1. BACKGROUND The use of Benzylpenicillin in the management of suspected meningococcal disease is a national recommendation. Qualified ambulance staff are licensed to give Benzylpenicillin by the use of Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines 1 which instructs its use in the presence of a fever and a non blanching rash. Evidence suggests that the use of Benzylpenicllin is more effective if given earlier in the disease. 2 Recent changes to Out of Hours provision has meant that qualified ambulance staff are working as part of a multidicisplinary team based in walk in Centres and out of hours providers undertaking home visits. EPIDEMIOLOGY The West Midlands rate is 70% higher than any other region. 3 The highest rates of disease were seen in Coventry and Warwickshire HPU (3.21 per 100 000) with South Warwickshire PCT having the highest rate of disease for an individual PCT (5.87 per 100 000), Coventry and Warwickshire HPU is the only HPU to have seen an increase in the rates of meningococcal disease in 2004 compared to 2003 a 24% increase (2.59 to 3.21). There is much evidence to suggest that early recognition and prompt treatment can influence outcome in meningococcal disease. 2 Benzylpenicillin should be administered promptly, preferably intravenously, whenever meningococcal disease is suspected. 4 EARLY MANAGEMENT RESULTS 35 (54%) of the Sixty six cases of probable and confirmed cases of meningococcal disease for 2005 were treated by qualified ambulance staff. Presenting symptoms No. % Rash 1440 Headache 1337 Vomiting 926 Fever 1851 Tachycardia 2160 Altered consciousness 1544 Joint pains 822 14 of the 35 presented with symptoms rash, fever, shock and altered consciousness fulfilling the criteria for giving benzylpenicillin 5 of these were given benzylpenicillin 3 of which were under GP instruction 9 did not receive benzylpenicillin Meningococcal disease was suspected in a further 8 cases but they did not fit the full criteria of JRCALC guidelines for giving benzylpenicillin CONCLUSION Contact with a meningitis case in the pre hospital phase is likely to be by qualified ambulance staff. Therefore training, updates and reminders of giving Benylpenicillin should be targeted at this group. Development of extended practice by implementation of a Patient Group Direction (PGD) will allow ambulance staff to supply and administer Benzylpenicillin earlier in the disease to locally agreed arrangements. This will require specific training of staff supported by an ongoing audit programme with dissemination of results. This should support paramedics diagnostic abilities and reduce inappropriate administration of Benzylpenicillin with potential serious adverse reactions. 5 Granier,S owen, P and Stoot,NC. ( 1998) Recognizing meningococcal disease: the case for further research in primary care.Br J Gen Pract 1998; 48: 1167 - 71 6 Roberts, K, Jewkes,F, Whalley, H, Hopkins, D and Porter,K. (2005) A review of emergency equipment carried and procedures performed by UK front Line paramedics on paediatric patients. EMJ ( 2005); 22: 572-576 The sole indication for the pre-hospital administration of Benzyl Penicillin by paramedics is the suspected diagnosis of meningococcal septicaemia, which should be identified by the presence of a non-blanching purpuric rash with a patient presenting with a history of fever, evidence of shock and diminished conscious level. OBJECTIVES To identify the involvement of qualified ambulance staff in the management and diagnosis of suspected meningococcal disease case in 2005 in one HPU area with a increase in incidence of meningococcal disease. To assess the implementation of the JRCALC guidelines in providing the most appropriate and evidenced based care. METHOD 66 cases of probable and confirmed cases of meningococcal disease notified for 2005 were reviewed for paramedic involvement and administration of Benzylpenicillin. Patient report forms from the ambulance service were reviewed for Compliance with JRCALC clinical guidelines and diagnosis on admission to hospital References; 1. Joint Royal Colleges ambulance liaison committee ( JRCALC) 2003.Meningococcal Septicaemia: Identification & Management for ambulance personnel Cartwright, K, Reilly,S, White, D and Stuart, J. ( 1992) Early treatment with parenteral 2. Penicillin in meningococcal disease.BMJ 1992; 305: 143 - 7 3. WestMidlands report on meningococcal disease, ( 2005) West Midlands regional HPA 4. Wang VJ, Malley R, Fleisher GR, Inkelis SH, Kuppermann N. Antibiotic treatment of children with unsuspected meningococcal disease. Arch Pediatr Adolesc Med 2000; 154: 556-560 A REVIEW OF THE ADMINSITRATION OF BENZYLPENICILLLIN FOR MENINGOCOCCAL DISEASE BY QUALIFIED AMBULANCE STAFF IN A HIGH INCIDENCE AREA D Khan and F Jabeen Coventry and Warwickshire Health Protection Unit A Butters and M Wyse Coventry and Warwickshire Ambulance Trust