First reported 20 Dec 2019•Latest report 10 Apr 2026
Definition
What this concern includes
Includes failures of dedicated pre-hospital medication-provision controls, including decisions about carrying, authorising, supplying, or enabling paramedics to administer required emergency medicines.
Not included
Excludes medication-prescribing, dispensing or administration failures occurring after hospital admission unless they are specifically part of pre-hospital medication provision.
Excludes generic ambulance staffing, training or equipment deficiencies unless they directly prevent paramedics from carrying or administering a required emergency medicine.
Excludes clinical decisions about which medicine is appropriate where access or authorisation to provide the medicine is not deficient.
Excludes medicines and treatments unrelated to emergency pre-hospital care.
Reports
8
Distinct published reports
Individual concerns
8
A report can raise multiple concerns
Date range
2019–2026
First to latest report issue date
Stated actions
18
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.
Welsh Ambulance Services NHS Trust2
West Midlands Ambulance Service University NHS Foundation Trust2
Department of Health and Social Care1
East Midlands Ambulance Service NHS Trust1
Home Office1
Joint Royal Colleges Ambulance Liaison Committee1
Kettering General Hospital1
Medicines and Healthcare products Regulatory Agency1
NHS England1
Office of the Chief Coroner1
South East Coast Ambulance Service NHS Foundation Trust1
NHS trust6
Ministerial department2
Coronial office1
Executive non-departmental public body1
Healthcare site1
Health professional committee1
Medicines and medical devices regulator1
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 raised1
Insufficient Naloxone stock carried per ambulance for opioid-related cardiac arrest
This report raised 2 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.
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.4
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.
West Sussex, Brighton and Hove
Concerns raised1
Unavailability of methylene blue on ambulances for relevant chemical ingestions
This report raised 2 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.
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
Remain engaged in national ambulance-service discussions about methylene blue for sodium nitrite poisoning and review emerging authoritative recommendations.
Stated by South East Coast Ambulance Service NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 13 November 2024.
Action
Continuously review the medication formulary against emerging guidance and new evidence to support patient safety.
Stated by South East Coast Ambulance Service NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 13 November 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Equipping all frontline ambulances with methylene blue and specialist diagnostic equipment is not clinically feasible or cost-effective because of diagnostic, logistical and resource constraints.
Stated by South East Coast Ambulance Service NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Rapid hospital transfer and advanced cardiac life support remain the most appropriate existing response because definitive treatment is available at hospital.
Stated by South East Coast Ambulance Service NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Mandating ambulance services to carry Methylene Blue is outside NHS England’s remit because medication carriage is an operational matter for individual trusts.
Stated by NHS EnglandOutside remitThe respondent said that this matter was outside its role or authority.
Position
Individual ambulance trusts are responsible for deciding whether to carry Methylene Blue; NHS England does not mandate this operational arrangement.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Northamptonshire
Concerns raised1
Unavailability of nasal or buccal analgesics to paramedics
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.1
Action
Take account of concerns when agreeing next steps with NHS England on expanding medicines supply, administration and prescribing responsibilities.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 7 August 2024.
Swansea and Neath Port Talbot
Concerns raised1
Failure of paramedics and ambulance crew to carry flumazenil for acute emergencies
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.1
Action
Authorise trained paramedics to carry and use flumazenil under a patient group directive only to reverse benzodiazepines they administered.
Stated by Welsh Ambulance Services NHS TrustStated completedThe respondent said that this action was complete when they made their response on 25 June 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Flumazenil should not be carried for suspected benzodiazepine overdose because its use is hazardous and contrary to current clinical guidance.
Stated by Welsh Ambulance Services NHS TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Use of flumazenil outside its licensed indication cannot legally be authorised for paramedic use.
Stated by Welsh Ambulance Services NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Existing advanced airway techniques and supportive care strategies are considered more appropriate for managing benzodiazepine overdose.
Stated by Welsh Ambulance Services NHS TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
North West Wales
Concerns raised1
Unavailability of rapid analgesics to paramedics for immediate pre-hospital pain relief
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Northamptonshire
Concerns raised1
Failure to accept recommendations to carry and administer buccal midazolam when necessary
This report raised 5 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.
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.5
Action
Assess the impact of adding buccal midazolam to the medicines formulary, including effectiveness, access, storage and alternative treatments.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Action
Develop an action plan covering training for staff who access or administer buccal midazolam, including patient-held medication.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Action
Add permission to administer buccal midazolam to the Scope of Practice Policy for paramedic staff.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Action
Begin the governance and legal process for transitioning from the current anticonvulsant medication to buccal midazolam.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Action
Develop and present a business case for moving to buccal midazolam, using gathered data and liaison with other ambulance trusts.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
No audit of buccal midazolam training was required because it was not in the medicines formulary at the time.
Stated by East Midlands Ambulance Service NHS TrustNo action considered necessaryThe respondent said that no further action was needed.
Warwickshire
Concerns raised1
Unavailability of an effective antidote on ambulances
This report raised 2 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.
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
Review whether HART paramedics can carry and administer methylene blue for sodium nitrate ingestion cases.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 8 February 2020.
Action
Raise nationally with the NARU clinical subgroup the proposal to make methylene blue availability standard practice.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 8 February 2020.
North Wales (East and Central)
Concerns raised1
Unavailability of intravenous antibiotic administration by ambulance paramedics when emergency department admission is delayed
This report raised 2 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.
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.1
Action
Conduct the PhRASe feasibility study, including paramedic screening, randomisation, blood-culture collection and intravenous antibiotic administration, and complete anonymised follow-up analysis.
Stated by Welsh Ambulance Services NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 3 January 2020.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The Trust will not provide routine pre-hospital antibiotics because evidence, training, equipment, costs and antimicrobial-resistance concerns constrain implementation.
Stated by Welsh Ambulance Services NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Health Board Emergency Department staff are responsible for initiating antibiotics for patients delayed in ambulances because they prescribe and select appropriate treatment.
Stated by Welsh Ambulance Services NHS TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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Includes failures of dedicated pre-hospital medication-provision controls, including decisions about carrying, authorising, supplying, or enabling paramedics to administer required emergency medicines.
