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Every second counts during a cardiac arrest, and the actions taken before an ambulance arrives can make a critical difference.  In this Shocktober episode of Clinical Practice Radio (CPR), the team is joined by St John WA Community Response Manager Caitlyn Pavey-Smith and Resuscitation Improvement Specialist Jason Belcher to explore the importance of early intervention and the role our community plays in strengthening the chain of survival.  Together, they discuss St John WA's First Responder app and State Defibrillator Network, and how these initiatives help connect people experiencing cardiac arrest with trained community responders and accessible defibrillators in those crucial first few minutes. Through real-life examples, they highlight the importance of early CPR, defibrillation and the collective effort involved in responding to cardiac arrest.  The conversation also explores how everyone can play a part, from learning CPR and completing first aid training to registering a defibrillator or becoming a community first responder. A great discussion about how the chain of survival helps save lives.

It's Shocktober! In this episode, the team is joined by St John WA Resuscitation Improvement Specialist Jason Belcher to take a deep dive into the science of defibrillation and the small changes that can help make the first shock the best shock.  The conversation focuses on the three Ps – placement, prep and perfusion – exploring why correct pad placement matters, how preparing the patient can improve pad contact, and why minimising interruptions to chest compressions is so important when delivering a shock.  The team also discusses the differences between public AEDs and the defibrillators used by paramedics, high-performance CPR and some of the emerging approaches to defibrillation, including vector change and double sequential defibrillation. They unpack what current research tells us, where the evidence is still developing and why getting the fundamentals right remains key.  A practical discussion on the science behind defibrillation and how clinicians can optimise everything within their control to give patients the best possible chance during cardiac arrest.    References  ANZCOR BLS Guideline 7 – Automated External Defibrillation in Basic Life Support  ANZCOR ALS Guideline 11.4 – Electrical Therapy for Adult Advanced Life Support   Cheskes et al (2011) Perishock Pause: An Independent Predictor of Survival From Out-of-Hospital Shockable Cardiac Arrest https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.010736  Cheskes et al (2022) Defibrillation Strategies for Refractory Ventricular Fibrillation [DOSE-VF study] https://www.nejm.org/doi/abs/10.1056/NEJMoa2207304  Other ongoing Double Sequential External Defibrillation (DSED) trials  German Clinical Trials Register  NCT06672159 | Initial Double Sequential External Defibrillation in Out of Hospital Cardiac Arrest (DUALDEFIB)  NCT06447805 | Early Double Sequential Defibrillation in Out-of-hospital Cardiac Arrest (DOUBLE-D)  NCT06781892 | Strategies for Defibrillation During Out-of-Hospital Cardiac Arrest (STRAT-DEFI)

In this episode, Megan Currie and Nick Overington are joined by St John WA First Nations Lead and Paramedic Jeremy Maitland-Smith to explore trauma-informed and culturally informed care when working with First Nations patients and communities. The conversation explores the key principles of trauma-informed practice - safety, trust, choice, collaboration and empowerment - and how these can be brought back to two simple concepts: respect and trust. Jeremy shares practical considerations for culturally informed care, highlighting that clinicians don't need to know everything about every culture. Instead, keeping an open mind, asking respectful questions and taking the time to listen can help clinicians better understand the individual, their family and the cultural considerations that may influence their care.  An insightful discussion on starting the conversation, allowing space for silence and working with patients to make decisions about their care – principles that can support better interactions with every patient, every time.

In this episode of Clinical Practice Radio, Megan and Nick are joined by hyperbaric physician Dr Ian Gawthrope and critical care paramedic intern Andrew “Wishy” Wishart to discuss decompression illness, including decompression sickness and arterial gas embolism. The team explores how diving-related bubbles affect the body, common symptoms, the importance of taking a detailed dive history, and conditions that can mimic DCI, such as immersion pulmonary oedema and inner-ear barotrauma. For pre-hospital clinicians, key management priorities include early hyperbaric consultation, keeping patients supine, administering high-flow oxygen, assessing neurological status, giving fluids and analgesia, preventing hypothermia, and arranging timely transport.

Recorded live in front of an audience, this special episode of Clinical Practice Radio puts trauma principles into practice through a regional case study.  The team is joined by St John WA Rural and Remote Clinical Development Lead Ben O'Regan to work through the case using the MARCHE principles, exploring assessment, clinical priorities and decision-making as the scenario unfolds.  The conversation looks at how clinicians can apply a structured approach to trauma while navigating the additional challenges of the rural and remote environment, where distance, resources and access to definitive care can influence patient management.  A practical, case-based discussion that brings trauma principles to life and reinforces the importance of structured assessment, clinical decision-making and keeping patient priorities at the centre of care.    References: Cannon, J. W. (2018). Hemorrhagic shock. The New England Journal of Medicine, 378(4), 370–379. https://doi.org/10.1056/NEJMra1705649  Dawkins Mills, J. (2024). Trauma diamond of death: Adding calcium to the lethal triad. Journal of Emergency Nursing, 50(3), 330–335. https://doi.org/10.1016/j.jen.2023.12.011 Nutbeam, T., Fenwick, R., Haldane, C., Leech, C., Foote, E., Todd, S., & Lockey, D. (2025). Extrication following a motor vehicle collision: A consensus statement on behalf of the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), Article 3. https://doi.org/10.1186/s13049-024-01312-z Owattanapanich, N., Chittawatanarat, K., Benyakorn, T., & Sirikun, J. (2018). Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: A meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26, Article 107. https://doi.org/10.1186/s13049-018-0572-4  Tran, A., Yates, J., Lau, A., Lampron, J., & Matar, M. (2018). Permissive hypotension versus conventional resuscitation strategies in adult trauma patients with hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials. The Journal of Trauma and Acute Care Surgery, 84(5), 802–808. https://doi.org/10.1097/TA.0000000000001816  Wang, C.-H., Hsieh, W.-H., Chou, H.-C., Huang, Y.-S., Shen, J.-H., Yeo, Y. H., Chang, H.-E., Chen, S.-C., & Lee, C.-C. (2014). Liberal versus restricted fluid resuscitation strategies in trauma patients: A systematic review and meta-analysis of randomized controlled trials and observational studies. Critical Care Medicine, 42(4), 954–961. https://doi.org/10.1097/CCM.0000000000000050

Pre-hospital emergency anaesthesia is about far more than intubation. In this episode, the team is joined by St John WA Critical Care Paramedic Cornell Greyling to explore the preparation, teamwork and clinical decision-making that underpin one of the most complex interventions in pre-hospital care. Together, they discuss when pre-hospital emergency anaesthesia is indicated, how understanding patient physiology helps clinicians prepare for induction, and why optimising oxygenation, ventilation and haemodynamics before intubation is critical to patient safety. The conversation also unpacks the structured approach used by Critical Care teams, highlighting the importance of communication, human factors and shared situational awareness throughout the procedure. Whether you're interested in airway management, critical care or improving team performance in high-pressure environments, this episode provides practical insights into safely navigating one of paramedicine's most challenging clinical procedures.

Delivering the right care doesn't always mean transporting every patient to hospital.  In this episode, the team is joined by St John WA Extended Care Paramedic Lead Pat O'Dal to explore how Extended Care Paramedics are helping patients receive safe, appropriate care in the community. Together they discuss the growing role of extended care paramedicine, the additional training and clinical skills involved, and how this model is improving outcomes for patients while supporting the wider health system. They also explore which patients benefit most from the extended care model, how paramedics can identify appropriate referrals, and what the future of advanced practice could look like. Whether you're interested in advanced paramedic practice, community-based healthcare or improving patient outcomes through collaborative care, this episode provides valuable insights into an evolving area of pre-hospital care.

In this episode, the team is joined by St John WA Extended Care Paramedic Lead Pat O'Dal to explore the role of palliative care in paramedicine and the broader health system.  They discuss what palliative care really means, challenging the common misconception that it is simply end-of-life care. The conversation focuses on providing patient-centred care, supporting quality of life, and understanding how treatment goals can differ depending on the wishes of patients and their families, whether that involves prolonging life through treatment or focusing on comfort.  A thoughtful discussion on the evolving role of paramedicine in palliative care, and how greater understanding, education and patient-centred decision-making can help deliver the right care, in the right place, at the right time.    Resources for clinicians mentioned in this episode:   Palliative Care Education  End-Of-Life Essentials Education

In this episode, the team explores what it really means to be “fit for duty” and why physical health is so important for first responders. Joined by paramedic and personal trainer Mark Henderson, they discuss the physical demands of the role, from long periods of inactivity to sudden high‑intensity tasks like lifting and carrying patients, and how this can increase the risk of injury if you’re not prepared. The conversation covers building strength through functional training, creating sustainable routines around shift work, and the importance of consistency over intensity. They also unpack the challenges of night shift, including sleep, nutrition and fatigue, and share practical strategies for planning meals, managing caffeine and improving recovery. A practical discussion on how investing in strength, movement and recovery can support injury prevention, improve performance and help first responders stay fit for the job long term.

In this episode of Clinical Practice Radio (CPR), the team unpacks what resilience really means for paramedics and other first responders working in high‑pressure environments. They explore why resilience is not a fixed trait, but something that needs to be built, maintained and regularly reassessed across both work and personal life. They discuss how factors like sleep, nutrition, relationships and life stressors all influence a clinician’s ability to cope with challenging situations, and why resilience often only becomes visible when it starts to slip. The conversation then focuses on practical ways to strengthen resilience, including self‑reflection, mindset, physical wellbeing and strong social connections. The team introduces the concept of a “resilience shield”, a layered approach that brings together personal, social and professional factors to better manage stress and recovery. A thoughtful discussion on recognising early warning signs, supporting colleagues, and building resilience before it’s tested, highlighting that strong performance starts with looking after yourself.   References: The Resilience Shield by Dr Dan Pronk, Ben Pronk and Tim Curtis The Paramedic Mindset by Leigh Anderson

In this first episode of season two, the team explores crush injury and crush syndrome, discussing how these patients present, why they can deteriorate rapidly, and the importance of early recognition in the pre-hospital environment. The conversation covers the difference between local crush injuries and the wider systemic effects that can occur after extrication, including why long lies and seemingly minor presentations can still become life-threatening. The team also discusses practical management strategies, preparation for deterioration, and the importance of understanding the underlying physiology to guide treatment decisions. A practical discussion on recognising high-risk patients, preparing for worst-case scenarios, and managing crush injuries safely and effectively.   References: Crush Syndrome • LITFL • CCC Trauma Rhabdomyolysis - EMCrit Project Gonzalez, Dario MD, FACEP. Crush syndrome. Critical Care Medicine 33(1):p S34-S41, January 2005. | DOI: 10.1097/01.CCM.0000151065.13564.6F

In this episode, the team explores two critical but often overlooked parts of pre-hospital care: handovers and debriefing. They discuss why clear communication shapes patient outcomes, how structured handovers help deliver concise, relevant information, and why preparation and confidence matter in high-pressure environments. The conversation also covers adapting handovers to the patient, setting and receiving team. They then turn to debriefing, unpacking the value of hot and cold debriefs, constructive feedback, and creating a culture where reflection feels safe and productive. A practical discussion on how stronger communication before and after every job can improve teamwork, performance and patient care. References: Walker, C. A., McGregor, L., Taylor, C., & Robinson, S. (2020). STOP5: a hot debrief model for resuscitation cases in the emergency department. Clinical and experimental emergency medicine, 7(4), 259–266. https://doi.org/10.15441/ceem.19.086 The Paramedic Mindset (2024).  Leigh Anderson. Think Again (2021).  Adam Grant. Wood, K., Crouch, R., Rowland, E., & Pope, C. (2015). Clinical handovers between prehospital and hospital staff: literature review. Emergency Medicine Journal, 32(7), 577-581.

In this episode, the team explores the evolving approach to patient extrication, with insights from DFES rescue officer Andrew “Strunky” Strunk. They unpack the evidence behind the Extrication in Trauma (EXIT) project, challenging long-held practices, particularly the low incidence of spinal cord injury, and the shift away from movement minimisation toward faster, patient-focused extrication. A practical look at what’s changing on the ground, and how closer collaboration between paramedics and rescue crews is improving outcomes by getting patients to definitive care sooner. References:  Nutbeam, T., Fenwick, R., Haldane, C., Leech, C., Foote, E., Todd, S., & Lockey, D. (2025). Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 3. Nutbeam, T., Fenwick, R., May, B., Stassen, W., Smith, J. E., Wallis, L., ... & Shippen, J. (2021). The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision-a biomechanical study using healthy volunteers. Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), 108. Nutbeam, T., Fenwick, R., Marritt, I., Lee, B., Staveley-Wadham, L., Lang, N., ... & Leech, C. (2025). Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 137. Hawkridge, K., Ahmed, I., & Ahmed, Z. (2022). Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. European Journal of Trauma and Emergency Surgery, 48(1), 647-657.

In this episode, the team turns their focus to major burns, one of the most complex and confronting presentations in pre-hospital care. They discuss what defines a major burn, the systemic cascade that follows large TBSA injuries, and key priorities including early cooling, analgesia, fluid management, airway considerations, hypothermia prevention and transport decisions. A practical refresher for clinicians who may not see major burns often but need to manage them well when they do. References: Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients | Journal of Burn Car… Hypothermia in acutely presenting burn injuries to a regional burn service: The incidence and impac…  Further Reading: Research And Technology Development In Burn Medicine - Fiona Wood Foundation First Aid Management of Injuries Effect of early administration of inhaled heparin on outcomes of smoke inhalation injury: A randomi…

In this episode, the team tackles some of the most enduring myths in emergency medical services and asks a simple question: are we still doing things because they work, or because it’s how they’ve always been done? Topics include analgesia and pain management, soft tissue injuries and the RICE principle, oxygen use in COPD patients, ketamine and haemodynamic effects, tourniquet use, and other long-held assumptions in pre-hospital care. Through evidence, physiology and reflective practice, the conversation highlights how clinical practice continues to evolve and why staying curious and adapting to new evidence is essential for delivering high-quality patient care. A thought-provoking listen for clinicians at any stage of their career. References: April, M. D., Arana, A., Schauer, S. G., Davis, W. T., Oliver, J. J., Fantegrossi, A., ... & NEAR Investigators. (2020). Ketamine versus etomidate and peri‐intubation hypotension: a national emergency airway registry study. Academic Emergency Medicine, 27(11), 1106-1115. Kamran, H., Salciccioli, L., Kumar, P., Pushilin, S., Namana, V., Trotman, S., & Lazar, J. (2010). The relation between blood pressure changes induced by passive leg raising and arterial stiffness. Journal of the American Society of Hypertension, 4(6), 284-289. ICED! The illusionary treatment option.  Gary Rein Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73. Walsh B, Cone DC, Meyer EM, Larkin GL. Paramedic attitudes regarding prehospital analgesia. Prehosp Emerg Care. 2013 Jan-Mar;17(1):78-87. doi: 10.3109/10903127.2012.717167. Epub 2012 Sep 12. PMID: 22971168. Oxygen and Carbon Dioxide Retention in COPD • LITFL • CCC Respiratory Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. doi: 10.1186/cc11475. PMID: 23106947; PMCID: PMC3682248. https://doi.org/10.1016/j.ajem.2023.08.040 Morgan MM, Perina DG, Acquisto NM, Fallat ME, Gallagher JM, Brown KM, Ho J, Burnett A, Lairet J, Rowe D, Gestring ML. Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement. Prehosp Emerg Care. 2021 Jul-Aug;25(4):588-592. doi: 10.1080/10903127.2020.1801920. Epub 2020 Aug 27. PMID: 32776812. Xacur-Trabulce A, Casas-Fuentes G, Ruiz-Vasconcelos V, Reitz MM, Henry SM, Scalea TM, Ribeiro MAF Jr. Tourniquet-related complications in extremity injuries: a scoping review of the literature. World J Emerg Surg. 2025 Jun 25;20(1):57. doi: 10.1186/s13017-025-00625-3. PMID: 40556023; PMCID: PMC12188649. Pascoe B, Weinrauch P. Timeline effects of tourniquets used in trauma care. JHTAM. 2024;6(2):26-32