Clinical Conversations

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 opport...

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 3, we look at challenges in building a system that leads to good pain relief as well as some special circumstances in...

A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Overview 1. Clinical Practice Updates •CPG App Update Details: oSecondary triage review oChanges to pediatric analgesia guidelines oStacked shock CWI updates oMinor error corrections • Pediatric Cannulation: oALS IV access is supported for: Major trauma and traumatic arrest (all ages), and Pain re...

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 2, we look at best practice in the management of pain. Further resources ⁠Acute Pain Management: Scientific Evidence:...

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 clinica...

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 d...

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...

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

Part 2 of David's discussion with Associate Professor Andrew Udy on Sepsis Management. Get in touch ⁠clinicalguidelines@ambulance.vic.gov.au⁠   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, randomis...

Sepsis is arguably the most common time critical emergency we face as paramedics. This is the first of a two part series on sepsis with Professor Andrew Udy. Andrew is Head of Research at The Alfred ICU, and Deputy Director, Australian and New Zealand Intensive Care Research Centre. He was involved in the development of the recently released Ambulance Victoria Sepsis and Infection guideline. In th...

In Australia, penetrating truncal trauma is rare and the care of these patients involves a quite different mindset than we're used to. This is a cohort where our stay-and-play approach can do harm. James and David discuss the evidence relating to penetrating trauma and practical recommendations for your practice. Further resources Over view of major traumatic injury in Australia–Implications...

Clinical practice varies between the different state ambulance services in Australia. Yet we all claim to be evidence-based. So why is this, how big of a problem is it and what should we do about it? Are national guidelines the answer? James speaks with paramedic and PhD candidate Matt Wilkinson-Stokes to find out, while David shares his perspective on national guidelines. Further resources Matt&a...

For over a decade after a large study showed a mortality benefit, this drug remained controversial. David and James look at the TXA saga.

Clinical conversations is back. But where have we been, what have we been doing and what do we have planned for the future?

We’re all familiar with the concept of STEMI. But the definition is built around a single ECG sign – not the underlying problem itself. Is that the best way to do it? Should we be thinking about this in a totally different way? Is Occlusive Myocardial Infarction (OMI) the new STEMI? Notes OMI Manifesto Amal Mattu on YouTube Subtle STEMI iOS app The Ancient Scholar

Capnography plays a crucial role in the treatment of a range of life-threatening conditions. Its central role following intubation is undeniable and it's also an important part of our approach to cardiac arrest and sedated patients of all kinds. Yet it is not always as straightforward as it might seem. In this episode, David and James speak with Matt Humar (intensive care paramedic, acting pa...

Shock is the quintessential critical illness. Bread and butter for everyone involved in prehospital and critical care. But do we really understand it? Could we be doing better for these patients? James is joined by Assoc. Prof. David Anderson, intensivist and Ambulance Victoria Medical Director, for a... shocking discussion. 

People experiencing acute behavioral disturbance are some of the most vulnerable patients we treat. It’s a deeply distressing situation for the patient and extremely confronting for clinicians and carers. In this episode, we speak with psychiatrist Dr Alison Taylor about important changes we're making to improve care for these patients.

Family violence is a deeply confronting and serious problem that occurs across all ages, genders, and socioeconomic groups. It has a profound impact on the health and well-being millions of people across the globe. How can we identify family violence? How should we respond to a disclosure of family violence? How can we help victim survivors? Ambulance Victoria Safe Guarding Care Lead Amber Smith j...

The decision to withhold or cease resuscitation is one of the most impactful and also one of the more confronting decisions that paramedics make in the field. AV Medical Director Associate Professor David Anderson discuss Dr Natalie Anderson, PhD discuss the decision making process and how to better approach these difficult cases.    MyGriefToolbox - Great Canadian resource for all paramedics, wit...

Ambulance Victoria recently introduced intranasal ketamine for the treatment of moderate and severe pain. It has proven to be effective but we have identified opportunities to do better. Clinical Practice Development Specialist James Oswald and Medical Director David Anderson discuss the new Clinical Practice Guideline and some of the lessons we've learned along the way.