Clinical Conversations

Your monthly clinical update covering:·  CPG updates: New measles CPG + updated CPP for ACOs & CERTs ·  Hand hygiene refresher: Back to basics in challenging environments ·  Cardiac arrest outcomes: Conversation with Ziad Nehme on recent improvements ·  Survey plug: Clinical & Operational Service Delivery Plan ·  Patient safety: Case review – consulting via the Clinician when engaging external agencies (e.g. PIPER) ·  Tourniquets: Balancing risks and benefits ·  Paper of the month: Ambulance offload delays and causes of ramping ·  Equipment update ·  Professional development highlights ·  Small steps: Practical changes to transform your practice =======CPG update: CPG update – April 2026VOD update: Updated guidance - Requests for Verification of Death (VOD) Hand hygiene: Take Five for Hand Hygiene Transmission based precautions clinical work instructionCWI OPS 184 Infection Prevention and Control Transmission Based Precautions.pdf Paper of the month: Initiatives to reduce ambulance offload delays in emergency departments: a scoping review - PubMedProfessional development:Fast Tracked Higher Education Pathway for AV Clinical Instructors – Now Open for Mid-Year IntakeClinical Insights: Issue 8 now availableThe Australasian College of Paramedicine Conference | ACPIC26CAA Congress | The Council of Ambulance Authorities Inc.Trauma 2026 Conference - Trauma ConferenceSAS Events – Safe Airway SocietyClinical Technology and Equipment Committee Idea Sharing: Clinical Technology and Equipment Committee / [email protected] Get in touch: [email protected]  Producer

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).This month's episode covers:Planned updates to CPGs in 2026Posterior StrokePatient Care RecordsEvaluation data of droperidol and dexamethasone as antiemeticsPaper of the Month: IV vs IO in cardiac arrestEquipment updateProfessional development opportunitiesSmall steps to transform your practicePaper of the Month Vascular access by paramedics during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A retrospective study of insertion success rates and survival outcomes of intravenous versus intraosseous route https://www.sciencedirect.com/science/article/abs/pii/S0735675726000628 Professional Development OpportunitiesThe Australasian College of Paramedicine | Primary Care Conference 2026ACP 2026 Education Grants: 2026 Education Grants OpenPosterior StrokeNot so FAST: pre-hospital posterior circulation stroke - PMCGet in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry

In this episode of Clinical Conversations, we're joined by Associate Professor Carmel Crock (Director of the Emergency Department at the Royal Victorian Eye and Ear Hospital and Chair of the Quality & Patient Safety Committee at the Australasian College of Emergency Medicine) to unpack what diagnosis is, how diagnostic error happens, and how we can make diagnosis safer. We explore common pitfalls like premature closure and diagnostic momentum, and practical ways to improve diagnostic safety. Get in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversationsProducer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).Cardiac Arrest Update with AV Resuscitation Coordinator Steve MusgravePatient Safety Update: Stroke Assessment and Elderly FallsAlpine and Wilderness Response AlagaesiaToxicology EvaluationAlcohol Withdrawal GuidelineEquipment Update: Syringe DriversPaper of the MonthPrehospital transesophageal echocardiography versus conventional advanced life support in out-of-hospital cardiac arrest (PHTEE–OHCA) – a randomized controlled pilot study: https://link.springer.com/article/10.1186/s13054-025-05805-wProfessional Development OpportunitiesFast-Tracked Higher Education Pathway for AV Clinical Instructors:  https://ambulancevic.sharepoint.com/sites/OneAV-news-and-updates/SitePages/Exciting-Opportunity-Fast-Tracked-Higher-Education-Pathway-for-AV-Clinical-Instructors.aspx?web=1 ACP Primary Care Conference Canberra: 21-22 May ACPIC Melbourne : 8-11 SeptemberEMS Asia Singapore 7-13 November Grad Cert MH: https://victoriauniversity.online/ppc/graduate-certificate-mental-health https://www.latrobe.edu.au/courses/graduate-certificate-in-mental-health#/overview?location=ON&studentType=dom&year=2026 https://online.scu.edu.au/online-courses/graduate-certificate-mental-health https://handbook.monash.edu/2024/courses/m4039 AICG: Clinical Governance, Effective Leadership, Clinical Education, Clinical Feedback.  https://www.aicg.edu.au/education/online-courses/ Get in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry 

In this episode of Clinical Conversations, James Oswald and Ambulance Victoria Medical Director Dr David Anderson unpack non-invasive ventilation (NIV) for prehospital care.They explain the key physiology (oxygenation vs ventilation), the practical difference between CPAP and BiPAP, and how this guides use in COPD, acute pulmonary oedema, COVID, asthma, and undifferentiated dyspnoea. The discussion also covers patient coaching, mask fit troubleshooting, essential monitoring, and how to recognise early success vs failure—including when to escalate and call for help.Get in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversationsProducer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).Hear from Louise Reynolds (Victoria’s Chief Paramedic Officer) on the women’s pain inquiry findings—and what it means for paramedic practice.Spotlight the VVED back pain pathway: for many patients, opioids + ED isn’t the answer—community physio support can be surprisingly effective.Adam Ho (AV Senior Pharmacist) answers the most common medication questions.Paper of the Month: a must-read on post-intubation hypotension.Ben runs through key professional development opportunities for 2025 and what’s coming in 2026.Equipment update.And we wrap with small steps to transform your practiceFurther resourcesVVED Back pain pathway presentation (AV employees only): https://engage.cloud.microsoft/main/threads/eyJfdHlwZSI6IlRocmVhZCIsImlkIjoiMzU5OTQ5NzU4NzMzNTE2OCJ9?trk_copy_link=V1AI Professional Development CoursesFree micro-skill course in AI: https://www.australianindustrygroup.com.au/education-training/centre-for-education-and-training/blog/free-introduction-to-artificial-intelligence-microskill-courseDigital health 101: https://digitalhealthworkforce.org.au/education-and-resources/Australian Institute of Digital Health AI essentials: https://cpd.digitalhealth.org.au/course/ai-essentials AI PodcastsNEJM AI Grand rounds (AI Podcast): https://store.nejm.org/signup/ai/podcastsBeyond the prompt (AI podcast): https://www.beyondtheprompt.ai/Paper of the monthPrehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841682Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults: https://www.nejm.org/doi/abs/10.1056/NEJMoa2511420Get in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry 

In our first ever live episode of Clinical Conversations, James Oswald (CPG specialist and paramedic) is joined by Ambulance Victoria Medical Director Dr David Anderson for an end-of-year Q&A on the latest CPG updates.We work through staff questions on the “why” behind key changes—including respiratory care and oxygen targets, NIV expansion and mask issues, airway and RSI updates (including crash induction and consultation for single-responder MICA), and several medication updates such as magnesium compatibility, levetiracetam after midazolam, IV GTN in APO, and opioid choice and multimodal analgesia. They also cover practical operational issues like VVED wait times and what to do when access delays are affecting crews.Get in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):02:10 – CPG Update Released • Highlights major 2025 CPG changes, app issues, and expected three-month transition period (IFS ceases immediately). • Emphasis on professional judgment, understanding over memorisation, and upcoming live Q&A. • Request for staff feedback on new learning methods.05:42 – Women’s Pain Inquiry Findings • Large Victorian inquiry confirms women’s pain is frequently dismissed; implications for paramedic practice.06:58 – Registration & Professional Capabilities • Registration season brings opportunity to review Paramedicine Board capabilities: communication, cultural safety, risk management, lifelong learning.08:05 – Paper 1: AI ECG for STEMI • AI ECG analysis outperforms clinicians in complex cases and may reduce cath lab false activations; human–AI collaboration is the future.10:20 – Paper 2: Community Paramedicine Study • Time-and-motion study shows community paramedicine is a thinking-intensive role with few interventions.13:40 – Paper 3: Methoxy vs Fentanyl vs Morphine • Methoxyfluorane provides fastest early analgesia; supports multimodal pain management with methoxy as a strong first-line option.17:56 – Equipment Update • Reminder not to pre-connect sensitive devices (e.g., EtCO₂ adapters, Yankauer) due to temperature and contamination risks.19:54 – AI Professional Development Workshop • Upcoming Monash workshop on trustworthy generative AI for healthcare, available in-person and virtually.Resources  Inquiry into women’s pain: https://www.health.vic.gov.au/inquiry-into-womens-pain Gender disparities in EMS care: https://pubmed.ncbi.nlm.nih.gov/36369725/ Sex Differences in Patients With Acute Chest Pain:  https://www.sciencedirect.com/science/article/pii/S0735109723000839 Professional capabilities: https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx  Papers of the month Community paramedicine: https://www.sciencedirect.com/science/article/pii/S2588994X25000909?via%3Dihub Pain relief study: https://www.sciencedirect.com/science/article/abs/pii/S0140673625015752 AI-Enabled ECG Analysis: https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018 Professional development Building Trustworthy GenAI for Healthcare Innovation: https://shop.monash.edu/masterclass-building-trustworthy-genai-for-healthcare-innovation.html Get in touch ⁠[email protected]⁠James: https://linktr.ee/ClinicalConversationsBen: ⁠@ben_meadley⁠ , Ben - Linkedin Producer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):01:40 – 2025 Clinical Update Coming Soon02:20 – IFS Retirement & Paediatric RSI Feedback07:05 – STEMI Performance Update08:50 – Free Birth: Paramedic Implications11:50 – PANDA Trial Update13:50 – Patient Safety: Cognitive bias & discounting concerning symptoms19:20 – Missing PCRs in Severe Adverse Events21:50 – Guideline Monitoring: Minor Head Injury & VVED Outcome Data22:50 – Paper of the Month & New Cardiac Arrest Guidelines25:45 – Equipment Updates26:59 – Professional Development Opportunities28:15 – Small Steps to Transform Your PracticeFurther resourcesFreebirth - Position statement | Safer Care VictoriaEMCRIT episode on paediatric FONA: https://emcrit.org/emcrit/pediatric-tracheotomy/ ERC 2025 Guidelines: https://www.erc.edu/science-research/guidelines/guidelines-2025/guidelines-2025-english/AHA 2025 Guidelines: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelinesOpinion piece - Iain Beardsell: https://www.bmj.com/content/390/bmj.r2051 ACP Regional Paramedic Symposium: https://paramedics.org/events/rps-2025?tab=AboutEmergency, Trauma & Critical Care Conference: https://www.fltr-ed.com/  Get in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry 

James Oswald is joined by an expert panel to discuss the background, evidence and rationale behind the retirement of intubation facilitated by sedation:Richard Armour – MICA paramedic, PhD candidate, CPG specialist.Dr Claire Wilkin – PEM, AV Medical Advisor - PaediatricsA/Prof David Anderson – AV Medical Director Get in touch⁠[email protected]⁠David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):Clinical UpdateWarm IV fluid (13:38): Stop warming IV fluids in overhead compartments or with hot water bottles. Risks scalding/superheating. Store in equipment towers only.Paediatric distraction (03:26): kits available now. Evidence-based, non-digital active tools work best. Order via iProc. Document use in VACIS.Paediatric NIV (9:20): pathways with RCH/Monash/PIPER. Use patient device if feasible; alternatives include Flow-Safe and Zoll Z-Vent. More guidance coming.Patient safetyLow acuity, high risk (12:32): Some high-risk patients sit in apparently low acuity cases. Advocate, self-upgrade when risk warrants. Lodge cases in RiskMan.Standing height falls (14:49): Standing-height falls in older adults: great feedback from the field, we discuss common themes.Paper of the Month (19:26): measurable “hyperacute T-wave” definition predicts OMI even without STEMI criteria.Equipment (21:40): new neonatal BVMs; syringe-holder prototypes to separate RSI meds.CPD (24:21): short courses and LinkedIn Learning suggestions.Further resourcesOcclusion myocardial infarction and artificial intelligenceHyperacute T-wave definitionhttps://journals.sagepub.com/doi/full/10.1177/27536386251371078https://shortcourses.rmit.edu.au/collections/allhttps://mbs.edu/short-courseshttps://www.monash.edu/business/corporate-education/short-coursesLinkedin.com/learning/Get in touchJames: https://linktr.ee/ClinicalConversationsBen: X/Twitter⁠ | [email protected] 

This month James and David look at cardiogenic shock: recognition and classification, oxygen targets, fluid resuscitation, vasopressors, inotropes, and the possibility of shock centres in the future. They're joined by Professor Dion Stub, an interventional cardiologist, prolific researcher, professor at Monash University, member of the Australian Resuscitation Council, and medical advisor to Ambulance Victoria.Further resourcesAvoid trial: https://www.ahajournals.org/doi/10.1161/circulationaha.114.014494DETO2XAMI:  https://www.nejm.org/doi/full/10.1056/NEJMoa1706222#:~:text=The%20Determination%20of%20the%20Role,not%20have%20hypoxemia%20at%20baseline. EXACT pilot trial: Concerns regarding the safety of prehospital titrated oxygen in post-cardiac arrest patients  https://pubmed.ncbi.nlm.nih.gov/29684433/PANDA Trial (AV Staff) https://ambulancevic.sharepoint.com/sites/OneAVQualityandClinicalInnovation/SitePages/PANDA-TRIAL-(.aspxGet in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations

Your monthly clinical update covering:Mandatory VVED Consults for Infants <28 Days – trends, rationale for policy, clarifications, and case example demonstrating impact.Stroke updates - performing ACT-FAST on all MASS positive patients, changes to VACIS and a plug for IV access.Complex Paediatric Respiratory Patients – Managing patients on home non-invasive ventilation, maintaining continuity of care, and upcoming resources.Trauma Updates –Blood component therapy expansion and compliance requirements.STAB-5 mnemonic and minimising scene time in major trauma.PANDA trial enrolment reminder.Standing-Height Falls in Elderly – Missed spinal injury cases, cultural pendulum shift, guideline review, and call for feedback.Manual Handling & Patient Safety in ED Cohorting – Safe movement of high-risk patients and preventing deterioration during cohorting.Paper of the Month – Danish machine learning study outperforming NEWS2 for predicting deterioration from first-five-minute vitals, with explainable AI.Equipment Committee Updates – New traction splints, medication safety devices via 3D printing, thermal blanket effectiveness, and syringe driver software updates.Professional Development & Resources – Coroner’s Communiques, ACP International Conference, new paramedic podcasts.Small Steps to Transform Practice –Treat elderly standing-height falls as potential spinal injuries.Minimise scene time for major trauma unless safety or critical intervention requires it.Further resourcesACP ConferenceThermal blanket studyMachine learning studySTAB-5Coroner's communique Get in [email protected] / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBen

In this special Q&A episode of Clinical Conversations, James Oswald and Dr. David Anderson respond to the most common — and most complex — questions we've received on sedation, CPG implementation, and the evolving role of paramedics. We also reflect on why clinical guidelines are becoming more detailed, how to balance complexity with emergency care, and what the future holds for paramedics. Get in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social| LinkedInJames: https://linktr.ee/ClinicalConversations | LinkedIn

Your monthly update on clinical issues including:Clinical Practice Care and Control Powers (02:38 – 07:10)Overview of section 232 and 241 powers. Documentation: VACIS + RiskMan entries are essential.More info: See Mental Health Crisis Reform on OneAV. Verification of Death (07:10 – 08:48)Verifying death is voluntary for paramedics.Review WinOps 025 for current processes.AV is working with VicPol to improve processes.Encourage local discussion with TM/CSO about your approach. Resus Ready Campaign (08:48 –10:34)Aims to boost preparedness for cardiac arrest.Includes: equipment checks, airway readiness, skills rehearsal.Backed by patient safety reviews and cardiac arrest strategy.Goal: Ensure every paramedic is ready regardless of experience/frequency. Case 1: Pediatric respiratory case attended with only adult equipment.Reflect on the potential trajectory of cases with reference to the balance of between taking all equipment vs minimising manual handling risk Case 2: Chest rise/fall insufficient alone to assess ventilation.Use waveform capnography early and consistently.Case 3: CO₂ of 6mmHg was the only clue of incorrect tube placement in intubated asthma patient.Always consider full clinical picture and question if data doesn’t make sense.Paper of the month (14:46 – 20:55)Parental Concern in Pediatric DeteriorationAsking "Are you worried your child is getting worse?" adds predictive value.Parents who said “yes” had children:4x more likely to go to ICU/be ventilated.More likely to be admitted or have longer stays.Concern was a stronger predictor than abnormal vital signs.Recommendation: Make carer concern an active, routine part of pediatric assessment.Equipment Update (20:55 – 22:55)New absorbent transfer sheet ("large bluey") improves:Patient hygiene and comfort.Paramedic safety.Part of AV's broader equipment strategy under new Clinical Technology & Equipment Committee.Professional Development: Postgraduate Study (22:55 – 24:59)Encouragement for paramedics to pursue study outside paramedicine:Public health, digital health, systems leadership, etc.Builds capability to:Lead teams, influence policy, improve care.Resource guide in show notes; feedback encouraged.Small Steps to Transform Practice (24:59 – 26:42)Ben’s tip: Don’t rely on chest rise alone—use capnography toassess ventilation.James’s tip: Proactively ask parents if they’re worried their child is deteriorating.ResourcesAssociation between caregiver concern for clinicaldeterioration and critical illness in children presenting to hospital: a prospective cohort study https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00098-7/abstractClinical Technology andEquipment Committeehttps://ambulancevic.sharepoint.com/sites/OneAV-resource-hub/_layouts/15/viewer.aspx?sourcedoc={1633f009-99d3-4d08-9805-d5fb409fec3b}

In this episode of Clinical Conversations, we explore the complexities of managing acute behavioural disturbance (ABD) in children and adolescents—a small but increasingly common and high-risk cohort. Host James Oswald and AV Medical Director Dr. David Anderson are joined by paediatric emergency physician Dr. Claire Wilkin, who brings deep expertise in paediatric critical care. Together, they discuss the causes of ABD in younger patients, differences from adult presentations, principles of de-escalation, the role of sedation, and how to assess and manage risk.Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠ | LinkedinJamesDavid

Your monthly clinical update covering:Clinical Practice 03:10 – Respiratory CPG Update: Pulmonary edema, COVID, ILI, paediatric asthma changes coming soon.04:00 – First Responder Analgesia: Supply challenges beingaddressed; updates coming. 05:10 – Button Batteries: New blue dye marker—importantvisual sign but not universally present.06:00 – Mushroom Season Warning: Watch for toxidromes; VPIC support emphasized.06:40 – VVED changes: Easier access to emergency physicians.Patient Safety 08:30Case: Declined transport with adverse outcome.Consent must be truly informed—document clearly, especially under cognitive load or red flags.Guideline monitoring 11:15Sedation Safety Update: Improved safety with guidelinechanges.Case Reports & Engagement 13:10Case reports welcome—CPG team happy to assist.Paper of the month 13:40Comparison of demand valve vs. standard BVM. No differencein oxygenation delivery in healthy volunteers. Nasal prongs speed time to oxygenation saturation. Continue using both tools in RSI prep.New ACS Guidelines Summary (ft. Andrew Bishop) (18:30)ACOMI terminology replaces STEMI/Non-STEMI binary. Key ECG findings added. Serial ECGs every 10 mins; prehospital thrombolysis within 30mins.Equipment 23:50Asset Numbers: Include in Riskman reports to aid faultresolution.Professional Development 24:30AICG Highlight: Leadership training relevant across paramedicine—CPD eligible and recommended.Small Steps to Transform Practice 26:30Get in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBen

James Oswald and Dr David Anderson explore how consultation has evolved from a perceived weakness to a hallmark of clinical maturity. They discuss the growing role of virtual emergency care, particularly the Victorian Virtual Emergency Department (VVED), in supporting paramedics with decision-making—especially when assessing young infants. Joined by pediatric emergency specialist Dr Harith Al-Rawi, the episode dives into the challenges of remote pediatric assessment, the value of collaboration between paramedics and virtual care clinicians, and the structured information required during remote consultation to safely support care at home. The conversation highlights that newborns are a uniquely high-risk group, and outlines why VVED consultation is now a must for infants aged 28 days or younger.   Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠  LinkedinJamesDavid Producer: Liam Hennebry

Your monthly clinical update covering:VVED Consultations for small infantsNew requirement: VVEDconsultation for non-transport of infants ≤28 daysStrong recommendation for 29days–3 monthsDriven by patient safety reviewand expert consensusNot about removing autonomy —it’s about adding clinical supportRSI Checklist UpdateAddition of a pop-off valve checkfollowing a critical safety eventPrevents misdiagnosis of failedventilationReinforces value of checklists,even for experienced cliniciansAdvanced Paramedic PracticeProposalPublic consultation openFramework for advanced practiceregistration in primary care and critical careFacilitates further advancementssuch as prescribing rights and scope self-determinationBig implications for AVparamedics — see link in show notes to respondSTEMI Transfer PilotALS paramedics trialing regionalSTEMI transfersTarget: stable patientspost-thrombolysisReflects data showing most STEMIpatients are low riskPatient Safety FocusStanding height falls in theelderly: don’t underestimate riskRhythm misinterpretation:shockable rhythms missed or misidentifiedNo link between junior staff anderror rates — we all share responsibility, we are all vulnerableGuideline Monitoring:Palliative Care CPG9.9% increase in patients dyingat home — great outcomeNo major change in meds given —possibly due to barriers in the current CPGEvidence supports simplifying CPGCase Reports on Viva EngageRecent cases: paediatricrespiratory failure, polypharmacy overdose, snake biteSubmit your own case via the Vivatemplate Paper of the Month: PACKMaNTrialRCT comparing ketamine vsmorphine for trauma painFound no difference ineffectivenessPoints to multimodal analgesia asa next step in research, which is already AV’s approachEquipmentCheck Pop-off Valve position atstart of shift“Resus Ready” campaign comingsoonCardiac Monitor ReplacementProgram- New device comingDiscussion underway: do we needto carry everything all the time? Professional DevelopmentOpportunitiesCritical Care Summit – May 15–16,EssendonGrand Rounds (CPG + RMH collab) –May 27, Sunshine Hub or virtualTrauma Grand Rounds – June 18 atRoyal Children’s or online Small steps to transform youpracticeDeliberate practice = highperformance, visualisation and mental rehearsal make a differencePractice rhythm recognition Rehearse SITREPsResourcesParamedic analgesia comparing ketamine and morphine in trauma (PACKMaN): a randomised,double-blind, phase 3 trialPalliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacyProposal to regulate advanced practice paramedicsRhythm recognitionGet in touchX /

In Part 2 of their sedation safety conversation, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) cover preparation for sedation and how to recognize and respond to deterioration. They break the problem into three evidence‑backed pillars:Prevent deterioration (have a listen to Part 1)Prepare for side‑effects – if you plan to sedate, you must plan to resuscitate Recognise & Respond when things go wrongFurther resourcesAPIC Session: https://paramedics.org/recordings/acpic24-spotlight-on-sedationClinical Conversations – Acute Behavioural Disturbance https://open.spotify.com/episode/2ahoO2WWHc27zOLocqoQR8?si=u4Sr_RjeQj-_lzPUWkUelQSafer Care Victoria ABD guideline: https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/emergency/acute-behavioural-disturbance Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠ |@jamesoz1.bsky.social LinkedinJamesDavid

Your monthly clinical update covering:Cardiac arrest outcomes An update on the sedation safety guidelineLessons learned from the patient safety team: appropriate use of the CT-6 traction splint and having a high index of suspicion for spinal and head injuries in older adults followingstanding height falls BVM blow off valve reminderPaper of the month: Prehospital antibiotics in sepsisMiller blade use for ALS paramedicsResourcesACP Critical Care SummitGet in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBen

In this episode of Clinical Conversations, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) dive into one of the most ethically and clinically complex areas of pre-hospital care—the questions of safety for during sedation for acute behavioural disturbance (ABD). They explore the ethical and legal considerations surrounding the use of sedation, the significant clinical risks, and real-world cases that highlight the gravity of these situations.The episode features a discussion on the tragic case of Elijah McClain, whose death following pre-hospital sedation underscores the importance of safe practices, inter-agency communication, and decision-making in high-stress environments. James and David also break down Ambulance Victoria’s current approach to sedation, including agent selection, risk assessment, and the importance of de-escalation. They stress the role of checklists, consultation, and a "prevention-first" approach to mitigate risks.This is the first of a two-part discussion. In the next episode, they will cover preparation for sedation and how to recognize and respond to deterioration. Further resources APIC Session: https://paramedics.org/recordings/acpic24-spotlight-on-sedation Clinical Conversations – AcuteBehavioural Disturbance https://open.spotify.com/episode/2ahoO2WWHc27zOLocqoQR8?si=u4Sr_RjeQj-_lzPUWkUelQ Safer Care Victoria ABD guideline: https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/emergency/acute-behavioural-disturbance  Get in touch⁠[email protected]⁠ X / Twitter / BluskyDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.socialJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social LinkedinJamesDavid

James and Ben cover the latest clinical news from across Ambulance Victoria, including:Intranasal Fentanyl Update – Using IV preparation for intranasal use.Other guidelines updates: Extrication monitoring, shoulder reduction, wilderness pain relief.Blood Administration – New pre-hospital blood transfusion training coming.Rocuronium Storage – Heat-related potency issues; rotate every 30 days.Communication Book – New tool for patients with communication disabilities.MICA targeted Dispatch – 8-week trial, enter any patient safety concerns in Riskman or ROAM appPaper of the Month – ALS paramedics safely managing post-thrombolysis STEMI.Equipment Update – Check serial numbers when reporting medical device issues.Professional Development – Advanced mechanical ventilation workshop available.Chapters00:00 Introduction and Overview of ClinicalUpdates01:21 Rapid summary02:50 Updates on Intranasal Fentanyl 5:40 Other CPG updates: Extrication monitoring, shoulder reduction, wilderness pain relief. 07:50 Blood Product Administration andSafety10:00 Rocuronium storage and efficacy concerns11:18  Emergency Healthcare Communication Book12:11 Medical Advisor on Call and PatientSafety12:50 MICA targeted Dispatch and PatientSafety Reporting14:12 Extrication related adverse events15:30 Case reports16:01 Paper of the Month: STEMI CareInsights17:30 Equipment updates18:31 External Professional DevelopmentOpportunities19:25 Small Steps to Transform YourPractice Further resourcesAdverse events and paramedic interventionsduring extended ground transport in a rural pharmaco-invasive STEMI program https://onlinelibrary.wiley.com/doi/full/10.1111/1742-6723.70005?saml_referrer=Ventilator workshop: https://www.alfredicu.org.au/files/general/Documents/2025_EVENT_FLYER_CURRENT.pdfMedication stability in hot environments: https://www.sciencedirect.com/science/article/pii/S2211419X23000630 Get in touchX / TwitterJames: ⁠⁠⁠@JamesOz1⁠⁠Ben: ⁠@ben_meadley⁠LinkedinJamesBenBluesky SocialJames: ⁠⁠@jamesoz1.bsky.social

In this episode of Clinical Conversations, James Oswald (Paramedic and Clinical Practice Guidelines Specialist) and Dr. David Anderson (Ambulance Victoria Medical Director) tackle one of the most challenging aspects of paramedicine—delivering bad news. Joined by guest Liz Perry (MICA Paramedic), they explore the difficulties paramedics face when communicating death and critical updates to families in the pre-hospital setting.We talk personal experiences, theoretical models like SPIKES, and practical strategies to navigate these conversations with confidence, clarity, and compassion. They also discuss the impact of breaking bad news on paramedics themselves and strategies to prevent burnout.Get in touch⁠[email protected]⁠ X / TwitterDavid: ⁠@expensivecare⁠James: ⁠@JamesOz1

James Oswald and Director of Paramedicine Dr Ben Meadley discuss the important clinical messages for January 2025: patient safety during sedation and the importance of planning for resuscitation; the exploration of low acuity pathways; and they review a significant research paper on physician-led teams in pre-hospital care. The episode also covers equipment updates, professional development opportunities, and practical steps for paramedics to enhance their practice.Time stamps:0:45 Rapid summary02:20 Patient Safety Update: If you sedate, plan to resuscitate. 06:13 Exploring Low Acuity Pathways10:40 Strategic Planning for 202511:27 Case Reports and Community Engagement12:21 Research Update: Physician-Led Teams – do they improve outcomes?16:59 Equipment Update and Safety Protocols19:22 Professional Development Opportunities21:04 Small Steps to Transform Your PracticeResourcesBenefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically Ill and injured patients: a systematic review and meta-analysisGet in touchX / TwitterJames: ⁠⁠⁠@JamesOz1⁠⁠Ben: ⁠@ben_meadley⁠LinkedinJamesBen

Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 3, we look at challenges in building a system that leads to good pain relief as well as some special circumstances including opioid dependence and chronic pain. Further resources⁠⁠Acute Pain Management: Scientific Evidence: 5th Edition⁠⁠ ⁠⁠Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm⁠⁠⁠⁠Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain⁠⁠ ⁠⁠Ambulance call triage outcomes for patients reporting pain: a retrospective cross-sectional analysis of pain score versus triage level⁠⁠ ⁠⁠Chronic pain in the paramedic practice setting – a qualitative study of patients’ perspective⁠⁠ ⁠⁠Influence of patient race on administration of analgesia by student paramedics⁠⁠  ⁠⁠Report on Government Services 2024⁠⁠  Get in touch⁠⁠⁠[email protected]⁠⁠⁠ X / TwitterDavid: ⁠⁠⁠@expensivecare⁠⁠⁠James: ⁠⁠⁠@JamesOz1⁠Linkedin⁠⁠James⁠⁠David⁠Bluesky SocialJames: ⁠@jamesoz1.bsky.social

A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Overview1. Clinical Practice Updates•CPG App Update Details: oSecondary triage review oChanges to pediatric analgesia guidelines oStacked shock CWI updates oMinor error corrections•Pediatric Cannulation: oALS IV access is supported for: Major trauma and traumatic arrest (all ages), and Pain relief (12-15 years). oAvoid IV access in younger patients unless necessary; consider IN route for pain relief in children.•Joint Reduction Adverse Event: oImportant that we share the outcomes of adverse events openly but without blame. oRecent adverse event involved shoulder reduction that was not indicated. oOur main focus is on the system issues: we’re looking at making the indications clearer. oIn the meantime, we’d like to raising awareness of the indication for reduction at the start of the CPG •Amiodarone & Ondansetron: oVT following Ondansetron administration only contraindicated if the drug is suspected to be the cause.___________________________2. Patient Safety Review•Scene Safety vs. Patient Care: oBoth paramedic and patient safety are important. No easy answers. oWe encourage reflection on the best way to optimize the balance of risks rather than to be overly simplistic.•Manual Handling of Bariatric Patients: oRisks and benefits of asking patients with high BMI to move themselves to minimize manual handling injuries. oImportance of recognizing strained physiology and the need for careful risk assessment in every case.•Ambulation Risk Assessment: oShout out to this guideline, which highlights risk factors in patient extrication.___________________________3. Research Update•Video Assisted Technology: oStudy on EMS providers in New York using smart glasses for live-streaming cases to medical control. oLimited adoption so far, but promising developments for future use in 2025. Stay tuned for more in this space at AV. •Intraosseous Access: oNew research indicates IO access has minimal long-term complications (e.g., osteomyelitis, osteonecrosis) and should remain a viable option when IV access isn't possible.•Cardiac Arrest Survival Rates: oStudy shows a three-fold increase in survival to hospital discharge from 2003-2022 in Victoria. oPost-COVID recovery efforts and ongoing strategies for improving cardiac arrest survival rates. oPlease consider attending a HPCPR refresher session if possible. ___________________________4. Equipment Updates•Ketone Strips: New bags for separating ketone strips from glucose strips in response to feedback.___________________________5. Professional Development Opportunities•Institute for Healthcare Improvement & Australian Institute of Clinical Governance: oCourses, memberships, and qualifications focusing on clinical governance, leadership, and patient safety.•Australasian College of Paramedicine: oUpcoming Critical Care Summit in May 2

Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 2, we look at best practice in the management of pain. Further resources⁠Acute Pain Management: Scientific Evidence: 5th Edition⁠ ⁠Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm⁠⁠Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain⁠ ⁠Ambulance call triage outcomes for patients reporting pain: a retrospective cross-sectional analysis of pain score versus triage level⁠ ⁠Chronic pain in the paramedic practice setting – a qualitative study of patients’ perspective⁠ ⁠Influence of patient race on administration of analgesia by student paramedics⁠  ⁠Report on Government Services 2024⁠  Get in touch⁠⁠[email protected]⁠⁠ X / TwitterDavid: ⁠⁠@expensivecare⁠⁠James: ⁠⁠@JamesOz1Linkedin⁠JamesDavidBluesky SocialJames: @jamesoz1.bsky.social

A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Quick summary (0:30)Patient Safety (1:30)Discussing the lessons from specific adverse events is challenging due to patient privacy/consent, crew psychological safety, and investigation timelines. We need to find a way to collectively share these lessons in a safe way. Plans for quarterly clinical forums (2025) to foster psychologically safe discussions.Clinical Updates (4:52)IV Cannulation for STEMI:Avoid sites near the radial artery to support PCI access.Extrication Monitoring: Monitoring is sometimes removed during extrication, especially self-extrication. Associated with adverse events. We need to emphasise monitoring (especially ECG/pulse oximetry) during extrication.Ectopic Pregnancy: Patient safety Assume ectopic pregnancy for women of childbearing age with abdominal pain and shock.Cardiac Arrest:Always prioritize high-performance CPR over antiarrhythmics.Clarification on stacked shocks and their intended use. CWI out soon.  ALS paramedics encouraged to consult for post-ROSC hypotension management.Guideline Monitoring (12:36)Success of expanded croup guidelines: increased dexamethasone use and reduced hospital transports.Research Updates (14:20)PANDA Trial: Comparing noradrenaline and adrenaline in cardiogenic shock.IV vs IO Access: Preference for IV first in cardiac arrest; IO as backup.ROSC Blood Pressure: Minimum diastolic pressure of 35mmHg linked to better outcomes.Equipment Notices (19:20)Normal saline shortages persist; substitute with Hartmann’s or PlasmaLite.New ketone strips now available—use carefully.Professional Development (20:11)CPD resources from the Australasian College of Paramedicine and Victorian Ambulance Union.Links to registration standards and CPD tools in the show notes.ResourcesPARAMEDIC 3Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac ArrestPrehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomesPANDA trial - If you want to learn more about the study or have any questions, search for PANDA on the AV intranet or contact the team at [email protected]. Pain research with Monash - Get involved:Paramedic confidence & barriers to paediatric pain management External development opportunities https://www.paramedicineboard.gov.au/professional-standards/faq/faq-cpd.aspxhttps://paramedics.org/

Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 1, we look at assessment, bias, and disparities in pain care. In the coming months, we’ll bring you the rest of our discussion covering best practice pain relief, system issues, myths about opioids, and special circumstances in pain care. Further resourcesAcute Pain Management: Scientific Evidence: 5th Edition Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harmPain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain Ambulance call triage outcomes for patients reporting pain: a retrospective cross-sectional analysis of pain score versus triage level Chronic pain in the paramedic practice setting – a qualitative study of patients’ perspective Influence of patient race on administration of analgesia by student paramedics  Report on Government Services 2024  Get in touch⁠[email protected]⁠ X / TwitterDavid: ⁠@expensivecare⁠James: ⁠@JamesOz1

This is the first in a new series of monthly clinical updates for Ambulance Victoria clinical staff. Director of Paramedicine A/Prof Ben Meadley and Clinical Guideline Specialist James Oswald summarise the need-to-know clinical information, all in one spot. This month: New CPG updates, trends in our patient safety data, and new cardiac monitors.  Times stamps:2:00 New CPG updates4:40 Snakebite6:30 Acute coronary syndrome and activating the cath lab7:35 Patient safety trends10:20  Dislocation reduction – how are we doing?12:10 Ketone strips13:50 Case report templates15:05 Thunderstorm asthma15:25 IV Fluid shortage15:50 PANDA trial update16:40 New cardiac monitors17:25 Professional development opportunities  ResourcesAustralasian College ofParamedicine Critical Care Summit April 2025EuropeanEMS Congress Copenhagen June 2025Safe airwaysocietyGet in touchX / TwitterJames: ⁠⁠⁠@JamesOz1⁠⁠Ben: ⁠@ben_meadley⁠LinkedinJamesBen

In this episode, James speaks with critical care paramedic, academic, and newly appointed Director of Paramedicine, Associate Professor Ben Meadley. We discuss strategic clinical leadership and the future of the profession. X / TwitterDavid: ⁠⁠⁠@expensivecare⁠⁠⁠James: ⁠⁠⁠@JamesOz1⁠⁠Ben: ⁠@ben_meadley⁠

Part 2 of David's discussion with Associate Professor Andrew Udy on Sepsis Management. Get in touch⁠[email protected]⁠ X / TwitterDavid: ⁠@expensivecare⁠James: ⁠@JamesOz1Resources mentioned[PHANTASI trial] Alam N, Oskam E, Stassen PM, Exter Pv, van de Ven PM, Haak HR, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Respiratory Medicine. 2018;6(1):40-50.Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-96.Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376(23):2235-44.ARISE Invetigators. Goal-Directed Resuscitation for Patients with Early Septic Shock. New England Journal of Medicine. 2014;371(16):1496-506.PRISM Investigators. Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis. New England Journal of Medicine. 2017;376(23):2223-34.Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard 2022 [Available from: https://www.safetyandquality.gov.au/standards/clinical-care-standards/sepsis-clinical-care-standard#:~:text=The%20Sepsis%20Clinical%20Care%20Standard,Commission%20on%2030%20June%202022.Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510.Other resourcesPoynter MJ, Farrugia A, Kelly E, Simpson PM. Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review. Paramedicine. 2024;21(2):52-65.Varney J, Motawea KR, Kandil OA, Hashim HT, Murry K, Shah J, et al. Prehospital administration of broad-spectrum antibiotics for sepsis patients: A systematic review and meta-analysis. Health Sci Rep. 2022;5(3):e582.

Sepsis is arguably the most common time critical emergency we face as paramedics. This is the first of a two part series on sepsis with Professor Andrew Udy. Andrew is Head of Research at The Alfred ICU, and Deputy Director, Australian and New Zealand Intensive Care Research Centre. He was involved in the development of the recently released Ambulance Victoria Sepsis and Infection guideline. In this episode, Ambulance Victoria Medical Director A/Prof David Anderson and Andrew discuss the assessment and diagnosis of sepsis. Get in touch⁠⁠[email protected]⁠⁠ X / TwitterDavid: ⁠⁠@expensivecare⁠⁠James: ⁠⁠@JamesOz1⁠Further resourcesNICE. Sepsis: recognition, diagnosis and early management 2017. Available from: https://www.nice.org.uk/guidance/ng51.Royal Children's Hospital. Sepsis – assessment and management 2020. Available from: https://www.rch.org.au/clinicalguide/guideline_index/SEPSIS_assessment_and_management/.Inada-Kim M. NEWS2 and improving outcomes from sepsis. Clin Med (Lond). 2022;22(6):514-7.Lisa S, Shammi R, Steve G. Comparison of qSOFA and Hospital Early Warning Scores for prognosis in suspected sepsis in emergency department patients: a systematic review. Emergency Medicine Journal. 2022;39(4):284.Mellhammar L, Linder A, Tverring J, Christensson B, Boyd JH, Sendi P, et al. NEWS2 is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department. J Clin Med. 2019;8(8).Oduncu AF, Kıyan GS, Yalçınlı S. Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department. Am J Emerg Med. 2021;48:54-9.Patel R, Nugawela MD, Edwards HB, Richards A, Le Roux H, Pullyblank A, et al. Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review. Resuscitation. 2018;132:101-11.Steve G, Laura S, Ben T, Olivia H, Khurram I, Susan C, et al. Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study. Emergency Medicine Journal. 2023;40(11):768.Verity Frances T, Melanie M, Graham H, Andy S, Aroha B, Tony S, et al. Predictive value of the New Zealand Early Warning Score for early mortality in low-acuity patients discharged at scene by paramedics: an observational study. BMJ Open. 2022;12(7):e058462.Wang C, Xu R, Zeng Y, Zhao Y, Hu X. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS ONE. 2022;17:e0266755.

In Australia, penetrating truncal trauma is rare and the care of these patients involves a quite different mindset than we're used to. This is a cohort where our stay-and-play approach can do harm. James and David discuss the evidence relating to penetrating trauma and practical recommendations for your practice.Further resourcesOver view of major traumatic injury in Australia–Implications for trauma system design The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environmentAssociation of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania - PubMed (nih.gov) The effect of transport mode on mortality following isolated penetrating torso Trauma - PubMed Every minute counts: The impact of pre-hospital response time and scene time on mortality of penetrating trauma patientsGet in [email protected] / TwitterDavid: @expensivecareJames: @JamesOz1

Clinical practice varies between the different state ambulance services in Australia. Yet we all claim to be evidence-based. So why is this, how big of a problem is it and what should we do about it? Are national guidelines the answer? James speaks with paramedic and PhD candidate Matt Wilkinson-Stokes to find out, while David shares his perspective on national guidelines. Further resourcesMatt's presentation on the differences between state ambulance service guidelinesComparisons of clinical guidelines between statesOther papers mentioned:https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2243-yGet in [email protected] / TwitterDavid: @expensivecareJames: @JamesOz1

For over a decade after a large study showed a mortality benefit, this drug remained controversial. David and James look at the TXA saga.

Clinical conversations is back. But where have we been, what have we been doing and what do we have planned for the future?

We’re all familiar with the concept of STEMI. But the definition is built around a single ECG sign – not the underlying problem itself. Is that the best way to do it? Should we be thinking about this in a totally different way? Is Occlusive Myocardial Infarction (OMI) the new STEMI? NotesOMI ManifestoAmal Mattu on YouTubeSubtle STEMI iOS appThe Ancient Scholar

Capnography plays a crucial role in the treatment of a range of life-threatening conditions. Its central role following intubation is undeniable and it's also an important part of our approach to cardiac arrest and sedated patients of all kinds. Yet it is not always as straightforward as it might seem. In this episode, David and James speak with Matt Humar (intensive care paramedic, acting patient safety review lead at Ambulance Victoria, and secretary of the safe airway society) about matters capnographic. Further reading https://derangedphysiology.com/main/cicm-primary-exam/required-reading/respiratory-system/Chapter%20414/difference-between-end-tidal-and-arterial-pco2 https://www.capnography.com/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231274/

Shock is the quintessential critical illness. Bread and butter for everyone involved in prehospital and critical care. But do we really understand it? Could we be doing better for these patients?James is joined by Assoc. Prof. David Anderson, intensivist and Ambulance Victoria Medical Director, for a... shocking discussion. 

People experiencing acute behavioral disturbance are some of the most vulnerable patients we treat. It’s a deeply distressing situation for the patient and extremely confronting for clinicians and carers. In this episode, we speak with psychiatrist Dr Alison Taylor about important changes we're making to improve care for these patients.

Family violence is a deeply confronting and serious problem that occurs across all ages, genders, and socioeconomic groups. It has a profound impact on the health and well-being millions of people across the globe. How can we identify family violence? How should we respond to a disclosure of family violence? How can we help victim survivors? Ambulance Victoria Safe Guarding Care Lead Amber Smith joins James and David to discuss this important issue.MARAM Family violence practice guide

The decision to withhold or cease resuscitation is one of the most impactful and also one of the more confronting decisions that paramedics make in the field. AV Medical Director Associate Professor David Anderson discuss Dr Natalie Anderson, PhD discuss the decision making process and how to better approach these difficult cases.   MyGriefToolbox - Great Canadian resource for all paramedics, with helpful modules covering decision-making, patient death and grief.Breaking bad news in the ED - Notifying family members of a death in the emergency department.

Ambulance Victoria recently introduced intranasal ketamine for the treatment of moderate and severe pain. It has proven to be effective but we have identified opportunities to do better.Clinical Practice Development Specialist James Oswald and Medical Director David Anderson discuss the new Clinical Practice Guideline and some of the lessons we've learned along the way.