Royal College of Emergency Medicine Guidance 

The Royal College of Emergency Medicine (RCEM) has clinical guidelines available for professionals working in emergency medicine. This section includes guidance on the following: RCEM Guidance, Toolkits and Best Practice. You will find information and college guidance below regarding the following: paracetamol overdose, mental health, drugs and alcohol and guidance implementation. 

RCEM Guidance

College Guidelines 

This page contains guidelines and statements produced by the College's Quality in Emergency Care (QEC) committee. For clinical guidelines relevant to EM published by other organisations please go the External Guidelines page. For clinical guidelines written by Emergency Departments (EDs) and shared for use/adaptation by other EDs please go to the Local Guidelines page.  We'd love to hear your feedback on our guidance documents.

NEW: Security and Restraint in the ED (March 2021)


Coronavirus information page (updated regularly)
NEWEmergency Department Infection Prevention and Control (IPC) during the Coronavirus Pandemic (revised February 2021)

Position Statements

Ambulances Handover Delays: Options Appraisal to Support Good Decision Making (March 2021)
EM Advanced Clinical Practitioners providing safe sedation in the adult Emergency Department (November 2020)
Governance responsibilities for patients who do not attend booked appointments in Emergency Departments (Oct 2020)
RCEM & NASMeD: The management of ADULT cardiac arrest patients taken to EDs during the Covid-19 Pandemic (June 2020)
ED Doctors performing Mental Health Act assessments in England and Wales (Apr 2020)
Sepsis and the Emergency Department (Feb 2020)
Cauda Equina Syndrome (Feb 2020)
Paediatric Trauma: Stabilisation of the Cervical Spine (Jan 2020)
Winter pressures in children's emergency care settings (November 2019)
Improving Quality Indicators & System Metrics for EDs in England (March 2019)
Advanced Life Support (February 2019)
CQUIN to reduce attendances by frequent attenders and mental health attendances (Aug 2017)
Ambulatory Emergency Care Position Statement (Jul 2017)
Complications of Early Pregnancy and the role of the ED (Apr 2017)
Resuscitative Thoracotomy in Trauma Units (Apr 2017)
RCEM Response to RCR Imaging in Paediatric Trauma Guidelines (Mar 2017)
Clinical responsibility for patients within the emergency department (Nov 2016)
Acute Ischaemic Stroke and Intravenous Thrombolysis (Dec 2015)
Alcohol related harm (May 2015)
Needlesticks - ED care of patients who have been potentially exposed to blood borne viruses (Feb 2013)
Providing pre-transfusion blood samples for Police (Oct 2011)
Triage (April 2011) - published by CEM, ENCA, FEN & RCN
Unscheduled Care Facilities (2009) - Minimum requirements for units which see the less seriously ill or injured. Published by CEC, ENCA, FEN & RCN

Resource Toolkits

End of Life Care Toolkit (December 2020)
Ambulatory Emergency Care (Feb 2019)
Mental Health in the ED (revised October 2019)
Initial assessment of Emergency Department patients (Feb 2017)
Sepsis (Sept 2016)
ED crowding overview and toolkit (Dec 2015)
Alcohol toolkit (June 2015)
The Safety Toolkit (Dec 2013)

Best Practice Guidelines

NEWEmergency Department Infection Prevention and Control (IPC) during the Coronavirus Pandemic (revised February 2021)
HIV Testing in the Emergency Department (revised December 2020)
Management of Suspected Internal Drug Trafficker (SIDT) (December 2020)
Nursing Workforce Standards for Type 1 Emergency Departments (October 2020)
Pharmacological Agents for Procedural Sedation and Analgesia (revised October 2020)
Fascia Iliaca Block in the Emergency Department (revised July 2020)
The Patient who Absconds (June 2020)
Raising a Concern - 'Whistleblowing' (May 2020)
Management of Investigation Results in the Emergency Department (revised May 2020)
Homelessness and Inclusion Health (April 2020)
Ketamine Procedural Sedation for Children in EDs (February 2020)
Side by side: A UK-wide consensus statement on working together to help patients with mental health needs in acute hospitals (February 2020)
Traumatic Cardiac Arrest in Adults (September 2019)
Drug Misuse and the Emergency Department  (May 2019)
Emergency Department Out of Hours Discharge Medications  (April 2019)
Management and Transfer of Patients with a Diagnosis of Ruptured Abdominal Aortic Aneurysm to a Specialist Vascular Centre (January 2019)
The Patient who Absconds (June 2018)

Consent in Adults, Adolescents and Children in Emergency Departments (Jan 2018)
A brief guide to Section 136 for Emergency Departments (Dec 2017)
Intravenous Regional Anaesthesia for Distal Forearm Fractures (Bier's Block) (revised Nov 2017)
Information sharing to reduce Community Violence (Sept 2017)
Frequent Attenders in the ED (Aug 2017)
Emergency Department Care (Jul 2017)
Management of Radiology Results in the Emergency Department (revised Jul 2017)
Management of Pain in Children (revised Jul 2017)
A universal FGM flowchart and reporting tool (Jun 2017)
Giving Information to Patients in the Emergency Department (Feb 2017)
The Mental Capacity Act in Emergency Medicine Practice (Feb 2017)
ED Patients in Police Custody (revised Jun 2016)
RCEM guidelines for management of Acute Behavioural Disturbance (May 2016)
Reducing redundant activity in the acute setting (Dec 2015)
Management of Adult Patients who attend Emergency Departments after Sexual Assault and / or Rape (revised Oct 2015)
Management of Domestic Abuse (Mar 2015)
Chaperones in the Emergency Department (Mar 2015)
Management of Pain in Adults (revised Dec 2014)
Caring for adult patients suspected of having concealed illicit drugs (Jun 2014)
Safeguarding Children (Mar 2014)
Safe Sedation in the Emergency Department - Report and Recommendations byRCOA and RCEM (Nov 2012)
'The Silver Book': Quality Care for Older People with Urgent and Emergency Care Needs (Intercollegiate, Jun 2012)
Providing a witness statement for the Police (Feb 2012)
Clinical guideline use in the Emergency Department (Aug 2011)
Cervical Spine: Management of alert, adult patients with potential cervical spine injury in the Emergency Department (Nov 2010)
Practical guide - a short summary of the above c-spine guideline (Nov 2010)

GEMNet Guidelines

The following evidence-based guidelines have been published by GEMNet:
Suspected Scaphoid Fractures - (Flowchart) (Sept 2013)
Thromboprophylaxis in ambulatory trauma patients requiring temporary limb immobilisation - (Flowchart) (Oct 2012)
Info re thromboprophylaxis rev Aug 2013
Example protocol (with thanks to University Hospitals Bristol NHSFT)
Acute allergic reaction - (Flowchart) (Dec 2009)
First seizure in the ED - (Flowchart) (Dec 2009)
Lone acute severe headache - (Flowchart) (Dec 2009)
Tricyclic Antidepressant Overdose - (Flowchart) (Dec 2009)  


RCEM / NPIS Guideline on Antidote Availability for EDs (Jan 2017):
RCEM NPIS Antidote Guideline List
RCEM NPIS Antidote Guideline Appx 1
RCEM NPIS Antidote Guideline Letter
UPDATE: Cyanide poisoning recommendations on first aid treatment for employers and first aiders - Joint Guidance from the Health and Safety Executive and National Poisons Information Service
Emergency treatment of hydrofluoric acid (HF) burns and injury prior to transfer to hospital - Joint Guidance from the CIA, Health and Safety Executive, and National Poisons Information Service


External Guidelines

For clinical guidelines relevant to Emergency Medicine produced by external organisations please click here.

COVID-19 coronavirus

Coronavirus information - including assessment and management of suspected UK cases (PHE, Jan 2020)
Statement on the coronavirus situation in Wuhan, China (DoH, Jan 2019)
Statement by Secretary of State for Health and Social Care - video and transcript (UK Parliament, Jan 2019)
Blog - what you need to know (PHE, Jan 2020)
Information for the public (Department if Health and Social Care, Jan 2020)
Advice for travel to China (PHE, Jan 2020)
Coronavirus (COVID-19) guidance for clinicians (NHS England, March 2020)
Supporting doctors in the event of a Covid19 epidemic in the UK (March 2020)

Ebola Guidance

RCEM Ebola Guidance (RCEM, revised December 2014 )
EPRR CRG Opinion on emergency care for Ebola (24 October 2014)

RCEM letter to clinicians - travel history (Public Health England, March 2015)
Ebola: infection prevention and control for emergency departments (Public Health England, November 2014)
Ebola: infection prevention and control for primary care (Public Health England, November 2014)
Ebola outbreak in West Africa (European Centre for Disease Prevention and Control)

Rapid Risk Assessment (European Centre for Disease Prevention and Control, 13 October 2014)
WHO Global Alert and Response (GAR) (WHO)


Selected further guidance and resources

Invasive procedure checklist for EDs (May 2016)
Paracetamol overdose guidance
H1N1 influenza: Principles and resources for EDs (last updated 4th Jan 2011)

Committee templates

Best Practice guideline template (March 2021)

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