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Your monthly clinical update covering: Clinical practice update: -          Needle sizes for IM injections -          New clinician health channel and forthcoming CSO forum -          Prehospital whole blood Patient safety update: What we can learn the Coroner’s inquest into the death of Philip Walton -          Inquest into the death of Phillip Walton -          Transport requests for definitive medical care - paramedic responsibilities -          WIN/OPS/015 Operational Workforce Key Response Requirements Paper of the month: Prehospital Point-of-Care GFAP for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma | Emergency Medicine | JAMA Network Open | JAMA Network  Paramedicine Editorial: Who gets to be sick?  Equipment update: Fentanyl 100 mcg/2 mL ampoules – Inconsistent ampoule breakage with Hameln brand Professional development opportunities: Improving Diagnosis Symposium Australian & New Zealand Society of Palliative Medicine (ANZSPM) - Paramedicine Palliative Care Study Day  Red Dirt Resus 2026   AWEMS Conference  Imaginal simulation/mental rehearsal: https://pubmed.ncbi.nlm.nih.gov/38244027/ https://paramedics.org/recordings/rs24-mental-rehearsal-in-paramedicine-an-acceptability-study       Get in touch [email protected] Linkedin James Ben     Producer: Liam Mylebry

When is a clinical examination reliable enough to clear the spine? In this first episode of our spinal series, James and David unpack clinical spinal clearance - stable and unstable injuries, challenge common assumptions about neurological deterioration, compare NEXUS with the Canadian C-Spine Rule, and work through the modified NEXUS approach used in Victoria. We also explain why low-energy falls, older age and bone-weakening conditions deserve particular caution.     Further resources  • Hoffman et al. (2000), Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. The landmark multicentre validation of the five NEXUS low-risk criteria.   • Stiell et al. (2001), The Canadian C-Spine Rule for radiography in alert and stable trauma patients. The derivation study describing the rule's three-step structure.   • Stiell et al. (2003), The Canadian C-Spine Rule versus the NEXUS low-risk criteria in patients with trauma. A prospective head-to-head comparison of the two decision rules.   • Vaillancourt et al. (2009), The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Prospective evidence on paramedic application of the Canadian C-Spine Rule.   • Domeier et al. (2005), Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. A four-year prospective EMS study of 13,357 patients evaluating a NEXUS-like selective immobilisation protocol; sensitivity was 92% for any spine injury, and no non-immobilised patient had a spinal cord injury.   • Paykin et al. (2017), The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. In patients aged 65 years and older with cervical spine fractures, NEXUS had 94.8% sensitivity, supporting caution when applying the rule to older adults.   • Denver et al. (2015), Falls and Implementation of NEXUS in the Elderly (The FINE Study). A prospective study of patients older than 65 years after low-level falls; NEXUS sensitivity was 88.9% for clinically significant cervical spine injury.   • Delaney et al. (2022), Prevalence of midline cervical spine tenderness in the non-trauma population. Useful context for interpreting midline tenderness and its limited specificity.  • Oto et al. (2015), Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature. A systematic review examining the incidence, timing and causes of secondary neurological deterioration after blunt spinal trauma, including deterioration associated with unstable injuries, delayed diagnosis and subsequent patient movement.    Get in touch  ⁠[email protected]⁠    Socials  David: ⁠@expensivecare⁠ |@expensivecare.bsky.social | LinkedIn  James: https://linktr.ee/ClinicalConversations

Your monthly clinical update from Ambulance Victoria covering:  Clinical Practice Update:2026 CPG changes  Respiratory illness  Avian influenza Calcium gluconate precipitation Dual sequential and vector change defibrillation Patient safety update: Shortened RSI checklist  Cutting the bougie for cricothyroidotomyGuideline monitoring: Evaluation of sedation for acute behavioural disturbance Paper of the month: STEMI care in Victoria Temporal improvements in prehospital systems-of-care for ST-elevation myocardial infarction patients in Victoria, Australia: a retrospective study | BMC Emergency Medicine | Springer Nature Link Equipment updateProfessional development opportunities Small steps to transform your practice  Clinical Podcasts Reccomendations: Australian  Prehospital Nerds — Hosted by MICA flight paramedic and an ED doctor, covering clinical pearls, cases, gear, procedures and prehospital decision-making.Clinical Practice Radio (CPR) — St John WA's podcast, hosted by their Deputy Director of Paramedicine Andy Bell with clinical leads Megan Currie and Nick Overington, using current evidence and subject matter experts.The Australasian College of Paramedicine podcasts — The Debrief, Student Talk and the Talking Research series. UK  The Resus Room — Absolute classic. Emergency medicine built on evidence-based medicine. Papers of the Month is the efficient way to keep up.  PHEMCAST — Prehospital emergency medicine specifically.  St Emlyn's — a UK emergency medicine podcast for anyone working in emergency care, from a team of educators and clinicians focused on evidence-based education. Best of the group on human factors and broadening our thinking beyond paramedicine in Australia.   North America  FOAMfrat — prehospital emergency and critical care from Tyler Christifulli and Sam Ireland. Strong on underlying physiology.  EMCrit — Scott Weingart. The OG. His passion is easy to listen to.      Get in touch [email protected]  Linkedin  James  Ben      Producer: Liam Mylebry

Your monthly clinical update from Ambulance Victoria covering: Paediatric anaphylaxis and asthma – a message from Safer Care VictoriaPre-hospital blood productsPatient safety update: CSO Matt Shepard on paediatric airway managementGuideline monitoring: Head injury guidelinePaper(s) of the month:  Torniquet use for severe bleeding | Pre-hospital vital signsEquipment updateProfessional development opportunitiesSmall steps to transform your practiceResources Paediatric Anaphylaxis: Acute Paediatric Asthma and Anaphylaxis – Practice point | Safer Care Victoria Pre-hospital Blood Products: BloodSafe eLearning Australia: Clinical Transfusion Practice: Pre-hospital and RetrievalRePHILL Trial: Resuscitation with blood products in patients with trauma-related haemorrhagic shock…Prehospital Whole Blood in Traumatic Haemorrhage: Randomised Controlled Trial (NEJM)Mitra et al. (2023), Pre-hospital Freeze-Dried Plasma for Critical Bleeding After Trauma: A Pilot R…System and Sustainability Considerations Young PP, Wood D, Holcomb JB, Jenkins DH, Levy MJ. Scaling of Prehospital Blood: A Model Describing…Whole Blood Research Hadley J, Conner J, Thomas C, et al. Whole Blood First Resuscitation and Association of Blood Produ…Ambulance Victoria Resources: Blood Component Access WIN/OPS/404 Blood Component Access from Air Ambulance Victoria: Essendon Fields. Describes pathways for metropolitan and inner regional access to blood components through AAV. WIN/OPS/405 Blood Component Access from a Health Service. Describes pathways for regional and remote access to blood components via health services and Adult Retrieval Victoria.   Positioning Infants for Airway Management (video) Hear more from Matt Shepard in the Prehospital Nerds podcast: Website | TikTok   Paper(s) of the month: Prehospital tourniquet use and associated outcomes in a low-resource conflict settingPrehospital physiologic instability and in-hospital mortality among non-trauma patients with low-ri…  Get in touch [email protected] Linkedin James Ben Producer: Liam Mylebry

Can a machine diagnose, triage, document a case, or show empathy? AI is everywhere and the pace of change makes it difficult to know when to stop and take stock. In this episode, we explain how AI works for clinicians, what the evidence shows, what the risks and benefits are in healthcare, and what it means for our clinical practice.    Disclaimer: While we did our best to ensure the content was accurate, we don’t script everything  and sometimes we do make mistakes. If you hear something in this episode that you disagree with, we want to hear from you, so please get in touch.   Further resources  AI-Assisted Decision Trees for Emergency Call Classification: The IAppel Project | Springer Nature Link  Transforming Health Care Through Chatbots for Medical History-Taking and Future Directions: Comprehensive Systematic Review - PubMed  Clinical Reasoning of a Generative Artificial Intelligence Model Compared With Physicians - PMC  A systematic review and meta-analysis of diagnostic performance comparison between generative AI and physicians - PubMed  Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial  Assessing the potential of GPT-4 to perpetuate racial and gender biases in health care: a model evaluation study  Comparing ambient scribes: a randomized crossover clinical trial addressing ambient scribe technologies’ impact on physician burnout  Ambient AI Scribes in Clinical Practice: A Randomized Trial    Get in touch  ⁠[email protected]⁠    Socials  David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn  James: https://linktr.ee/ClinicalConversations    Producer: Liam Mylebry

Your monthly clinical update covering: · Clinical Practice Update: Forthcoming CPG changes including AF referral pathways, low‑risk chest pain risk scoring, and paediatric gastro guideline  Ebola bulletin and CHO advisory Cardiac Arrest Team Performance Report: insights and practical takeaways for improving CPR quality PANDA trial update · Patient safety update: Non-transport decisions, assessment, trusting our equipment · Paper of the month:  Naloxone and Clinical Outcomes in Suspected Opioid-Associated Out-of-Hospital Cardiac Arrests | Emergency Medicine | JAMA Network Open | JAMA Network  Naloxone for Out-of-Hospital Cardiac Arrest Due to Opioid Toxicity | Emergency Medicine | JAMA Network Open | JAMA Network  · Equipment update: Hypothermia, auxiliary purchase list updates, and giving sets · Professional development opportunities: Expression of Interest - 2026 CAA Congress Attendance  Grand Round | 23 June 2026  · Small steps to improve your practice ======= Get in touch  [email protected]  Linkedin  James  Ben      Producer: Liam Mylebry

Your monthly clinical update covering: ·  CPG updates: New measles CPG + updated CPP for ACOs & CERTs  ·  Hand hygiene refresher: Back to basics in challenging environments  ·  Cardiac arrest outcomes: Conversation with Ziad Nehme on recent improvements  ·  Survey plug: Clinical & Operational Service Delivery Plan  ·  Patient safety: Case review – consulting via the Clinician when engaging external agencies (e.g. PIPER)  ·  Tourniquets: Balancing risks and benefits  ·  Paper of the month: Ambulance offload delays and causes of ramping  ·  Equipment update  ·  Professional development highlights  ·  Small steps: Practical changes to transform your practice  ======= CPG update: CPG update – April 2026 VOD update: Updated guidance - Requests for Verification of Death (VOD) Hand hygiene: Take Five for Hand Hygiene Transmission based precautions clinical work instruction CWI OPS 184 Infection Prevention and Control Transmission Based Precautions.pdf Paper of the month: Initiatives to reduce ambulance offload delays in emergency departments: a scoping review - PubMed Professional development: Fast Tracked Higher Education Pathway for AV Clinical Instructors – Now Open for Mid-Year Intake Clinical Insights: Issue 8 now available The Australasian College of Paramedicine Conference | ACPIC26 CAA Congress | The Council of Ambulance Authorities Inc. Trauma 2026 Conference - Trauma Conference SAS Events – Safe Airway Society Clinical Technology and Equipment Committee Idea Sharing: Clinical Technology and Equipment Committee / [email protected]  Get in touch: [email protected] Linkedin James Ben     Producer

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine). This month's episode covers: Planned updates to CPGs in 2026Posterior StrokePatient Care RecordsEvaluation data of droperidol and dexamethasone as antiemeticsPaper of the Month: IV vs IO in cardiac arrestEquipment updateProfessional development opportunitiesSmall steps to transform your practicePaper of the Month Vascular access by paramedics during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A retrospective study of insertion success rates and survival outcomes of intravenous versus intraosseous route  https://www.sciencedirect.com/science/article/abs/pii/S0735675726000628  Professional Development Opportunities The Australasian College of Paramedicine | Primary Care Conference 2026 ACP 2026 Education Grants: 2026 Education Grants Open Posterior Stroke Not so FAST: pre-hospital posterior circulation stroke - PMC Get in touch [email protected] X / Twitter  James: ⁠⁠⁠@JamesOz1⁠⁠  Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

In this episode of Clinical Conversations, we're joined by Associate Professor Carmel Crock (Director of the Emergency Department at the Royal Victorian Eye and Ear Hospital and Chair of the Quality & Patient Safety Committee at the Australasian College of Emergency Medicine) to unpack what diagnosis is, how diagnostic error happens, and how we can make diagnosis safer. We explore common pitfalls like premature closure and diagnostic momentum, and practical ways to improve diagnostic safety.   Get in touch ⁠[email protected]⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations Producer: Liam Hennebry

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine). Cardiac Arrest Update with AV Resuscitation Coordinator Steve MusgravePatient Safety Update: Stroke Assessment and Elderly FallsAlpine and Wilderness Response AlagaesiaToxicology EvaluationAlcohol Withdrawal GuidelineEquipment Update: Syringe DriversPaper of the Month Prehospital transesophageal echocardiography versus conventional advanced life support in out-of-hospital cardiac arrest (PHTEE–OHCA) – a randomized controlled pilot study: https://link.springer.com/article/10.1186/s13054-025-05805-w Professional Development Opportunities Fast-Tracked Higher Education Pathway for AV Clinical Instructors:  https://ambulancevic.sharepoint.com/sites/OneAV-news-and-updates/SitePages/Exciting-Opportunity-Fast-Tracked-Higher-Education-Pathway-for-AV-Clinical-Instructors.aspx?web=1  ACP Primary Care Conference Canberra: 21-22 May  ACPIC Melbourne : 8-11 September EMS Asia Singapore 7-13 November  Grad Cert MH: https://victoriauniversity.online/ppc/graduate-certificate-mental-health  https://www.latrobe.edu.au/courses/graduate-certificate-in-mental-health#/overview?location=ON&studentType=dom&year=2026  https://online.scu.edu.au/online-courses/graduate-certificate-mental-health  https://handbook.monash.edu/2024/courses/m4039  AICG: Clinical Governance, Effective Leadership, Clinical Education, Clinical Feedback.  https://www.aicg.edu.au/education/online-courses/  Get in touch [email protected] X / Twitter  James: ⁠⁠⁠@JamesOz1⁠⁠  Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

In this episode of Clinical Conversations, James Oswald and Ambulance Victoria Medical Director Dr David Anderson unpack non-invasive ventilation (NIV) for prehospital care. They explain the key physiology (oxygenation vs ventilation), the practical difference between CPAP and BiPAP, and how this guides use in COPD, acute pulmonary oedema, COVID, asthma, and undifferentiated dyspnoea. The discussion also covers patient coaching, mask fit troubleshooting, essential monitoring, and how to recognise early success vs failure—including when to escalate and call for help. Get in touch ⁠[email protected]⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations Producer: Liam Hennebry

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine). Hear from Louise Reynolds (Victoria’s Chief Paramedic Officer) on the women’s pain inquiry findings—and what it means for paramedic practice.Spotlight the VVED back pain pathway: for many patients, opioids + ED isn’t the answer—community physio support can be surprisingly effective.Adam Ho (AV Senior Pharmacist) answers the most common medication questions.Paper of the Month: a must-read on post-intubation hypotension.Ben runs through key professional development opportunities for 2025 and what’s coming in 2026.Equipment update.And we wrap with small steps to transform your practiceFurther resources VVED Back pain pathway presentation (AV employees only): https://engage.cloud.microsoft/main/threads/eyJfdHlwZSI6IlRocmVhZCIsImlkIjoiMzU5OTQ5NzU4NzMzNTE2OCJ9?trk_copy_link=V1 AI Professional Development Courses Free micro-skill course in AI: https://www.australianindustrygroup.com.au/education-training/centre-for-education-and-training/blog/free-introduction-to-artificial-intelligence-microskill-course Digital health 101: https://digitalhealthworkforce.org.au/education-and-resources/ Australian Institute of Digital Health AI essentials: https://cpd.digitalhealth.org.au/course/ai-essentials   AI Podcasts NEJM AI Grand rounds (AI Podcast): https://store.nejm.org/signup/ai/podcasts Beyond the prompt (AI podcast): https://www.beyondtheprompt.ai/ Paper of the month Prehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841682 Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults: https://www.nejm.org/doi/abs/10.1056/NEJMoa2511420 Get in touch [email protected] X / Twitter  James: ⁠⁠⁠@JamesOz1⁠⁠  Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

In our first ever live episode of Clinical Conversations, James Oswald (CPG specialist and paramedic) is joined by Ambulance Victoria Medical Director Dr David Anderson for an end-of-year Q&A on the latest CPG updates. We work through staff questions on the “why” behind key changes—including respiratory care and oxygen targets, NIV expansion and mask issues, airway and RSI updates (including crash induction and consultation for single-responder MICA), and several medication updates such as magnesium compatibility, levetiracetam after midazolam, IV GTN in APO, and opioid choice and multimodal analgesia. They also cover practical operational issues like VVED wait times and what to do when access delays are affecting crews. Get in touch ⁠[email protected]⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations

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  ⁠[email protected]⁠ 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 X / Twitter / Bluesky James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry