Unreliable antidote treatment arrangements for toxic-substance poisoning
First to latest report 29 Jul 2021 — 10 Apr 2026
Reports that mention this concern
3
Times this concern has been raised
4
Stated actions linked to this concern
8
What this concern includes
Includes failures in arrangements for identifying, selecting, making available, carrying, storing, administering or escalating possible antidote treatment for toxic-substance poisoning, including guidance for cardiac-arrest cases and protocols for on-scene antidote administration.
What is not included
Excludes treatment of poisoning where no antidote-related control is deficient.
Excludes general toxicology, poisoning recognition or emergency-response failures that do not concern possible antidote treatment.
Excludes condition-specific anticoagulant-reversal systems where the assertion is confined to Factor Xa or another named anticoagulant pathway with a more specific supported concern.
Excludes medication prescribing, storage or administration failures unrelated to antidotes for toxic-substance poisoning.
Excludes failures occurring after an appropriate antidote has been reliably selected, made available and administered.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Association of Ambulance Chief Executives1
Department of Health and Social Care1
Emergency Call Prioritisation Advisory Group1
Joint Royal Colleges Ambulance Liaison Committee1
National Ambulance Resilience Unit1
National Ambulance Service Medical Directors1
NHS England1
Public Health England1
Royal College of Psychiatrists1
West Midlands Ambulance Service University NHS Foundation Trust1
Executive agency1
Executive non-departmental public body1
Health professional body1
Health professional committee1
Health-sector membership body1
Ministerial department1
NHS trust1
Other public body1
Professional body1
Sub-organisation1
Reports and published responses 3 reports
See individual reports that have raised this concern, and the actions taken in response
Shropshire, Telford and Wrekin
Concerns raised2
Difficulties in locating the appropriate cardiac-arrest Naloxone guidance on the JRCALC app
Insufficient Naloxone stock carried per ambulance for opioid-related cardiac arrest
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
Association of Ambulance Chief Executives
West Midlands Ambulance Service University NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
West Midlands Ambulance Service University NHS Foundation Trust
Complete formal clinical reviews of ambulance Naloxone Hydrochloride quantities and confirm the current ten-ampoule load list remains appropriate.
Association of Ambulance Chief Executives
Review the naloxone monograph.
Association of Ambulance Chief Executives
Approve changes to the naloxone monograph in response to the concerns raised.
Association of Ambulance Chief Executives
Remove naloxone use during cardiac arrest from the JRCALC guidance.
Association of Ambulance Chief Executives
Have the agreed naloxone changes reviewed by the national ambulance service medical directors group.
Association of Ambulance Chief Executives
Introduce the approved naloxone changes into ambulance service clinical practice guidelines, subject to approval.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
West Midlands Ambulance Service University NHS Foundation Trust
JRCALC and Class Publishing are responsible for resolving the app’s format, navigation and usability issues.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
West Midlands Ambulance Service University NHS Foundation Trust
The recommended maximum naloxone stock is not a realistic operational benchmark because benefit during established cardiac arrest is limited and uncertain.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
West Midlands Ambulance Service University NHS Foundation Trust
Increasing naloxone stock would impose significant logistical and financial burdens disproportionate to its limited and uncertain cardiac-arrest benefit.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
West Midlands Ambulance Service University NHS Foundation Trust
The current load-list quantity of 10 naloxone ampoules per ambulance is considered appropriate for respiratory arrest or respiratory depression.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Association of Ambulance Chief Executives
Increasing naloxone stocks is unnecessary because naloxone will no longer be recommended during opioid-related cardiac arrest.
No action considered necessaryThe respondent said that no further action was needed.
Buckinghamshire
Concerns raised1
Lack of ambulance carriage of appropriate antidote medication for on-scene administration
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
Association of Ambulance Chief Executives
NASMeD (National Ambulance Service Medical Directors group
National Ambulance Resilience Unit
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
National Ambulance Resilience Unit
Convene the September Clinical Subgroup to discuss toxicological incidents, methylene blue, methaemoglobinaemia management, and potential expansion of HART carriage or trial activity.
National Ambulance Resilience Unit
Collate evidence from HART experience and subject-matter experts, then present a report to NASMeD for consideration and review by NASMeD and AACE/JRCALC.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.7
NHS England
Decisions about ambulance services carrying specific antidotes are operational matters for individual ambulance trusts.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Association of Ambulance Chief Executives and NASMeD (National Ambulance Service Medical Directors group
Individual ambulance trusts, authorised by their medical directors, decide which drugs their services carry.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Association of Ambulance Chief Executives and NASMeD (National Ambulance Service Medical Directors group
Routine ambulance carriage, training and JRCALC inclusion of methylene blue are not considered appropriate because evidence is currently insufficient.
No action considered necessaryThe respondent said that no further action was needed.
National Ambulance Resilience Unit
Mandating methylene blue carriage on frontline ambulances is outside NARU’s authority.
Outside remitThe respondent said that this matter was outside its role or authority.
National Ambulance Resilience Unit
Each ambulance Trust, authorised by its Executive Medical Director and Chief Pharmacist, decides which drugs its ambulances carry.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
National Ambulance Resilience Unit
NARU cannot provide guidance on HART carriage until incidence, benefits and costs are better understood through further evidence.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
National Ambulance Resilience Unit
Equipping every ambulance with methylene blue may be prohibitively costly and create substantial storage, equipment and training burdens.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Cambridgeshire and Peterborough
Concerns raised1
Lack of national guidance for A&E clinicians on when to administer possible antidotes for toxic substances
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Royal College of Psychiatrists
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Royal College of Psychiatrists
Emergency Department treatment and related toxicology references are the responsibility of those controlling that setting.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.