Clinical Updates: December 2024
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Overview 1. Clinical Practice Updates • CPG App Update Details: o Secondary triage review o Changes to pediatric analgesia guidelines o Stacked shock CWI updates o Minor error corrections • Pediatric Cannulation: o ALS IV access is supported for: Major trauma and traumatic arrest (all ages), and Pain relief (12-15 years). o Avoid IV access in younger patients unless necessary; consider IN route for pain relief in children. • Joint Reduction Adverse Event: o Important that we share the outcomes of adverse events openly but without blame. o Recent adverse event involved shoulder reduction that was not indicated. o Our main focus is on the system issues: we’re looking at making the indications clearer. o In the meantime, we’d like to raising awareness of the indication for reduction at the start of the CPG • Amiodarone & Ondansetron: o VT following Ondansetron administration only contraindicated if the drug is suspected to be the cause. ___________________________ 2. Patient Safety Review • Scene Safety vs. Patient Care: o Both paramedic and patient safety are important. No easy answers. o We encourage reflection on the best way to optimize the balance of risks rather than to be overly simplistic. • Manual Handling of Bariatric Patients: o Risks and benefits of asking patients with high BMI to move themselves to minimize manual handling injuries. o Importance of recognizing strained physiology and the need for careful risk assessment in every case. • Ambulation Risk Assessment: o Shout out to this guideline, which highlights risk factors in patient extrication. ___________________________ 3. Research Update • Video Assisted Technology: o Study on EMS providers in New York using smart glasses for live-streaming cases to medical control. o Limited adoption so far, but promising developments for future use in 2025. Stay tuned for more in this space at AV. • Intraosseous Access: o New research indicates IO access has minimal long-term complications (e.g., osteomyelitis, osteonecrosis) and should remain a viable option when IV access isn't possible. • Cardiac Arrest Survival Rates: o Study shows a three-fold increase in survival to hospital discharge from 2003-2022 in Victoria. o Post-COVID recovery efforts and ongoing strategies for improving cardiac arrest survival rates. o Please consider attending a HPCPR refresher session if possible. ___________________________ 4. Equipment Updates • Ketone Strips: New bags for separating ketone strips from glucose strips in response to feedback. ___________________________ 5. Professional Development Opportunities • Institute for Healthcare Improvement & Australian Institute of Clinical Governance: o Courses, memberships, and qualifications focusing on clinical governance, leadership, and patient safety. • Australasian College of Paramedicine: o Upcoming Critical Care Summit in May 2024, focusing on clinical excellence. • Critical Care Reviews Conference: o Dissecting randomized control trials in medicine and pre-hospital care. o Also a great opportunity to learn how feedback can be delivered and received positively. ___________________________ Resources A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design StudyAn assessment of long-term complications following prehospital intraosseous access: A nationwide study Out-of-hospital cardiac arrests in Victoria, 2003–2022: retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data Cardiac arrest improvement strategy External development opportunities Australasian Institute of Clinical Governance IHI Open School ACP Critical Care Summit Get in touch X / Twitter James: @JamesOz1 Ben: @ben_meadley Linkedin James Ben Bluesky Social James: @jamesoz1.bsky.social