Clinical Conversations – Details, episodes & analysis

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):

02:10 – CPG Update Released
• Highlights major 2025 CPG changes, app issues, and expected three-month transition period (IFS ceases immediately).

 • Emphasis on professional judgment, understanding over memorisation, and upcoming live Q&A.

 • Request for staff feedback on new learning methods.

05:42 – Women’s Pain Inquiry Findings
• Large Victorian inquiry confirms women’s pain is frequently dismissed; implications for paramedic practice.

06:58 – Registration & Professional Capabilities
• Registration season brings opportunity to review Paramedicine Board capabilities: communication, cultural safety, risk management, lifelong learning.

08:05 – Paper 1: AI ECG for STEMI
• AI ECG analysis outperforms clinicians in complex cases and may reduce cath lab false activations; human–AI collaboration is the future.

10:20 – Paper 2: Community Paramedicine Study
• Time-and-motion study shows community paramedicine is a thinking-intensive role with few interventions.

13:40 – Paper 3: Methoxy vs Fentanyl vs Morphine
• Methoxyfluorane provides fastest early analgesia; supports multimodal pain management with methoxy as a strong first-line option.

17:56 – Equipment Update
• Reminder not to pre-connect sensitive devices (e.g., EtCO₂ adapters, Yankauer) due to temperature and contamination risks.

19:54 – AI Professional Development Workshop
• Upcoming Monash workshop on trustworthy generative AI for healthcare, available in-person and virtually.

Resources  

Inquiry into women’s pain: https://www.health.vic.gov.au/inquiry-into-womens-pain 

Gender disparities in EMS care: https://pubmed.ncbi.nlm.nih.gov/36369725/ 

Sex Differences in Patients With Acute Chest Pain:  https://www.sciencedirect.com/science/article/pii/S0735109723000839 

Professional capabilities: https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx 

Papers of the month 

Community paramedicine: https://www.sciencedirect.com/science/article/pii/S2588994X25000909?via%3Dihub 

Pain relief study: https://www.sciencedirect.com/science/article/abs/pii/S0140673625015752 

AI-Enabled ECG Analysis: https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018 

Professional development 

Building Trustworthy GenAI for Healthcare Innovation: https://shop.monash.edu/masterclass-building-trustworthy-genai-for-healthcare-innovation.html 

Get in touch 

⁠clinicalguidelines@ambulance.vic.gov.au⁠

James: https://linktr.ee/ClinicalConversations

Ben: ⁠@ben_meadley⁠ , Ben - Linkedin 

Producer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):

01:40 – 2025 Clinical Update Coming Soon

02:20 – IFS Retirement & Paediatric RSI Feedback

07:05 – STEMI Performance Update

08:50 – Free Birth: Paramedic Implications

11:50 – PANDA Trial Update

13:50 – Patient Safety: Cognitive bias & discounting concerning symptoms

19:20 – Missing PCRs in Severe Adverse Events

21:50 – Guideline Monitoring: Minor Head Injury & VVED Outcome Data

22:50 – Paper of the Month & New Cardiac Arrest Guidelines

25:45 – Equipment Updates

26:59 – Professional Development Opportunities

28:15 – Small Steps to Transform Your Practice

Further resources

Freebirth - Position statement | Safer Care Victoria

EMCRIT episode on paediatric FONA: https://emcrit.org/emcrit/pediatric-tracheotomy/

 ERC 2025 Guidelines: https://www.erc.edu/science-research/guidelines/guidelines-2025/guidelines-2025-english/

AHA 2025 Guidelines: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines

Opinion piece - Iain Beardsell: https://www.bmj.com/content/390/bmj.r2051 

ACP Regional Paramedic Symposium: https://paramedics.org/events/rps-2025?tab=About

Emergency, Trauma & Critical Care Conference: https://www.fltr-ed.com/

 Get in touch

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James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben

Producer: Liam Hennebry 

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

⁠clinicalguidelines@ambulance.vic.gov.au⁠

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David: ⁠@expensivecare⁠ | @expensivecare.bsky.social

James: ⁠⁠⁠@JamesOz1⁠⁠

Linkedin

James

David

Producer: Liam Hennebry

Your monthly clinical update covering:

VVED Consultations for small infants

• New requirement: VVEDconsultation for non-transport of infants ≤28 days
• Strong recommendation for 29days–3 months
• Driven by patient safety reviewand expert consensus
• Not about removing autonomy —it’s about adding clinical support

RSI Checklist Update

• Addition of a pop-off valve checkfollowing a critical safety event
• Prevents misdiagnosis of failedventilation
• Reinforces value of checklists,even for experienced clinicians

Advanced Paramedic PracticeProposal

• Public consultation open
• Framework for advanced practiceregistration in primary care and critical care
• Facilitates further advancementssuch as prescribing rights and scope self-determination
• Big implications for AVparamedics — see link in show notes to respond

STEMI Transfer Pilot

• ALS paramedics trialing regionalSTEMI transfers
• Target: stable patientspost-thrombolysis
• Reflects data showing most STEMIpatients are low risk

Patient Safety Focus

• Standing height falls in theelderly: don’t underestimate risk
• Rhythm misinterpretation:shockable rhythms missed or misidentified
• No link between junior staff anderror rates — we all share responsibility, we are all vulnerable

Guideline Monitoring:Palliative Care CPG

• 9.9% increase in patients dyingat home — great outcome
• No major change in meds given —possibly due to barriers in the current CPG
• Evidence supports simplifying CPG

Case Reports on Viva Engage

• Recent cases: paediatricrespiratory failure, polypharmacy overdose, snake bite
• Submit your own case via the Vivatemplate

Paper of the Month: PACKMaNTrial

• RCT comparing ketamine vsmorphine for trauma pain
• Found no difference ineffectiveness
• Points to multimodal analgesia asa next step in research, which is already AV’s approach

Equipment

• Check Pop-off Valve position atstart of shift
• “Resus Ready” campaign comingsoon
• Cardiac Monitor ReplacementProgram- New device coming
• Discussion underway: do we needto carry everything all the time?

Professional DevelopmentOpportunities

• Critical Care Summit – May 15–16,Essendon
• Grand Rounds (CPG + RMH collab) –May 27, Sunshine Hub or virtual
• Trauma Grand Rounds – June 18 atRoyal Children’s or online

Small steps to transform youpractice

• Deliberate practice = highperformance, visualisation and mental rehearsal make a difference
• Practice rhythm recognition
• Rehearse SITREPs

Resources
Paramedic analgesia comparing ketamine and morphine in trauma (PACKMaN): a randomised,double-blind, phase 3 trial

Palliative paramedicine: An interrupted time series analysis of pre-hospital guideline efficacy

Proposal to regulate advanced practice paramedics

Rhythm recognition

Get in touch

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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:

1. Prevent deterioration (have a listen to Part 1)
2. Prepare for side‑effects – if you plan to sedate, you must plan to resuscitate
3. Recognise & Respond when things go wrong

Further resources

APIC Session: https://paramedics.org/recordings/acpic24-spotlight-on-sedation

Clinical Conversations – Acute Behavioural 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

⁠clinicalguidelines@ambulance.vic.gov.au⁠

X / Twitter / Blusky

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social

James: ⁠⁠⁠@JamesOz1⁠⁠ |@jamesoz1.bsky.social

Linkedin

James

David

Your monthly clinical update covering:

• Cardiac arrest outcomes
• An update on the sedation safety guideline
• Lessons 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 reminder
• Paper of the month: Prehospital antibiotics in sepsis
• Miller blade use for ALS paramedics

Resources

ACP Critical Care Summit

Get in touch

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James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben

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

⁠clinicalguidelines@ambulance.vic.gov.au⁠

X / Twitter / Blusky

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social

James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social

Linkedin

James

David

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 app
• Paper 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.

Chapters

00:00 Introduction and Overview of ClinicalUpdates

01:21 Rapid summary

02:50 Updates on Intranasal Fentanyl

5:40 Other CPG updates: Extrication monitoring, shoulder reduction, wilderness pain relief.

07:50 Blood Product Administration andSafety

10:00 Rocuronium storage and efficacy concerns

11:18  Emergency Healthcare Communication Book

12:11 Medical Advisor on Call and PatientSafety

12:50 MICA targeted Dispatch and PatientSafety Reporting

14:12 Extrication related adverse events

15:30 Case reports

16:01 Paper of the Month: STEMI CareInsights

17:30 Equipment updates

18:31 External Professional DevelopmentOpportunities

19:25 Small Steps to Transform YourPractice

Further resources

Adverse 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.pdf

Medication stability in hot environments: https://www.sciencedirect.com/science/article/pii/S2211419X23000630

Get in touch

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James: ⁠⁠⁠@JamesOz1⁠⁠

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben

Bluesky Social

James: ⁠⁠@jamesoz1.bsky.social

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

⁠clinicalguidelines@ambulance.vic.gov.au⁠

X / Twitter

David: ⁠@expensivecare⁠

James: ⁠@JamesOz1

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 summary

02:20 Patient Safety Update: If you sedate, plan to resuscitate.

06:13 Exploring Low Acuity Pathways

10:40 Strategic Planning for 2025

11:27 Case Reports and Community Engagement

12:21 Research Update: Physician-Led Teams – do they improve outcomes?

16:59 Equipment Update and Safety Protocols

19:22 Professional Development Opportunities

21:04 Small Steps to Transform Your Practice

Resources

Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically Ill and injured patients: a systematic review and meta-analysis

Get in touch

X / Twitter

James: ⁠⁠⁠@JamesOz1⁠⁠

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben