Clinical Conversations

• Q&A: Sedation, trauma, why we need to change and the future of paramedicine.

  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

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• Clinical Updates: July 2025

  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}

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• Paediatric acute behavioural disturbance

  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

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• Clinical Update

  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

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• Paediatric assessment, consultation and virtual emergency care

  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

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