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Clinical Conversations

The Ambulance Victoria Office of the Medical Director
Clinical Conversations
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  • Clinical Updates: November 2025
    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/ClinicalConversationsBen: ⁠@ben_meadley⁠ , Ben - Linkedin Producer: Liam Hennebry 
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  • Clinical Updates: October 2025
    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 Soon02:20 – IFS Retirement & Paediatric RSI Feedback07:05 – STEMI Performance Update08:50 – Free Birth: Paramedic Implications11:50 – PANDA Trial Update13:50 – Patient Safety: Cognitive bias & discounting concerning symptoms19:20 – Missing PCRs in Severe Adverse Events21:50 – Guideline Monitoring: Minor Head Injury & VVED Outcome Data22:50 – Paper of the Month & New Cardiac Arrest Guidelines25:45 – Equipment Updates26:59 – Professional Development Opportunities28:15 – Small Steps to Transform Your PracticeFurther resourcesFreebirth - Position statement | Safer Care VictoriaEMCRIT 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-guidelinesOpinion piece - Iain Beardsell: https://www.bmj.com/content/390/bmj.r2051 ACP Regional Paramedic Symposium: https://paramedics.org/events/rps-2025?tab=AboutEmergency, Trauma & Critical Care Conference: https://www.fltr-ed.com/  Get in touchX / Twitter / BlueskyJames: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.socialBen: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry 
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  • Clinical Updates: Paediatic intubation special
    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 - PaediatricsA/Prof David Anderson – AV Medical Director Get in touch⁠[email protected]⁠David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations
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  • Clinical Updates: September 2025
    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):Clinical UpdateWarm 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 safetyLow 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 resourcesOcclusion myocardial infarction and artificial intelligenceHyperacute T-wave definitionhttps://journals.sagepub.com/doi/full/10.1177/27536386251371078https://shortcourses.rmit.edu.au/collections/allhttps://mbs.edu/short-courseshttps://www.monash.edu/business/corporate-education/short-coursesLinkedin.com/learning/Get in touchJames: https://linktr.ee/ClinicalConversationsBen: X/Twitter⁠ | [email protected] 
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  • Cardiogenic shock
    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 resourcesAvoid trial: https://www.ahajournals.org/doi/10.1161/circulationaha.114.014494DETO2XAMI:  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-(.aspxGet in touch⁠[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversations
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About Clinical Conversations

The podcast for paramedics and anyone involved in out-of-hospital care that is critical, urgent, or unplanned. Hosted by James Oswald (Paramedic and clinical guideline developer) and A/Prof David Anderson (Medical Director).Keyword: Paramedic, paramedicine, Emergency Medical Service, EMS, Emergency Medical Technician, EMT, prehospital, pre-hospital critical care, retrieval medicine, ambulance, Helicopter Emergency Medical Service, HEMS, air ambulance, emergency, first responder, first aid.
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