Clinical Practice Radio (CPR)

In this first episode of season two, the team explores crush injury and crush syndrome, discussing how these patients present, why they can deteriorate rapidly, and the importance of early recognition in the pre-hospital environment. The conversation covers the difference between local crush injuries and the wider systemic effects that can occur after extrication, including why long lies and seemingly minor presentations can still become life-threatening. The team also discusses practical management strategies, preparation for deterioration, and the importance of understanding the underlying physiology to guide treatment decisions. A practical discussion on recognising high-risk patients, preparing for worst-case scenarios, and managing crush injuries safely and effectively.   References: Crush Syndrome • LITFL • CCC Trauma Rhabdomyolysis - EMCrit Project Gonzalez, Dario MD, FACEP. Crush syndrome. Critical Care Medicine 33(1):p S34-S41, January 2005. | DOI: 10.1097/01.CCM.0000151065.13564.6F

In this episode, the team explores two critical but often overlooked parts of pre-hospital care: handovers and debriefing. They discuss why clear communication shapes patient outcomes, how structured handovers help deliver concise, relevant information, and why preparation and confidence matter in high-pressure environments. The conversation also covers adapting handovers to the patient, setting and receiving team. They then turn to debriefing, unpacking the value of hot and cold debriefs, constructive feedback, and creating a culture where reflection feels safe and productive. A practical discussion on how stronger communication before and after every job can improve teamwork, performance and patient care. References: Walker, C. A., McGregor, L., Taylor, C., & Robinson, S. (2020). STOP5: a hot debrief model for resuscitation cases in the emergency department. Clinical and experimental emergency medicine, 7(4), 259–266. https://doi.org/10.15441/ceem.19.086 The Paramedic Mindset (2024).  Leigh Anderson. Think Again (2021).  Adam Grant. Wood, K., Crouch, R., Rowland, E., & Pope, C. (2015). Clinical handovers between prehospital and hospital staff: literature review. Emergency Medicine Journal, 32(7), 577-581.

In this episode, the team explores the evolving approach to patient extrication, with insights from DFES rescue officer Andrew “Strunky” Strunk. They unpack the evidence behind the Extrication in Trauma (EXIT) project, challenging long-held practices, particularly the low incidence of spinal cord injury, and the shift away from movement minimisation toward faster, patient-focused extrication. A practical look at what’s changing on the ground, and how closer collaboration between paramedics and rescue crews is improving outcomes by getting patients to definitive care sooner. References:  Nutbeam, T., Fenwick, R., Haldane, C., Leech, C., Foote, E., Todd, S., & Lockey, D. (2025). Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 3. Nutbeam, T., Fenwick, R., May, B., Stassen, W., Smith, J. E., Wallis, L., ... & Shippen, J. (2021). The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision-a biomechanical study using healthy volunteers. Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), 108. Nutbeam, T., Fenwick, R., Marritt, I., Lee, B., Staveley-Wadham, L., Lang, N., ... & Leech, C. (2025). Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 137. Hawkridge, K., Ahmed, I., & Ahmed, Z. (2022). Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. European Journal of Trauma and Emergency Surgery, 48(1), 647-657.

In this episode, the team turns their focus to major burns, one of the most complex and confronting presentations in pre-hospital care. They discuss what defines a major burn, the systemic cascade that follows large TBSA injuries, and key priorities including early cooling, analgesia, fluid management, airway considerations, hypothermia prevention and transport decisions. A practical refresher for clinicians who may not see major burns often but need to manage them well when they do. References: Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients | Journal of Burn Car… Hypothermia in acutely presenting burn injuries to a regional burn service: The incidence and impac…  Further Reading: Research And Technology Development In Burn Medicine - Fiona Wood Foundation First Aid Management of Injuries Effect of early administration of inhaled heparin on outcomes of smoke inhalation injury: A randomi…

In this episode, the team tackles some of the most enduring myths in emergency medical services and asks a simple question: are we still doing things because they work, or because it’s how they’ve always been done? Topics include analgesia and pain management, soft tissue injuries and the RICE principle, oxygen use in COPD patients, ketamine and haemodynamic effects, tourniquet use, and other long-held assumptions in pre-hospital care. Through evidence, physiology and reflective practice, the conversation highlights how clinical practice continues to evolve and why staying curious and adapting to new evidence is essential for delivering high-quality patient care. A thought-provoking listen for clinicians at any stage of their career. References: April, M. D., Arana, A., Schauer, S. G., Davis, W. T., Oliver, J. J., Fantegrossi, A., ... & NEAR Investigators. (2020). Ketamine versus etomidate and peri‐intubation hypotension: a national emergency airway registry study. Academic Emergency Medicine, 27(11), 1106-1115. Kamran, H., Salciccioli, L., Kumar, P., Pushilin, S., Namana, V., Trotman, S., & Lazar, J. (2010). The relation between blood pressure changes induced by passive leg raising and arterial stiffness. Journal of the American Society of Hypertension, 4(6), 284-289. ICED! The illusionary treatment option.  Gary Rein Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73. Walsh B, Cone DC, Meyer EM, Larkin GL. Paramedic attitudes regarding prehospital analgesia. Prehosp Emerg Care. 2013 Jan-Mar;17(1):78-87. doi: 10.3109/10903127.2012.717167. Epub 2012 Sep 12. PMID: 22971168. Oxygen and Carbon Dioxide Retention in COPD • LITFL • CCC Respiratory Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. doi: 10.1186/cc11475. PMID: 23106947; PMCID: PMC3682248. https://doi.org/10.1016/j.ajem.2023.08.040 Morgan MM, Perina DG, Acquisto NM, Fallat ME, Gallagher JM, Brown KM, Ho J, Burnett A, Lairet J, Rowe D, Gestring ML. Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement. Prehosp Emerg Care. 2021 Jul-Aug;25(4):588-592. doi: 10.1080/10903127.2020.1801920. Epub 2020 Aug 27. PMID: 32776812. Xacur-Trabulce A, Casas-Fuentes G, Ruiz-Vasconcelos V, Reitz MM, Henry SM, Scalea TM, Ribeiro MAF Jr. Tourniquet-related complications in extremity injuries: a scoping review of the literature. World J Emerg Surg. 2025 Jun 25;20(1):57. doi: 10.1186/s13017-025-00625-3. PMID: 40556023; PMCID: PMC12188649. Pascoe B, Weinrauch P. Timeline effects of tourniquets used in trauma care. JHTAM. 2024;6(2):26-32 

In this episode, the team takes a deep dive into Mass Casualty Incidents (MCIs) — one of the most complex and confronting scenarios in pre-hospital care. They explore what truly defines an MCI, why early recognition and declaration using tools like METHANE is critical, and how structured command and communication can bring order to chaotic scenes. The team also breaks down modern triage approaches, including 10-Second Triage, and discuss how prioritising rapid decision-making and simple algorithms can save lives when resources are overwhelmed. Whether you’re new to practice or an experienced clinician, this episode offers clear, practical insights to help you navigate MCIs with confidence and purpose. References: Vassallo, J., Cowburn, P., Park, C., Bull, D., Harris, S., Moran, C. G., & Smith, J. E. (2024). Ten second triage: A novel and pragmatic approach to major incident triage. Trauma, 26(1), 3-6. Davidson, L., Vassallo, J., Cowburn, P., Bull, D., Moran, C., & Carter, H. (2025). Evaluating Ten Second Triage: A Novel Multi‐Agency Prehospital Triage Tool for Major Incidents. Journal of Contingencies and Crisis Management, 33(1), e70025. Gebhart, M. E., & Pence, R. (2007). START triage: does it work?. Disaster Management & Response, 5(3), 68-73. Kuriyama, A., Urushidani, S., & Nakayama, T. (2017). Five-level emergency triage systems: variation in assessment of validity. Emergency Medicine Journal, 34(11), 703-710.

In this episode, the team is joined by Jason Belcher, Resuscitation Improvement Specialist at St John WA, to explore what makes the biggest difference in surviving an Out-of-Hospital Cardiac Arrest (OHCA). With a background in paramedicine, research and education, Jason’s work focuses on strengthening the entire chain of survival, from community recognition and bystander CPR through to high-performance resuscitation and clinical decision-making in the field. Together, the team discusses the critical role of early recognition, the impact of community defibrillators and first responder apps, and why mastering the fundamentals of CPR remains the most powerful intervention for saving lives.  Whether you’re a student, volunteer, or experienced clinician, this episode offers practical, evidence-based insights to help you deliver the best possible outcomes for patients in cardiac arrest. References: Science of CPR with Peter Kudenchuk, MD How likely is the patient to be in cardiac arrest? Caller breathing descriptors in ambulance calls that were dispatched as cardiac arrest - ScienceDirect Lifesaving Cardiopulmonary Resuscitation: A Pilot Evaluation of a Targeted Educational Intervention to Improve Cardiopulmonary Resuscitation Provision in Volunteer Surf Lifesavers - Journal of Emergency Medicine Neurological outcome in adult out-of-hospital cardiac arrest – Not all doom and gloom! - ScienceDirect Smartphone‐activated volunteer responders and survival to discharge after out‐of‐hospital cardiac arrests in Victoria, 2018–23: an observational cohort study - Delardes - 2025 - Medical Journal of Australia - Wiley Online Library https://news.stjohnwa.com.au/wp-content/uploads/2025/10/OHCA25_Annual-Report_Digital.pdf 

In this episode, the team is joined by Greta Hammer, a Clinical Lead Paramedic, to unpack red flag ECG findings in syncope. Greta has a special interest in cardiology and the nuances of ECGs, a passion that began during her years working under a cardiologist here in Perth, before transitioning to her career as a paramedic with St John WA. Since then, she has been involved in educating new paramedics and developing ECG tools tailored for the pre-hospital setting, all with the goal of enhancing clinical excellence in the field. Together, the team explores key warning signs that shouldn’t be missed and shares practical tools to help identify potentially life-threatening conditions. Greta also introduces a simple mnemonic – “ABCDE Left Right” – designed to make recognising these findings easier in the field. Whether you’re a student, volunteer, or seasoned clinician, this episode is full of valuable insights to elevate your patient care.  References:  EKG Library • LITFL • ECG Library Basics ECG – ProductiveMedic

Trigger Warning: This episode discusses birth experiences, including potentially distressing or sensitive content. Listener discretion is advised. In this episode, the team is joined by the incredible Mel Gardiner, a highly experienced paramedic with over 20 years on the road and a passion for improving maternal care in the pre-hospital space. Mel talks through the nuances of maternal assessment, highlighting the unique challenges paramedics face when providing care to mothers and babies outside of hospital.  The team dive into STORC (State Obstetrics Referral Call) — an innovative program Mel has helped develop. STORC connects paramedics with registered midwives trained specifically in pre-hospital care, offering immediate expert support, guidance, and even life-saving interventions over the phone. With WA’s vast and often remote geography, this program has been a game-changer for families and clinicians alike, bridging gaps between the community, paramedics, and maternity wards.  Whether you’re a paramedic, student, or simply curious about how critical maternal care is delivered in the field, this episode provides practical insights, valuable learning, and an inspiring look at how collaboration can transform patient outcomes. References Findlay, H. J., Anderson, J. K., Francis, K. L., Clegg, L. M., & Maria, S. J. (2023). The significance of paramedic communication during women’s birth experiences: A scoping review. Women and Birth, 36(5), e491–e501. https://doi.org/10.1016/j.wombi.2023.02.003 Hill, M., Miles, A., Flanagan, B., Mills, B., & Hopper, L. (2022). Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: A scoping review protocol. BMJ Open, 12(5), e062313. https://doi.org/10.1136/bmjopen-2022-062313 Keedle, H., Keedle, W., & Dahlen, H. G. (2022). Dehumanized, violated, and powerless: An Australian survey of women's experiences of obstetric violence in the past 5 years. Violence Against Women, 30(9), 2162–2184. https://doi.org/10.1177/10778012221140138  

In this episode, the team dive into the critical but often under-discussed phase of post-ROSC (Return of Spontaneous Circulation) care in non-traumatic adult cardiac arrest. Achieving ROSC is a major win, but it's just the beginning. What comes next can be the difference between survival and meaningful recovery. They break down the essential steps for optimising airway, ventilation, circulation, and neurological outcomes in the immediate post-arrest period, all through a practical and prehospital lens. From optimal positioning and end-tidal monitoring to fluid strategies and medication titration, this episode is packed with tips to help you stabilise and support your patient when it matters most.  They also explore the importance of tactical pauses, human factors, and mindset shifts that help crews transition from the chaos of resuscitation to focused post-arrest care. You’ll hear about the role of targeted temperature management, post-ROSC ECG interpretation, and real-world considerations like agitation, sedation, and hospital destination decisions. Whether you're a new clinician or an experienced provider, this episode will give you practical, evidence-based strategies to help keep your post-ROSC patients alive and thriving. Don’t just aim for ROSC—plan for what comes after. References Crewdson, K., Lockey, D., Voelckel, W., & others. (2019). Best practice advice on pre-hospital emergency anaesthesia & advanced airway management. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(6). https://doi.org/10.1186/s13049-018-0554-6 Life in the Fast Lane. (n.d.). Post-resuscitation syndrome. https://litfl.com/post-resuscitation-syndrome/ Stub, D., Bernard, S., Duffy, S. J., & Kaye, D. M. (2011). Post cardiac arrest syndrome: A review of therapeutic strategies. Circulation, 123(13), 1428–1435. https://doi.org/10.1161/CIRCULATIONAHA.110.988725

In this episode, the team unpack the vital topic of human factors—the skills and attributes beyond the technical that shape effective clinical performance. They explore how elements like situational awareness, communication, stress management, and decision-making influence paramedic practice in unpredictable environments. The conversation dives into the cognitive load faced on scene, how preparation and routine can enhance performance, and the importance of stress inoculation and reflective practice. Listeners will gain insight into how experienced clinicians filter variables more efficiently, why adaptability is key, and how good habits—like staying hydrated, being physically prepared, and knowing your kit—can reduce mental strain. The team also highlights how human factors can be developed through deliberate practice and how leadership style must flex to support team members' different learning and feedback needs. Whether you're new to the field or a seasoned paramedic, this episode offers practical strategies and relatable reflections to sharpen your non-technical skills and support better patient care. References Think Again, the power of knowing what you don’t know. Adam Grant. The Paramedic Mindset. Leigh Anderson (2024). The Captain Class, A new theory of Leadership. Sam Walker. Crameri, L., Hettiarachchi, I., & Hanoun, S. (2021). A Review of Individual Operational Cognitive Readiness: Theory Development and Future Directions. Human Factors, 63(1), 66-87. https://doi.org/10.1177/0018720819868409 The Monarch Human Performance Podcast - https://podcasts.apple.com/au/podcast/monarch-human-performance-podcast/id1520556844?i=1000531171251 https://podcasts.apple.com/au/podcast/monarch-human-performance-podcast/id1520556844?i=1000537193186 HeliNOTs program for developing Non-Technical or Human Factors in Search and Rescue Pilots (Hamlet et al, 2021). Hugelius, K., & Harada, N. (2025). What is Disaster Readiness Among Health Care Professionals? A Systematic Integrative Review Study. Disaster Medicine and Public Health Preparedness, 19, e57 Reid, C., Brindley, P., Hicks, C., Carley, S., Richmond, C., Lauria, M., & Weingart, S. (2018). Zero point survey: a multidisciplinary idea to STEP UP resuscitation effectiveness. Clinical and experimental emergency medicine, 5(3), 139–143. https://doi.org/10.15441/ceem.17.269  

In this episode, the team dives into the high-acuity, low-occurrence world of penetrating trauma, a critical but often under-practiced area in pre-hospital care. They explore how limited exposure can impact clinical confidence —and discuss how cognitive overload can affect approaches during major trauma situations. The conversation introduces the “STAB-5” approach, a UK-based system designed to guide clinicians through scene safety, triage, assertive management, bleeding control, and rapid transport, all within a targeted five-minute scene time. Emphasis is placed on early recognition of time-critical injuries, prioritising rapid transport over prolonged on-scene treatment, and using tools like direct pressure, arterial tourniquets, wound packing, and chest seals effectively. The team also reflects on the importance of balancing interventions with the urgency to move, highlighting the role of mentation and physical appearance over vital signs in assessing perfusion. It’s a practical, engaging episode for anyone looking to sharpen their skills in managing life-threatening penetrating trauma in the field. References  Winter E, Hynes AM, Shultz K, Holena DN, Malhotra NR, Cannon JW. Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania. JAMA Netw Open. 2021;4(1):e2034868. doi:10.1001/jamanetworkopen.2020.34868 Roberts I, Shakur H, Coats T, Hunt B, Balogun E, Barnetson L, Cook L, Kawahara T, Perel P, Prieto-Merino D, Ramos M, Cairns J, Guerriero C. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013 Mar;17(10):1-79. doi: 10.3310/hta17100. PMID: 23477634; PMCID: PMC4780956. Robinson, M., Rath, F., Sutton, C. et al. STAB-5: an aide-mémoire for the efficient prehospital management of penetrating trauma by emergency medical services. Crit Care 28, 261 (2024). https://doi.org/10.1186/s13054-024-05048-1  Figure 1 https://greatwesternairambulance.com/what-we-do/education/clinical-engagement/stab-5/