Clinical Conversations

• Sedation safety for acute behavioural disturbance

  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

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• Clinical Updates: February 2025

  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

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• "He's going to die" - Breaking bad news

  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

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• Clinical Updates: January 2025

  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

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• Pain (Part 3) - Systems issues and special circumstances

  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: Scientific Evidence: 5th Edition⁠⁠   ⁠⁠Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm⁠⁠ ⁠⁠Pain 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 / Twitter David: ⁠⁠⁠@expensivecare⁠⁠⁠ James: ⁠⁠⁠@JamesOz1⁠ Linkedin ⁠⁠James⁠ ⁠David⁠ Bluesky Social James: ⁠@jamesoz1.bsky.social

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