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P 008
  1. Richard Walker,
  2. Sarah Black
  1. South Western Ambulance Service NHS Foundation Trust, Exeter, UK


    In 2004 The National Institute for Health and Care Excellence (NICE) recommended in that ambulance services should carry Single Dose Activated Charcoal (SDAC) as an antidote to self-poisoning.

    A survey of ambulance services conducted a year later found a strong reluctance by services to carry the medication.

    As a result of a research project supporting the recommendation of NICE the South Western Ambulance Service conducted a six month trial of SDAC in two of its zones.

    A Patient Group Directive was produced and an education programme put in place.

    Patient Report Forms coded for overdose or where SDAC had been used were retrieved and examined for data. An on-line survey was completed by staff who had been involved in the trial.

    Paramedic crews attending cases of self-poisoning within one hour of ingestion offered SDAC to those patients.

    Of 69 occasions on which the medication was offered the uptake rate was 94%.

    54% of administrations (n=38) were for hepatotoxic overdoses of paracetamol with a further 3 administrations for lethal doses of other types of drug.

    Crews used Toxbase on 13 occasions finding their advice extremely clear and helpful. This resulted in SDAC administration on all 13 occasions where crews were uncertain about its suitability on grounds of type of toxin ingested or because the one hour window had been exceeded..

    Average time from ingestion to SDAC administration was 23 minutes and 26 seconds.

    Time on scene where SDAC was offered was 20 minutes and 24 seconds compared with 23 minutes and 26 seconds where SDAC was not offered.

    Vomiting post administration occurred in only 11% of cases and crews reported no problems encountered in managing patients.

    Concerns of ambulance services in 2005 of prolonged on-scene times, poor take-up and time required to clean ambulances appear unfounded.

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