Clinical Conversations

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 resourcesVVED Back pain pathway presentation (AV employees only): https://engage.cloud.microsoft/main/threads/eyJfdHlwZSI6IlRocmVhZCIsImlkIjoiMzU5OTQ5NzU4NzMzNTE2OCJ9?trk_copy_link=V1AI Professional Development CoursesFree micro-skill course in AI: https://www.australianindustrygroup.com.au/education-training/centre-for-education-and-training/blog/free-introduction-to-artificial-intelligence-microskill-courseDigital 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 PodcastsNEJM AI Grand rounds (AI Podcast): https://store.nejm.org/signup/ai/podcastsBeyond the prompt (AI podcast): https://www.beyondtheprompt.ai/Paper of the monthPrehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841682Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults: https://www.nejm.org/doi/abs/10.1056/NEJMoa2511420Get in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: 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]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: 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/ClinicalConversationsBen: ⁠@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 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 

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