Failure to ensure paramedics have required emergency medicines for pre-hospital care
First to latest report 20 Dec 2019 — 10 Apr 2026
Reports that mention this concern
8
Times this concern has been raised
8
Stated actions linked to this concern
18
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.
What is 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.
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.
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
Reports and published responses 8 reports
See individual reports that have raised this concern, and the actions taken in response
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.
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.4
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.
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.
Linked responses
NHS England
South East Coast Ambulance Service 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.2
South East Coast Ambulance Service NHS Foundation Trust
Remain engaged in national ambulance-service discussions about methylene blue for sodium nitrite poisoning and review emerging authoritative recommendations.
South East Coast Ambulance Service NHS Foundation Trust
Continuously review the medication formulary against emerging guidance and new evidence to support patient safety.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
South East Coast Ambulance Service NHS Foundation Trust
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.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
South East Coast Ambulance Service NHS Foundation Trust
Rapid hospital transfer and advanced cardiac life support remain the most appropriate existing response because definitive treatment is available at hospital.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
Mandating ambulance services to carry Methylene Blue is outside NHS England’s remit because medication carriage is an operational matter for individual trusts.
Outside remitThe respondent said that this matter was outside its role or authority.
NHS England
Individual ambulance trusts are responsible for deciding whether to carry Methylene Blue; NHS England does not mandate this operational arrangement.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Northamptonshire
Concerns raised1
Unavailability of nasal or buccal analgesics to paramedics
Linked response
Department of Health and Social Care
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Department of Health and Social Care
Take account of concerns when agreeing next steps with NHS England on expanding medicines supply, administration and prescribing responsibilities.
Swansea and Neath Port Talbot
Concerns raised1
Failure of paramedics and ambulance crew to carry flumazenil for acute emergencies
Linked response
Welsh Ambulance Services NHS 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.1
Welsh Ambulance Services NHS Trust
Authorise trained paramedics to carry and use flumazenil under a patient group directive only to reverse benzodiazepines they administered.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Welsh Ambulance Services NHS Trust
Flumazenil should not be carried for suspected benzodiazepine overdose because its use is hazardous and contrary to current clinical guidance.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Welsh Ambulance Services NHS Trust
Use of flumazenil outside its licensed indication cannot legally be authorised for paramedic use.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Welsh Ambulance Services NHS Trust
Existing advanced airway techniques and supportive care strategies are considered more appropriate for managing benzodiazepine overdose.
Existing 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
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.
Linked response
East Midlands Ambulance Service NHS 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.5
East Midlands Ambulance Service NHS Trust
Assess the impact of adding buccal midazolam to the medicines formulary, including effectiveness, access, storage and alternative treatments.
East Midlands Ambulance Service NHS Trust
Develop an action plan covering training for staff who access or administer buccal midazolam, including patient-held medication.
East Midlands Ambulance Service NHS Trust
Add permission to administer buccal midazolam to the Scope of Practice Policy for paramedic staff.
East Midlands Ambulance Service NHS Trust
Begin the governance and legal process for transitioning from the current anticonvulsant medication to buccal midazolam.
East Midlands Ambulance Service NHS Trust
Develop and present a business case for moving to buccal midazolam, using gathered data and liaison with other ambulance trusts.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
East Midlands Ambulance Service NHS Trust
No audit of buccal midazolam training was required because it was not in the medicines formulary at the time.
No 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.
Linked response
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.2
West Midlands Ambulance Service University NHS Foundation Trust
Review whether HART paramedics can carry and administer methylene blue for sodium nitrate ingestion cases.
West Midlands Ambulance Service University NHS Foundation Trust
Raise nationally with the NARU clinical subgroup the proposal to make methylene blue availability standard practice.
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.
Linked response
Welsh Ambulance Services NHS 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.1
Welsh Ambulance Services NHS Trust
Conduct the PhRASe feasibility study, including paramedic screening, randomisation, blood-culture collection and intravenous antibiotic administration, and complete anonymised follow-up analysis.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Welsh Ambulance Services NHS Trust
The Trust will not provide routine pre-hospital antibiotics because evidence, training, equipment, costs and antimicrobial-resistance concerns constrain implementation.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Welsh Ambulance Services NHS Trust
Health Board Emergency Department staff are responsible for initiating antibiotics for patients delayed in ambulances because they prescribe and select appropriate treatment.
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.