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Clinical Conversations

The Ambulance Victoria Office of the Medical Director
Clinical Conversations
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  • Clinical Updates: Paediatic intubation special
    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[email protected]⁠David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations
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  • Clinical Updates: September 2025
    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):Clinical UpdateWarm 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/Monash/PIPER. Use patient device if feasible; alternatives include Flow-Safe and Zoll Z-Vent. More guidance coming.Patient safetyLow acuity, high risk (12:32): Some high-risk patients sit in apparently low acuity cases. Advocate, self-upgrade when risk warrants. Lodge cases in RiskMan.Standing height falls (14:49): Standing-height falls in older adults: great feedback from the field, we discuss common themes.Paper of the Month (19:26): measurable “hyperacute T-wave” definition predicts OMI even without STEMI criteria.Equipment (21:40): new neonatal BVMs; syringe-holder prototypes to separate RSI meds.CPD (24:21): short courses and LinkedIn Learning suggestions.Further resourcesOcclusion myocardial infarction and artificial intelligenceHyperacute T-wave definitionhttps://journals.sagepub.com/doi/full/10.1177/27536386251371078https://shortcourses.rmit.edu.au/collections/allhttps://mbs.edu/short-courseshttps://www.monash.edu/business/corporate-education/short-coursesLinkedin.com/learning/Get in touchJames: https://linktr.ee/ClinicalConversationsBen: X/Twitter⁠ | [email protected] 
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  • Cardiogenic shock
    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 resourcesAvoid trial: https://www.ahajournals.org/doi/10.1161/circulationaha.114.014494DETO2XAMI:  https://www.nejm.org/doi/full/10.1056/NEJMoa1706222#:~:text=The%20Determination%20of%20the%20Role,not%20have%20hypoxemia%20at%20baseline. EXACT pilot trial: Concerns regarding the safety of prehospital titrated oxygen in post-cardiac arrest patients  https://pubmed.ncbi.nlm.nih.gov/29684433/PANDA Trial (AV Staff) https://ambulancevic.sharepoint.com/sites/OneAVQualityandClinicalInnovation/SitePages/PANDA-TRIAL-(.aspxGet in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations
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  • Clinical Updates: August 2025
    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 compliance requirements.STAB-5 mnemonic and minimising scene time in major trauma.PANDA trial enrolment reminder.Standing-Height Falls in Elderly – Missed spinal injury cases, cultural pendulum shift, guideline review, and call for feedback.Manual Handling & Patient Safety in ED Cohorting – Safe movement of high-risk patients and preventing deterioration during cohorting.Paper of the Month – Danish machine learning study outperforming NEWS2 for predicting deterioration from first-five-minute vitals, with explainable AI.Equipment Committee Updates – New traction splints, medication safety devices via 3D printing, thermal blanket effectiveness, and syringe driver software updates.Professional Development & Resources – Coroner’s Communiques, ACP International Conference, new paramedic podcasts.Small Steps to Transform Practice –Treat elderly standing-height falls as potential spinal injuries.Minimise scene time for major trauma unless safety or critical intervention requires it.Further resourcesACP ConferenceThermal blanket studyMachine learning studySTAB-5Coroner's communique Get in [email protected] / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBen
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  • 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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About Clinical Conversations

The podcast for paramedics and anyone involved in out-of-hospital care that is critical, urgent, or unplanned. Hosted by James Oswald (Paramedic and clinical guideline developer) and A/Prof David Anderson (Medical Director).Keyword: Paramedic, paramedicine, Emergency Medical Service, EMS, Emergency Medical Technician, EMT, prehospital, pre-hospital critical care, retrieval medicine, ambulance, Helicopter Emergency Medical Service, HEMS, air ambulance, emergency, first responder, first aid.
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