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 Soon 02:20 – IFS Retirement & Paediatric RSI Feedback 07:05 – STEMI Performance Update 08:50 – Free Birth: Paramedic Implications 11:50 – PANDA Trial Update 13:50 – Patient Safety: Cognitive bias & discounting concerning symptoms 19:20 – Missing PCRs in Severe Adverse Events 21:50 – Guideline Monitoring: Minor ...

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 ⁠clinicalguidelines@ambulance.vic.gov.au⁠ David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine): Clinical Update Warm 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/...

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 resources Avoid trial: https://www.ahajournals.org/doi/10.1161/circulati...

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 complia...

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 ⁠clinicalguidelines@ambulance.vic.gov.au⁠ Socials David: ⁠@expensivecar...

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. &...

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...

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 Safe...

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 collaboratio...

Your monthly clinical update covering: VVED Consultations for small infants New 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 support RSI Checklist Update Addition of a pop-off valve checkfollowing a critical safety eventPrevents misdiagnosis of failedventilationReinforces value of checklists,even for experienced clinicians...

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 wrong Furth...

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 paramedics Resources ACP Critical Care Summit Get in touch X / Twitter / Bluesky ...

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 th...

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-...

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 p...

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...

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 resources ⁠⁠Acute Pain Management: Scienti...

A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Overview 1. 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; con...

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 resources ⁠Acute Pain Management: Scientific Evidence: 5th Edition⁠ ⁠Ketamine for the treatment of prehospital acute pain: a systematic review...