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 practice

Further 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

clinicalguidelines@ambulance.vic.gov.au

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James: ⁠⁠⁠@JamesOz1⁠⁠

Ben: ⁠@ben_meadley⁠

Linkedin

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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

⁠clinicalguidelines@ambulance.vic.gov.au⁠

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

⁠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 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 - Paediatrics
• A/Prof David Anderson – AV Medical Director

Get in touch

⁠clinicalguidelines@ambulance.vic.gov.au⁠

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):

Clinical Update

• Warm 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 safety

• Low 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 resources

• Occlusion myocardial infarction and artificial intelligence
• Hyperacute T-wave definition
• https://journals.sagepub.com/doi/full/10.1177/27536386251371078
• https://shortcourses.rmit.edu.au/collections/all
• https://mbs.edu/short-courses
• https://www.monash.edu/business/corporate-education/short-courses
• Linkedin.com/learning/

Get in touch

James: https://linktr.ee/ClinicalConversations

Ben: X/Twitter⁠ | Linkedin

clinicalguidelines@ambulance.vic.gov.au

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 resources

Avoid trial: https://www.ahajournals.org/doi/10.1161/circulationaha.114.014494

DETO2XAMI: 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-(.aspx

Get in touch

⁠clinicalguidelines@ambulance.vic.gov.au⁠

Socials

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn

James: https://linktr.ee/ClinicalConversations

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 –

1. Treat elderly standing-height falls as potential spinal injuries.
2. Minimise scene time for major trauma unless safety or critical intervention requires it.

Further resources

ACP Conference

Thermal blanket study

Machine learning study

STAB-5

Coroner's communique

Get in touch

clinicalguidelines@ambulance.vic.gov.au

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James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben