Protocols 38–47
Emergency Department Protocol Commons
Consultation Edition, Version 0.9
Phase VI addresses ten groups of maternal, paediatric and vulnerable-patient emergencies in which physiology, age, pregnancy, development, dependency, mental state, safeguarding risk or complex chronic disease may alter recognition, treatment, consent, monitoring and disposition.
The protocols provide structured pathways for obstetric and postpartum emergencies, acute gynaecological emergencies, seriously ill children, neonatal emergencies, mental-health crisis and self-harm, safeguarding and sexual assault, frailty and acute functional decline, sickle cell disease, immunocompromised and oncology emergencies, and renal failure or dialysis-related emergencies—from immediate recognition and stabilization through investigation, specialist treatment, reassessment, admission, transfer, observation, safeguarding action, family support or safe discharge.
These protocols are intended for professional review and responsible local adaptation. They are not approved clinical policies and must not be implemented without verification against current guidance, local resources, professional scopes of practice, medication formularies, legislation, maternal and paediatric services, mental-health and safeguarding law, blood-bank and dialysis capability, specialist and transfer arrangements, consent and confidentiality requirements, and institutional governance processes.
Download Phase VI
The complete phase may be downloaded in either of the following formats:
Download the complete Phase VI package — PDF and editable Word copies
Download the Phase VI editable Word package for local adaptation
Readers may also review the individual PDF consultation copies below.
How to Review This Phase
Reviewers are not expected to comment on all ten protocols.
Please select the protocols most relevant to your experience and consider:
Clinical safety and accuracy
Medication, fluid and weight-based dosing safety
Maternal, fetal, neonatal and paediatric monitoring requirements
Mental-health, capacity, consent and least-restrictive-care safeguards
Safeguarding, forensic, confidentiality and reporting requirements
Frailty, disability, caregiver and functional considerations
Blood-bank, transfusion, oncology, haematology and dialysis capacity
Specialist referral and interfacility transfer arrangements
Trauma-informed, family-centred and culturally safe care
Resource-variable and small-island realities
Important omissions or unnecessary complexity
Please submit a separate feedback form for each protocol being reviewed.
Submit feedback on a Phase VI protocol
Protocol 38 — Obstetric and Postpartum Emergencies
This protocol provides a time-critical pathway for pregnant and postpartum patients with maternal instability, obstetric haemorrhage, severe hypertension, eclampsia, sepsis, thromboembolism, cardiopulmonary emergencies or imminent birth.
It covers maternal ABCDE stabilization, fetal assessment, emergency delivery, haemorrhage control, uterotonic and antihypertensive treatment, magnesium sulfate, newborn preparation, operative or critical-care escalation, bereavement support, transfer and safe disposition.
Read or download the PDF consultation copy
Protocol 39 — Acute Gynaecological Emergencies
This protocol addresses acute pelvic pain, vaginal bleeding, collapse and other presentations in which pregnancy-related or gynaecological disease may threaten life, fertility or long-term health.
It covers pregnancy assessment, ectopic pregnancy and pregnancy of unknown location, miscarriage complications, acute uterine bleeding, adnexal torsion, pelvic inflammatory disease, tubo-ovarian abscess, haemorrhage control, ultrasound, specialist escalation, surgery, transfer and follow-up.
Read or download the PDF consultation copy
Protocol 40 — Paediatric Emergency Assessment and the Seriously Ill Child
This protocol provides an age-appropriate pathway for infants, children and young people who may be seriously ill, deteriorating or at risk of under-triage.
It covers rapid visual assessment, full paediatric observations, PEWS escalation, ABCDE stabilization, weight-based medicines and fluids, fever and sepsis, respiratory distress, shock, dehydration, safeguarding, family partnership, repeated reassessment, admission, transfer and safe discharge.
Read or download the PDF consultation copy
Protocol 41 — Neonatal Emergencies
This protocol addresses emergency assessment and stabilization of newborn babies from birth through 28 completed days, including preterm and recently discharged infants.
It covers newborn resuscitation, thermal protection, hypoglycaemia, feeding failure, sepsis, jaundice, respiratory distress, circulatory instability, seizures, congenital heart disease, bowel obstruction, surgical emergencies, safeguarding, neonatal transport and safe disposition.
Read or download the PDF consultation copy
Protocol 42 — Mental Health Crisis, Self-Harm, Agitation, and Behavioural Emergency
This protocol provides a humane, integrated pathway for mental-health crisis, suicidal thoughts, self-harm, agitation, acute behavioural disturbance and other psychiatric emergencies.
It covers parallel medical and mental-health assessment, suicide and self-harm care, environmental safety, trauma-informed de-escalation, capacity, observation, least-restrictive intervention, monitored emergency sedation, restraint safeguards, mental-health consultation, transfer and collaborative safety planning.
Read or download the PDF consultation copy
Protocol 43 — Safeguarding, Abuse, Neglect, and Sexual Assault
This protocol provides a trauma-informed pathway for suspected or disclosed abuse, neglect, sexual assault, intimate-partner violence, exploitation and human trafficking involving children or adults at risk.
It covers urgent medical and psychological care, private enquiry, immediate safety, forensic preservation, preventive treatment, confidentiality, consent, mandatory reporting, child- and adult-protection referral, safe placement, coordinated follow-up and avoidance of repeated or investigative questioning.
Read or download the PDF consultation copy
Protocol 44 — Frailty, Falls, and Acute Functional Decline in Older Adults
This protocol addresses falls, new confusion, reduced mobility, weakness, poor intake and loss of usual function in older adults and other people living with frailty.
It covers delirium, occult illness and injury, medication burden, mobility, pain, nutrition, pressure risk, caregiver capacity, safeguarding, goals of care, comprehensive geriatric assessment, rehabilitation needs, admission, observation and safe supported discharge.
Read or download the PDF consultation copy
Protocol 45 — Sickle Cell Emergencies
This protocol provides a rapid, equitable pathway for people with sickle cell disease presenting with acute pain or possible life-threatening complications.
It covers timely analgesia, vaso-occlusive pain, acute chest syndrome, fever and sepsis, stroke, severe anaemia, aplastic crisis, splenic or hepatic sequestration, priapism, transfusion complications, pregnancy-related risk, paediatric presentations, specialist escalation and safe disposition.
Read or download the PDF consultation copy
Protocol 46 — Immunocompromised, Neutropenic, and Oncology Emergencies
This protocol addresses acute illness in immunocompromised patients and emergencies caused by cancer or its treatment, including presentations that may initially appear deceptively mild.
It covers neutropenic sepsis, central-line infection, tumour lysis syndrome, hypercalcaemia, metastatic spinal-cord compression, thrombosis, cytopenias and bleeding, malignant airway or mediastinal compromise, treatment extravasation, immune and cellular-therapy toxicity, specialist escalation and transfer.
Read or download the PDF consultation copy
Protocol 47 — Renal Failure and Dialysis-Related Emergencies
This protocol provides a dialysis-specific pathway for patients with renal failure, missed or interrupted dialysis, urgent dialysis indications and complications of haemodialysis or peritoneal dialysis.
It covers life-threatening hyperkalaemia, fluid overload, uraemic complications, dialysis-access haemorrhage or infection, catheter and fistula protection, peritoneal-dialysis peritonitis, medication adjustment, urgent renal consultation, stabilization during transfer and safe disposition.
Read or download the PDF consultation copy
Submit Feedback
Feedback from emergency clinicians, nurses, midwives, pharmacists, paediatric and neonatal professionals, obstetric and gynaecological teams, mental-health and safeguarding professionals, geriatric and rehabilitation teams, haematology, oncology and renal services, allied health professionals, administrators, patient-safety personnel and other relevant reviewers is welcomed.
Please identify:
The protocol number
The relevant section or page
The concern or recommendation
Suggested replacement wording where possible
Supporting evidence or local experience
Whether the issue may represent an urgent patient-safety concern
Submit feedback on the Emergency Department Protocol Commons
Complete Protocol Index
Browse all 59 protocols and download individual PDF or editable Word copies
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