First reported 29 Jul 2021•Latest report 10 Apr 2026
Definition
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.
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.
Reports
3
Distinct published reports
Individual concerns
4
A report can raise multiple concerns
Date range
2021–2026
First to latest report issue date
Stated actions
8
Described in published responses
Reports over time
Reports 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
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Complete formal clinical reviews of ambulance Naloxone Hydrochloride quantities and confirm the current ten-ampoule load list remains appropriate.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 17 April 2026.
Action
Review the naloxone monograph.
Stated by Association of Ambulance Chief ExecutivesStated in progressThe respondent said that this action was in progress when they made their response on 17 April 2026.
Action
Approve changes to the naloxone monograph in response to the concerns raised.
Stated by Association of Ambulance Chief ExecutivesStated completedThe respondent said that this action was complete when they made their response on 17 April 2026.
Action
Remove naloxone use during cardiac arrest from the JRCALC guidance.
Stated by Association of Ambulance Chief ExecutivesStated completedThe respondent said that this action was complete when they made their response on 17 April 2026.
Action
Have the agreed naloxone changes reviewed by the national ambulance service medical directors group.
Stated by Association of Ambulance Chief ExecutivesStated plannedThe respondent said that this action was planned when they made their response on 17 April 2026.
Action
Introduce the approved naloxone changes into ambulance service clinical practice guidelines, subject to approval.
Stated by Association of Ambulance Chief ExecutivesStated plannedThe respondent said that this action was planned when they made their response on 17 April 2026.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
JRCALC and Class Publishing are responsible for resolving the app’s format, navigation and usability issues.
Stated by West Midlands Ambulance Service University NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The recommended maximum naloxone stock is not a realistic operational benchmark because benefit during established cardiac arrest is limited and uncertain.
Stated by West Midlands Ambulance Service University NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Increasing naloxone stock would impose significant logistical and financial burdens disproportionate to its limited and uncertain cardiac-arrest benefit.
Stated by West Midlands Ambulance Service University NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The current load-list quantity of 10 naloxone ampoules per ambulance is considered appropriate for respiratory arrest or respiratory depression.
Stated by West Midlands Ambulance Service University NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Increasing naloxone stocks is unnecessary because naloxone will no longer be recommended during opioid-related cardiac arrest.
Stated by Association of Ambulance Chief ExecutivesNo 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.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Convene the September Clinical Subgroup to discuss toxicological incidents, methylene blue, methaemoglobinaemia management, and potential expansion of HART carriage or trial activity.
Stated by National Ambulance Resilience UnitStated plannedThe respondent said that this action was planned when they made their response on 14 June 2024.
Action
Collate evidence from HART experience and subject-matter experts, then present a report to NASMeD for consideration and review by NASMeD and AACE/JRCALC.
Stated by National Ambulance Resilience UnitStated plannedThe respondent said that this action was planned when they made their response on 14 June 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.7
Position
Decisions about ambulance services carrying specific antidotes are operational matters for individual ambulance trusts.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Individual ambulance trusts, authorised by their medical directors, decide which drugs their services carry.
Stated by Association of Ambulance Chief Executives and NASMeD (National Ambulance Service Medical Directors groupRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Routine ambulance carriage, training and JRCALC inclusion of methylene blue are not considered appropriate because evidence is currently insufficient.
Stated by Association of Ambulance Chief Executives and NASMeD (National Ambulance Service Medical Directors groupNo action considered necessaryThe respondent said that no further action was needed.
Position
Mandating methylene blue carriage on frontline ambulances is outside NARU’s authority.
Stated by National Ambulance Resilience UnitOutside remitThe respondent said that this matter was outside its role or authority.
Position
Each ambulance Trust, authorised by its Executive Medical Director and Chief Pharmacist, decides which drugs its ambulances carry.
Stated by National Ambulance Resilience UnitRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NARU cannot provide guidance on HART carriage until incidence, benefits and costs are better understood through further evidence.
Stated by National Ambulance Resilience UnitUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Equipping every ambulance with methylene blue may be prohibitively costly and create substantial storage, equipment and training burdens.
Stated by National Ambulance Resilience UnitUnable 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.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Emergency Department treatment and related toxicology references are the responsibility of those controlling that setting.
Stated by Royal College of PsychiatristsRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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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.
