Pathfinder Toolkit (June, 2020)
Tackling violence against disabled women & girls toolkit (Vision Sense, AVA Project and CeDR (Lancaster University) for DRILL, 2019)
Domestic Abuse: A Toolkit for Employers (Public Health England and Business In The Community, Jul 2018)
A cry for health: Why we must invest in domestic abuse services in hospitals (SafeLives, Nov 2016)
Domestic violence and abuse – how services can respond effectively (NICE PH50, Mar 2014)
Complicated Matters: A toolkit addressing domestic and sexual violence, substance abuse, and mental ill-health (Ava Project, 2013)

ED Care and Service Delivery

Nowhere else to turn. Exploring high intensity use of A&E services (British Red Cross, Nov 2021)
Multi-Professional team-working: The experience and lessons from COVID-19 (AoMRC, Nov 2021)
HSIB Report: Wrong site surgery – wrong patient: invasive procedures in outpatient settings (June 2021)
HSIB Report Summary – Wrong site surgery – wrong patient: invasive procedures in outpatient settings (June 2021)
Patient FIRST (CQC, Oct 2020)
Improving Care by Using Patient Feedback (NIHR, Jan 2020)
Consultation on changes to our revalidation requirements for patient feedback (GMC, July 2019).
Training for better outcomes: Developing quality improvement into practice (AoMRC, June 2019)
Lay involvement in revalidation: from the 2018 survey (AoMRC, June 2019)
Academy Patient and Lay Committee comment on Lay involvement in revalidation report (AoMRC, June 2019)
Acting as an expert or professional witness: Guidance for healthcare professionals (AoMRC, May 2019)
An Alliance Against Bullying, Undermining and Harassment in the NHS (RCSEd, 2019)
Clinical guidelines for major incidents and mass casualty events (NHS England, Dec 2018)
Clinical Guidance: onward referral – a working group report (AoMRC, May 2018)
Drug misuse and dependence: UK guidelines on clinical management (DH, Dec 2017)
Extract produced for hospital staff (PHE, Jun 2019)
Improving teams in healthcare – building effective teams (RCP Nov 2017)
Improving teams in healthcare – team culture (RCP Nov 2017
Improving teams in healthcare – team communication (RCP Nov 2017)
Improving teams in healthcare – team development (RCP Nov 2017)
GMC guidance on collecting patient feedback – Case studies about collecting feedback from patients and alternatives (GMC Nov 2017)
Emergency Healthcare Workers, Exposure Prone Procedures (EPPs) and the Exposure Prone Environment (UKAP & Public Health England, April 2017)
Guidelines for Management of Marathon Related Medical Emergencies (April 2017)
Guidance for entering information onto e-portfolios (AoMRC Nov 2016)
Emergency Standards for Children & Young People with Complex Medical Needs (BAPS, CEM, JRCALC, RCoA, RCGP, RCN and RCPCH, Sept 2014)

Ebola

Summary guidance for acute trust staff: identifying and managing patients who require assessment for Ebola virus disease (Public Health England, October 2014)

End of life

Care at the end of life (Faculty of Intensive Care Medicine, Sept 2019)
The role of Ambulance Trusts in respecting people’s end-of-life wishes (Compassion in dying, Sept 2018)
ReSPECT: Recommended Summary Plan for Emergency Care and Treatment (Mar 2017)
Priorities for Care – new approach to care for the dying published (DH, June 2014)
End of Life Care Co-ordination Information Standard (Public Health England’s National End of Life Care Intelligence Network, Jan 2014)
When a patient seeks advice or information about assistance to die (GMC, Jan 2013)
Guidance for the Investigation Committee and case examiners when considering allegations about a doctor’s involvement in encouraging or assisting suicide (GMC, Jan 2013)
The route to success in end of life care – achieving quality in ambulance services (National End of Life Care Programme, Feb 2012)
Treatment and care towards the end of life: good practice in decision making (GMC, 2010)
Diagnosis of death: A code of practice for the diagnosis and confirmation of death (Academy of Medical Royal Colleges, 2008)

Endocrinology

Acute Hypercalcaemia – Emergency Guidance (Society for Endocrinology, 2016)
Pituitary Apoplexy – Emergency Guidance (Society for Endocrinology, 2016)

Falls

Falls and fracture consensus statement & resource pack (Public Health England, July 2017)
Falls: the assessment and prevention of falls in older people (NICE CG161, June 2013)

Feverish children

Feverish illness in children under 5 years – quality standards (NICE QS64, July 2014)
Feverish illness in Children (NICE CG160, May 2013)

Fit notes

Fit notes: guidance for hospital doctors (HM Government, 2009)

Fitness to drive

Assessing Fitness to Drive – a guide for medical professionals (DVLA, Sept 2019)

GI

Acute upper GI bleeding (NICE CG141, Jun 2012) – Evidence update (Sept 2014)
Management of Bariatric Patients in the ED – poster (Monkhouse SJW, Morgan JDT, Norton SA, 2012)
Management of acute upper and lower gastrointestinal bleeding (Scottish Intercollegiate Guidelines Network, 2008)

Handover

Adult Critical Care Transfer services – Service specification covering the provision of Adult Critical Care Transfer Services (ACCTS)
Healthcare record standards – Standards for admission, handover, discharge, outpatient and referral records (AoMRC, July 2013)
The ABC of Handover – Tool for EM (Imperial College Healthcare, 2012)
Implementation Guide

Head injury

Management of Perceived Devastating Brain Injury – Consensus Statement (Faculty of Intensive Care Medicine, Jan 2018)
Head injury – Quality Standards (NICE QS74, Oct 2014)
Triage, assessment, investigation and early management of head injury in infants, children and adults (NICE CG176, January 2014)

Headache

Headaches: diagnosis and management of headaches in young people and adults (NICE CG150, Sept 2012)

Hip Fracture

NICE addendum on hip fracture: management (NICE CG124, May 2017)
Hip Fracture – Evidence Update (NHS Evidence, March 2013)
The management of hip fracture in adults (NICE CG124, June 2011)

Hospital Discharge

Hospital discharge: the patient, carer and doctor perspective (BMA April 2014)

Hypertension

Hypertension: management of hypertension in adults in primary care (NICE CG127, August 2011)

Infectious diseases

Annual flu programme (GOV UK, Nov 2018)
Tetanus: the green book (PHE, Nov 2018)

Intravenous Fluid Therapy

Intravenous fluid therapy in adults in hospital – Quality Standards (NICE, QS66, August 2014)
Intravenous fluid therapy in adults in hospital (NICE, CG174, Dec 2013)

Low back pain

Low back pain and sciatica in over 16s: assessment and management (NICE NG59, Nov 2016)

Meningitis

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults (Journal of Infection, Feb 2016)
Investigations algorithm (Feb 2016)
Algorithm for the empirical treatment of suspected meningitis (Feb 2016)
Poster for EDs (Feb 2016)
Meningococaccal Audit tool (Feb 2016)
Bacterial meningitis and meningococcal septicaemia (NICE CG102, Sept 2010)
NICE CG102 Evidence update (Jan 2012)
Meningitis – management of meningococcal disease in children and young people (Meningitis Research Foundation, 2013) (this is an expert opinion based algorithm which reflects best current practice – it is very useful and helpful) View Details
Meningitis – Management of Suspected Bacterial Meningitis and Meningococcal Septicaemia in Immunocompetent Adults (Meningitis Research Foundation, 2013) View Details

Mental Health (see also RCEM mental health toolkit, Self-Harm and Post Traumatic Stress Disorder)

Right to treat Mental Welfare Commission for Scotland (July 2011)
The Police Use of Restraint in Mental Health and Learning Disability Settings (College of Policing, Jan 2017)
Revised Code of Practice: Mental Health Act (GOV UK, 2015)
Revised Code of Practice: Mental Health Act – Reference Guide (DH, April 2015)
Recognising the importance of physical health in mental health and intellectual disability – achieving parity of outcomes (BMA, May 2014)
Positive and Proactive Care: reducing the need for restrictive interventions (Dept of Health, April 2014)
Mental Health Crisis Care Concordat (HM Government and intercollegiate, Feb 2014)
Liaison psychiatry for every acute hospital: Integrated Mental and Physical Healthcare (CR 183, RCPsych, Dec 2013)
Quality standard for self harm (NICE, QS34)
Resources for young people – U can cope (Royal College of Psychiatrists, Aug 2012)
Patient advice leaflet: Feeling on the edge? Helping you get through it (Royal College of Psychiatrists, Apr 2012)
Quality standard for service user experience in adult mental health (NICE, QS14, December 2011)Evidence update (June 2014)
Dignity in dementia: improving care in general hospital settings (Royal College of Nursing, Sept 2011)
Dignity in dementia – RCEM summary
Standards on the use of section 136 of the Mental Health Act (RCPsych, CR159, July 2011)
Delirium: Diagnosis, prevention and management (NICE CG103, July 2010)
CG103 evidence update April 2012
Managing Urgent Mental Health Needs in the Acute Trust (AoMRC, 2008)

Older People

Organ Donation

Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation (NICE CG135, Dec 2011)
The Role of Emergency Medicine in Organ Donation: Report of a Workshop, 4 October 2011 (BTS, NHS Blood & Transport, CEM)

Paediatric EM

Facing the Future: Standards and Resources
Facing the Future: Standards for children in emergency care settings (RCPCH, Jun 2018)
Urinary tract infection in under 16s: diagnosis and management (NICE, Spet 2017)
Stroke in Childhood: Clinical guideline for diagnosis, management and rehabilitation (RCPCH, May 2017)
Standards for Short-Stay Paediatric Assessment Units (SSPAUs) (RCPCH, Mar 2017)
Child Health Profiles 2014 (Child and Maternal Health Intelligence Network, Mar 2014)
Child Health Reviews – UK (Clinical Outcome Review Programme)
Overview of child deaths in the four UK countries (Sept 2013, RCPCH)
Coordinating Epilepsy Care: A UK-wide review of healthcare in cases of mortality and prolonged seizures in children and young people with epilepsies (Sept 2013, RCPCH)
Paediatric EM guidance (NHS Institute for Innovation and Improvement) Following the closure of the NHS Institute, their guidelines for Paediatric EM can now be found in the next section.
Feverish Illness in Children (NICE, CG160, May 2013)
Standards for Children and Young People in Emergency Care Settings, [third edition] (RCPCH, June 2012)
International Standards of Care for Children in Emergency Departments (IFEM, 2012)
Right care, right place, first time? Joint statement on the urgent and emergency care of children and young people (CEM, RCGP, RCN, RCPCH, Dec 2011)

Parkinson’s

Emergency Management of Patients with Parkinson’s

Pneumonia

Management of Community Acquired Pneumonia in Children (The British Thoracic Society, updated 2011)

Police Liaison

Management of choking in police care & custody (Oct 2018)
Disclosure of Personal Information to the Police (IGA, July 2017)
Information sharing to tackle violence – guidance for community safety partnerships (DH, Sept 2012)
Substance misuse detainees in police custody: guidelines for clinical management (RCPsych, CR169, Nov 2011)
Management of Choking in Police Care & Custody – Recommendations for Police Personnel (FFLM, April 2014)
Template Protocol for the management of detainees suspected of swallowing or having packed drugs or foreign objects into body orifices or cavities (CEM, NPIA, ACPO, ACE, June 2011)
Template Protocol for the Management of Detainees Who Require Hospital Treatment (CEM, NPIA, ACPO, ACE, June 2011)
Template Protocol for the Management of Intoxicated and Incapable Persons (CEM, NPIA, ACPO, ACE, June 2011)
Guide to Coroners and Inquests and Charter for Coroner Services in England and Wales (HM Government, Feb 2014)

Post traumatic stress disorder

Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care (NICE CG26, March 2005) Last reviewed Dec 2011

Pregnancy

Saving Lives, Improving Mothers Care (MBRRACE UK, December 2020)
The diagnosis of ectopic pregnancy (Healthcare Safety Investigation Branch, March 2020)
Acute care toolkit 15: Managing acute medical problems in pregnancy (RCP, October 2019)
Ectopic pregnancy and miscarriage (Quality Standards (NICE QS69, September 2014)
Ectopic pregnancy and miscarriage (NICE CG154, December 2012)
Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom (Centre for Maternal and Child Enquiries, March 2011)
Maternal Collapse in Pregnancy and the Puerperium (Royal College of Obstetricians and Gynaecologists, Feb 2011)
Pregnancy and complex social factors (NICE CG110, September 2010)

Pre-hospital

UK Ambulance Services Clinical Practice Guidelines (JRCALC, 2019)
Rabies: the green book, chapter 27 (PHE, revised July 2018)
Rabies: risk assessment, post-exposure treatment, management (PHE, revised July 2018)
Rabies post-exposure treatment: management guidelines (PHE, revised July 2018)
Acid attacks – NHS advice and services
NHS England acid advices (NHS England, Aug 2017)
Acid attack infographic (NHS England, Aug 2017)
Acid and chemical burns (NHS Choices, Aug 2017)
Pre-hospital Anaesthesia (Assoc. of Anaesthetists of Great Britain and Ireland, 2008)

Pulmonary embolism

Guideline for the initial outpatient management of pulmonary embolism (PE) (British Thoracic Society, July 2018)
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting With Suspected Pulmonary Embolism (American College of Emergency Physicians, 2011)

Radiology

Paediatric trauma radiology protocols (RCR, Sept 2014)
Standards of practice and guidance for trauma radiology in severely injured patients (Royal College of Radiologists, 2011)

Rheumatology

Guidelines for management of the hot swollen joint in adults (British Society of Rheumatology, 2006)Reviewed 2012

Safeguarding children

Child Protection Evidence: systematic review on bruising (RCPCH, March 2020)
Child Sexual Exploitation (AOMRC, Sep 2014)
Safeguarding Children and Young People (RCPCH, March 2014)
Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children (HM Government, Mar 2013) Archived
Protecting children and young people: the responsibilities of all doctors (GMC, July 2012)
Physical Signs of Child Sexual Abuse – Interim Statement (RCPCH, Aug 2011) – Details:http://www.rcpch.ac.uk/csa
When to suspect child mistreatment (NICE, CG89, July 2009) Reviewed August 2012
ED Safety Checklist
Healthcare Safety Investigation Branch reports
Emergency Department Safety Checklist (West of England Academic Health Science Network, developed by University Hospitals Bristol NHS Foundation Trust, Sept 2017)

Sedation

Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department (American College of Emergency Physicians, 2014)
Adverse event reporting tool to standardize the reporting and tracking of adverse events during procedural sedation: A consensus document from the World SIVA International Sedation Task Force (Jan 2012)
Sedation in children and young people (NICE CG112, December 2010)
RCEM Summary of NICE CG112

Seizure

The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (NICE CG137, Jan 2012)
CG137 Evidence update (Feb 2014)
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Seizures (American College of Emergency Physicians, 2014)

Self-harm

Quality standard for self harm (NICE QS34)
Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (NICE CG16, July 2004) Reviewed 2012

Sepsis

Quality standard for Sepsis (NICE QS161, Sept 2017)
See more here.

Sickle cell

Sickle cell acute painful episode (NICE CG143, June 2012)

Stroke/TIA

See the paediatric section below for the latest guidance on stroke in childhood
Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NICE NG128, May 2019) NOTE: this replaces CG68

Toxicity

Management of Severe Local Anaesthetic Toxicity (Assoc. of Anaesthetists of Great Britain and Ireland, 2010)
Guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances (NEPTUNE (Novel Psychoactive Treatment UK Network), 2015)

Transient loss of consciousness

Decreased Conscious Level Multi-site Audit Report (RCPCH, 2012)
RCEM summary of NICE CG109 (Jan 2012)
NICE CG109 Evidence Update (Mar 2012)
Transient loss of consciousness in adults and young people (NICE CG109, August 2010)
Management of the Child with a Decreased Conscious Level (RCPCH, 2005) UNDER REVIEW 2014

Urinary tract infection

RCEM Summary – Urinary Tract Infection in Children
Urinary tract infection in children: diagnosis, treatment and long-term management (NICE CG54, August 2007)

Venous thrombosis

Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (Update) (NICE NG89, March 2018)
Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing (NICE CG144, June 2012)

Violent/challenging behaviour

Violent and aggressive behaviours in people with mental health problems (NICE, QS154, July 2017)
Meeting needs and reducing distress: Guidance for the prevention and management of clinically related challenging behaviour in NHS settings (NHS Protect, Dec 2013)
Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments (NICE, NG10 May 2015)
NHS Protect resources

Additional resources

Syringe labelling in critical care areas (AAGBI, updated November 2016)
Suspected neurological conditions: recognition and referral Quality standard (NICE QS198, Jan 2021)
Suspected neurological conditions: recognition and referral (NICE NG127, July 2019)
Major trauma: assessment and initial management (NICE NG39, Feb 2016)
MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa (2nd edn) (RCPsych, April 2015)
Concussion guidelines for the education sector (Faculty of Sports and Exercise Medicine, June 2014)

NHS Evidence

NHS Evidence provides health and social care professionals with access to relevant and high quality information including the latest guidelines, high quality patient information, research uncertainties and other selected information across a wide range of conditions and specialties.

External Guidance