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Clinical Updates: December
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Quick summary (0:30) Patient Safety (1:30) Discussing the lessons from specific adverse events is challenging due to patient privacy/consent, crew psychological safety, and investigation timelines. We need to find a way to collectively share these lessons in a safe way. Plans for quarterly clinical forums (2025) to foster psychologically safe discussions. Clinical Updates (4:52) IV Cannulation for STEMI:Avoid sites near the radial artery to support PCI access. Extrication Monitoring: Monitoring is sometimes removed during extrication, especially self-extrication. Associated with adverse events. We need to emphasise monitoring (especially ECG/pulse oximetry) during extrication. Ectopic Pregnancy: Patient safety Assume ectopic pregnancy for women of childbearing age with abdominal pain and shock. Cardiac Arrest: Always prioritize high-performance CPR over antiarrhythmics. Clarification on stacked shocks and their intended use. CWI out soon. ALS paramedics encouraged to consult for post-ROSC hypotension management. Guideline Monitoring (12:36) Success of expanded croup guidelines: increased dexamethasone use and reduced hospital transports. Research Updates (14:20) PANDA Trial: Comparing noradrenaline and adrenaline in cardiogenic shock. IV vs IO Access: Preference for IV first in cardiac arrest; IO as backup. ROSC Blood Pressure: Minimum diastolic pressure of 35mmHg linked to better outcomes. Equipment Notices (19:20) Normal saline shortages persist; substitute with Hartmann’s or PlasmaLite. New ketone strips now available—use carefully. Professional Development (20:11) CPD resources from the Australasian College of Paramedicine and Victorian Ambulance Union. Links to registration standards and CPD tools in the show notes. Resources PARAMEDIC 3 Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes PANDA trial - If you want to learn more about the study or have any questions, search for PANDA on the AV intranet or contact the team at [email protected]. Pain research with Monash - Get involved: Paramedic confidence & barriers to paediatric pain management External development opportunities https://www.paramedicineboard.gov.au/professional-standards/faq/faq-cpd.aspx https://paramedics.org/education https://paraed.vau.org.au/events Get in touch X / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠ Linkedin James Ben
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Pain (Part 1) - Assessment, bias and disparities in care
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 1, we look at assessment, bias and, disparities in pain care. In the coming months, we’ll bring you the rest of our discussion covering best practice pain relief, system issues, myths about opioids, and special circumstances in pain care. 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
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Clinical Updates: October 2024
This is the first in a new series of monthly clinical updates for Ambulance Victoria clinical staff. Director of Paramedicine A/Prof Ben Meadley and Clinical Guideline Specialist James Oswald summarise the need-to-know clinical information, all in one spot. This month: New CPG updates, trends in our patient safety data, and new cardiac monitors. Times stamps: 2:00 New CPG updates 4:40 Snakebite 6:30 Acute coronary syndrome and activating the cath lab 7:35 Patient safety trends 10:20 Dislocation reduction – how are we doing? 12:10 Ketone strips 13:50 Case report templates 15:05 Thunderstorm asthma 15:25 IV Fluid shortage 15:50 PANDA trial update 16:40 New cardiac monitors 17:25 Professional development opportunities Resources Australasian College of Paramedicine Critical Care Summit April 2025 European EMS Congress Copenhagen June 2025 Safe airway society Get in touch X / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠ Linkedin James Ben
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The Future of Paramedicine
In this episode, James speaks with critical care paramedic, academic, and newly appointed Director of Paramedicine, Associate Professor Ben Meadley. We discuss strategic clinical leadership and the future of the profession. X / Twitter David: ⁠⁠⁠@expensivecare⁠⁠⁠ James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠
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Sepsis (Part 2) - Management
Part 2 of David's discussion with Associate Professor Andrew Udy on Sepsis Management. Get in touch ⁠[email protected]⁠ X / Twitter David: ⁠@expensivecare⁠ James: ⁠@JamesOz1 Resources mentioned [PHANTASI trial] Alam N, Oskam E, Stassen PM, Exter Pv, van de Ven PM, Haak HR, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Respiratory Medicine. 2018;6(1):40-50. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-96. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376(23):2235-44. ARISE Invetigators. Goal-Directed Resuscitation for Patients with Early Septic Shock. New England Journal of Medicine. 2014;371(16):1496-506. PRISM Investigators. Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis. New England Journal of Medicine. 2017;376(23):2223-34. Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard 2022 [Available from: https://www.safetyandquality.gov.au/standards/clinical-care-standards/sepsis-clinical-care-standard#:~:text=The%20Sepsis%20Clinical%20Care%20Standard,Commission%20on%2030%20June%202022. Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510. Other resources Poynter MJ, Farrugia A, Kelly E, Simpson PM. Prehospital administration of antibiotics in addition to usual care versus usual care alone for patients with suspected sepsis – a systematic review. Paramedicine. 2024;21(2):52-65. Varney J, Motawea KR, Kandil OA, Hashim HT, Murry K, Shah J, et al. Prehospital administration of broad-spectrum antibiotics for sepsis patients: A systematic review and meta-analysis. Health Sci Rep. 2022;5(3):e582.
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