NHS & Ambulance
Management Guide

1. Clinical Dress: Bare Below Elbows (BBE)

The Solution (Approved by Dept of Health):

• Disposable Oversleeves: Muslim staff can wear full sleeves, but must pull them up and wear disposable plastic oversleeves (gauntlets) when touching patients. These are changed between patients.
• Uniforms: NHS trusts must provide longer tunic tops to cover the hips. Standard scrubs are often too short/tight, causing exposure when bending over a bed.

2. Medicines & Diet

Many common medications contain animal products. This causes distress if not explained.

• Porcine Gelatine: Found in many capsules (e.g., Creon). Ruling: If it is life-saving and no alternative exists, it is Permissible (Halal). However, always check for "Vegetarian/Vegan" alternatives first to reassure the patient.
• Alcohol: Found in cough syrups. Ruling: It is not intoxicating, so generally permitted medicinally. but warn the patient so they can choose.
• Insulin & Fasting: Diabetic Muslims often stop insulin to fast. This is dangerous. Refer them to the British Islamic Medical Association (BIMA) Ramadan Compendium. Tell them: "Your fast is invalid if it harms your body."

3. End of Life & Rapid Release

For Ambulance and A&E staff, a Muslim death is a critical incident. The clock starts ticking immediately.

The Death Bed Rituals

• The Direction (Qibla): If a patient is dying, try to turn their bed so their face looks towards Mecca (South East in UK). If you can't move the bed, just propping their head gently is enough. This brings immense comfort to the family.
• The Prayer (Yasin): You may hear family reciting the Chapter "Yasin" (Heart of the Quran). Do not interrupt this if possible. It eases the soul's passing.
• Touching the Body: After death, the body should be handled by same-sex staff where possible. Close the eyes and bind the jaw gently (if policy allows) to prevent gaping. Cover the body fully.

The Autopsy Conflict

Muslims believe the deceased can "feel" the pain of an autopsy. It is viewed as mutilation.

• The Rush: Burial must be as soon as possible (ideally same day/next day). Delay is seen as trapping the soul in distress.
• The Solution: Non-Invasive Autopsy (MRI): Many Coroners now offer MRI Post-Mortems (Virtopsy). Always offer this option to the family (even if they have to pay for the scan privately). It avoids cutting the body and allows immediate release.

3. Patient Interaction (Gender)

Intimate Care

A female Muslim patient may be extremely distressed by a male nurse performing an ECG (requires chest exposure) or catheterisation.

• Capacity: If they have capacity, they can refuse care.
• The Fix: Always offer a female chaperone. If none is available, explain clearly: "I need to do this to check your heart. I will keep you covered as much as possible."

Male Staff & Female Patients

Muslim male nurses/doctors should practice "defensive modesty". - Do not be alone in a room with a female patient with the door shut (Khalwah). - Leave the door ajar or take a chaperone. This protects you from allegations and respects her comfort.

4. Fasting Clinicians

Surgeons and Paramedics fasting in summer face unique risks.

• Surgeons: Standing for 6 hours under hot theatre lights.
  Advice: Schedule complex lists for the morning. If they feel faint, they must break fast (Patient Safety First).
• Paramedics: Carrying patients down stairs.
  Advice: If it is a "Major Incident", the Fatwa for active duty soldiers applies. They can eat.