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

Om Podcasten

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.