St John EHS
On call · St John EHS

What's happening?

Pick the closest scenario. Always call Triple Zero (000) for life-threatening emergencies.
Severe allergic reaction
Adrenaline IM · thigh · 500/300/150 mcg
Severe bleed
Pressure · tourniquet · pack
Crushing chest pain
Aspirin 300 mg · GTN per Rx
Asthma or wheeze
Salbutamol 4·4·4 · spacer
Low blood sugar
Glucose · glucagon if Adv.
Suspected opioid overdose
Naloxone IN · airway · 000
Browse all medications & procedures
19 medications · 5 procedures · approval matrix
Recently used
  1. 19Adrenaline (auto-injector)2 min ago
  2. 16Arterial tourniquettoday
  3. 68Paracetamoltoday
Emergency · Anaphylaxis

Severe allergic reaction.

Source — Adrenaline (Epinephrine) auto-injector or ampoule. EpiPen®, AnaPen®.
If anaphylaxis: impaired LOC, or symptoms involving more than one body system.
Give adrenaline IM into the mid-lateral thigh. Hold the auto-injector firmly for 3 seconds.
Adult 12+
500mcg
Child 5–11
300mcg
Child < 5
150mcg
Repeat every 5 minutes if symptoms remain. Use a different muscle each time.
As First Responder
ApprovedAuto-injector approved.
Position the patient
  1. Lie flat. Do not let them stand or walk.
  2. If unconscious, place in the recovery position and give the auto-injector immediately.
  3. If pregnant and unconscious, recovery position on the left side.
  4. If breathing is difficult, allow the patient to sit with legs outstretched.
  5. Hold young children flat, not upright.
Sourcep. 20
Administer adrenaline IM
  1. Inject IM into mid-lateral thigh — or deltoid if thigh inaccessible.
  2. Press auto-injector firmly against skin and hold 3 seconds.
  3. Record drug and time on the Patient Record.
  4. Continue basic life support; provide oxygen therapy.
  5. Monitor conscious state, pulse, BP, pulse oximetry.
  6. If wheeze present, also treat with reliever (salbutamol or ipratropium) — but never delay IM adrenaline.
  7. Repeat at 5-minute intervals if symptoms remain. Different muscle each time.
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Critical

Any patient who has been treated with adrenaline must be assessed by a St John healthcare professional or the ambulance service.

Sourcep. 20 Sourcep. 19
Emergency · Catastrophic haemorrhage

Severe bleed.

Direct pressure first. If unable to control: arterial tourniquet for limbs; haemostatic packing for groin / armpit / neck.
Severe limb bleed not controlled by firm direct pressure.
Apply tourniquet 5–8 cm (≈ 3 finger-widths) above the bleeding site, directly to the skin. Twist windlass until bleeding stops.
Once on, do not remove. Mark application time on the limb. Call Triple Zero (000).
As First Responder
ApprovedAll EHS levels — tourniquet and wound packing.
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Cautions
  • Apply directly to the skin — never over a joint, wound, clothing, or wet suit.
  • Do not cover the tourniquet with bandages or clothing.
  • Once applied, do not remove. Limb will go cold and dusky — this is normal.
Apply the tourniquet
  1. Follow DRSABCD. Call Triple Zero (000).
  2. Wrap the strap around the bleeding limb.
  3. Position 5–8 cm above the bleeding site, directly to the skin (forearm, upper arm, leg, or thigh).
  4. Pull the strap tight but over the windlass clips.
  5. Twist the windlass until bleeding stops. Warn the conscious patient — significant pain.
  6. Secure the windlass to keep it in place.
  7. Check bleeding stopped & distal pulse absent. Limb cold + dusky is normal — do not remove.
  8. If bleeding does not stop, check position and how it has been applied.
  9. If still bleeding, apply a second tourniquet just above the first, if available.
  10. Record application time on the device or on the limb above the tourniquet.
  11. Confirm an ambulance has been called — Triple Zero (000).
Sourcep. 16 Sourcep. 18
Emergency · Asthma / wheeze

Asthma attack.

Salbutamol — the ‘blue puffer’.
Wheeze, persistent cough, or shortness of breath.
Give salbutamol via spacer: 4 puffs, 4 breaths each, every 4 minutes.
Sit the patient up. Reassure. Call 000 if no improvement after one cycle.
As First Responder
ApprovedSalbutamol inhaler approved.
Manage
  1. Sit the patient up. Comfortable, leaning slightly forward. Stay calm and reassure.
  2. If they have their own reliever, use it first.
  3. Salbutamol via spacer: 4 puffs · 4 breaths each · every 4 minutes.
  4. If first-time wheeze without history, treat as asthma.
  5. Provide oxygen therapy if available.
  6. Call 000 if no improvement, severe distress, or no salbutamol available.
Sourcep. 71
Emergency · Acute coronary syndrome

Crushing chest pain.

Aspirin · Glyceryl Trinitrate (only on patient’s own prescription).
Suspected acute coronary syndrome (angina, heart attack).
Give aspirin 300 mg — chewed if chewable, otherwise swallowed with water.
Adult / child 12 +. Skip if known allergy or anti-coagulant (e.g. warfarin).
As First Responder
Aspirin approvedGTN — only with the patient’s own prescription.
!
Caution

Cardiac pain may mimic indigestion. If in doubt, treat as cardiac, not gastric — request a St John healthcare professional or ambulance as a precaution.

Manage
  1. Sit the patient down, rest, reassure. Loosen tight clothing.
  2. Call Triple Zero (000).
  3. Aspirin 300 mg — chewed or swallowed. Adult / child 12 +.
  4. If patient has their own GTN spray and prescription, support them to use as directed (First Responder Y², Advanced Y).
  5. Monitor pulse, breathing, conscious state. Be ready to perform CPR.
Sourcep. 34 Sourcep. 42
Emergency · Hypoglycaemia

Low blood sugar.

Glucose tablets / gel · Glucagon hydrochloride (Advanced).
Conscious patient, able to swallow safely.
Give glucose — tablets or gel. Re-dose in 10–15 minutes if no improvement.
Unconscious or unable to swallow → recovery position; glucagon IM (Advanced Responder only); 000.
As First Responder
ApprovedGlucose. Glucagon is Advanced Responder only.
Manage
  1. Conscious & able to swallow: give glucose tablets or gel. Sit them down.
  2. Re-check in 10–15 minutes. Re-dose if no better.
  3. Once recovered, follow with a complex carb (sandwich, fruit) if safe to eat.
  4. Unconscious: recovery position, do not give anything by mouth, call 000.
  5. If Advanced Responder: glucagon IM (1 mg adult, 0.5 mg child < 25 kg).
Sourcep. 36 Sourcep. 40
Emergency · Suspected opioid overdose

Suspected opioid overdose.

Naloxone — intranasal spray (First Responder) or IM (Advanced).
Decreased LOC + pin-point pupils + slow / absent breathing.
Give naloxone intranasal, support airway and breathing, call 000.
Repeat as per product instructions if no response after 2–3 minutes.
As First Responder
ApprovedIntranasal naloxone. IM is Advanced Responder only.
Manage
  1. DRSABCD. Open airway, check breathing.
  2. If not breathing normally — start CPR. Call Triple Zero (000).
  3. Administer naloxone intranasal per device instructions.
  4. Re-assess every 2–3 minutes. Repeat dose if no response.
  5. Place in recovery position once breathing is restored.
  6. Stay until ambulance arrives — relapse is possible as naloxone wears off.
Sourcep. 56
Medication

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