Emergency Info

Guidelines on when to call the Emergency Services 999 for unwell recreational drug users

Call 999 if ANY one of the following is present:

Unconsciousness – if the patient does not respond to vocal commands, requires painful stimulus (e.g. pressure across the fingernails) to respond or does not respond at all.

Significant agitation (e.g. pacing around the room) or aggression not settling within 15 minutes.

Seizures (e.g. a convulsion similar to an epileptic fit)

Breathing difficulties such as fast breathing rate which does not settle within 15 minutes.

Heart rate over 140 beats per minute not settling within 5 minutes.

Temperature over 38.5 not settling after about 5 minutes of rest, or if very flushed and feels very hot if no thermometer is available.

Blood pressure – Systolic (“upper pressure”) over 180mmHg, or Diastolic (“lower pressure”) over 110mmHg on two repeated blood pressure measurements.

Other concerns – if there are any other concerns (e.g. severe headache, chest pain).


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Dealing with medical emergencies

A critical decision for medical/welfare staff is whether and when to call for an ambulance. This section provides authoritative guidance on this issue.

The Clinical Toxicology team at Guy’s and St Thomas’ NHS Foundation Trust, in partnership with a number of other agencies, as part of the European Drug Emergencies Network (Euro-DEN) have developed a set of guidelines advising club medics/staff when to call an ambulance to assess whether an individual needs to be taken to an Emergency Department for ongoing treatment. These emergency guidelines are reproduced in full here. A training package was developed for club medics/staff using these guidelines.

Implementation of these guidelines requires that club medics and staff are not only aware of the guidelines but are appropriately trained in the assessment of individuals with recreational drug toxicity. This training should be done on a regular basis with refresher courses for those who have previously attended. It is also important that the guidelines form a part of the standard induction for all new staff; this is particularly important for venues that use agency based rather than permanent staff.

The local ambulance service should be involved in the implementation of these guidelines to ensure that things go smoothly when an ambulance is called.


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