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Meningococcal septicaemia is not common in Australia. The disease does however have a rapid onset and relatively high levels of mortality and morbidity, particularly in children and adolescents. An effective vaccine has been introduced to protect against Group C disease, however no commercially available vaccine exists to protect against Group B which accounts for the majority of cases in Australia. Australian authorities recommend the early administration of antibiotics to cases of suspected meningococcal septicaemia. Ambulance services are important providers of primary healthcare with strong clinical governance processes. They are well placed to assist in meeting the goal of early antibiotic therapy particularly in rural and remote areas where there may be prolonged ambulance transport times and variable access to medical practitioners and other primary healthcare providers. In late 2003 Rural Ambulance Victoria introduced clinical practice guidelines which authorised ambulance and intensive care paramedics to administer the antibiotic Ceftriaxone in cases of suspected meningococcal septicaemia. This paper reviews meningococcal disease in Australia, explores the drivers and processes leading to the development of these guidelines, outlines experiences with the program to date, and identifies the need for further research in this area.

Pre-hospital paramedic administration of Ceftriaxone for suspected meningococcal septicaemia in Victoria, Australia