This information has been provided to the AADAI by the state and territory ambulance services. Please raise any issues you have with your ambulance service.
New South Wales M24 Protocol - Adrenal Insufficiency
Information approved by Executive Director - Clinical Systems Integration – September 2020
Queensland Adrenal Insufficiency Protocol
Information approved by Executive Manager – Clinical Policy Development - July 2022
Clinical Practice Guideline - Acute Adrenal Insufficiency
A/Executive Director
Clinical Services
Information Current as at July 2022
WA ambulances do not carry the Solu-Cortef® Act-o-Vial for patients with adrenal insufficiency and do not intend to at this stage. They will authorise their paramedics to administer the patient's own Solu-Cortef® Act-o-Vial.
They maintain a register of AI patients, and encourage anyone with AI to register with their local ambulance service. Patients also need to provide a letter from their doctor providing authorisation for the injection, preferably to be lodged with the Ambulance Service beforehand but can also be handed to the ambulance crew when needed.
Absence of a letter does not mean the crew will not administer the medication; they would have to get authorisation from the on-call medical doctor through their call centre. This would take more time. Likewise, if the patient is carrying the letter and hasn't registered it prior to the event the crew may still choose to get permission from the Clinical Support Paramedic, again taking longer.
The preferred method is to email a signed letter from the patient’s GP authorising the administration of the medication to ClinicalGovernanceAdmin@stjohnambulance.com.au. This will be stored, and a notation made against the patient's address giving advanced warning to any crew called out. Any change of address should be notified in the same way so records can be updated.
Clinical Services General Manager (Acting)
St John Ambulance Western Australia Ltd.
Updated February 2020
NT Ambulances carry dexamethasone as the steroid of choice. This may change later in the year when drug and therapeutic strategies are reviewed.
NT patients with adrenal insufficiency should register with their local ambulance service.
Updated August 2020
Approved by:
Chief Medical Officer
St John Ambulance Australia (NT) Inc.
ACT Hydrocortisone Pharmacology
ACT ambulances carry injectable hydrocortisone and will administer it.
Acting Clinical Assurance Officer –Clinical Governance Uni
Information supplied - May 2020
Adrenal Insufficiency (Paediatric)
Approved by Manager Clinical Practice Guidelines
Medical Directorate 2022
Ambulance Tasmania does not have a specific Clinical Practice Guideline for Addisonian (Acute Adrenal) Crisis.
They do carry intravenous fluids, glucose, and dexamethasone which can be used in the management of this condition.
Paramedics may obtain a medical consultation with the Retrieval Consultant which can be undertaken via State Operation Centre for guidance on the emergency management of this condition.
If there are specific requirements for a particular patient, an individual care plan can be created in line with the AT procedure for these care plans. This would be undertaken in conjunction with the Regional Training Unit, Director Medical Services, and patient’s physician.
Executive Support Officer
Office of the Director, Medical Services
Ambulance Tasmania
Approved by AADAI Executive - June 2020