Clinical Conversations

• Clinical Updates: April 2025

  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 / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry

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• Sedation safety for acute behavioural disturbance (Part 2)

  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

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• Clinical Updates: March 2025

  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

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• 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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