All Wales steroid card: the way forward
Kavitha Tharian, Carol Fraser & Rebekah Pryce
Introduction: Children on long-term steroid replacement for adrenal insufficiency may need emergency administration of i.m. hydrocortisone when unwell. There was a recent incident in Wales in terms of the out of hospital administration of hydrocortisone by ambulance crew. A child on long-term hydrocortisone for hypopituitarism became unwell at school. When the ambulance crew attended, it was brought to our attention that they cannot administer i.m. hydrocortisone unless the underlying diagnosis is Addisons disease!
Discussion: Majority of paediatric patients who require steroid replacement do not have Addisons as the underlying diagnosis (i.e. have adrenal insufficiency from other causes), this therefore causes a potential delay in emergency treatment to a large group of patients. This is, despite all ambulance teams carrying hydrocortisone as part of their emergency equipment. All the UK ambulance trusts follow the same guidelines and therefore this is a potential problem for the whole of UK.
The way forward: We wrote to BSPED - as a group representing paediatric patients with endocrine conditions in the UK to try and remedy this problem by highlighting this to the ambulance guidelines committee so that future publications may be amended. It should be clear that any patient on long term steroid replacement may present in an adrenal crisis at times of illness. A dose of intramuscular hydrocortisone should be considered in these circumstances.
In the interim period within Wales we are registering patients on long-term steroid use with the ambulance trust so that there is an alert on the system to highlight the potential need and thereby prevent adverse incidents.
We are also developing an All Wales steroid card in conjunction with the Welsh Ambulance Trust so that this may be recognized and acted upon by the attending paramedic. This may be later adopted all over the UK, if found useful.