In this episode of Clinical Conversations , we explore the complexities of managing acute behavioural disturbance (ABD) in children and adolescents—a small but increasingly common and high-risk cohort. Host James Oswald and AV Medical Director Dr. David Anderson are joined by paediatric emergency physician Dr. Claire Wilkin, who brings deep expertise in paediatric critical care. Together, they discuss the causes of ABD in younger patients, differences from adult presentations, principles of de-e...
Jun 30, 2025•56 min
Your monthly clinical update covering: Clinical Practice 03:10 – Respiratory CPG Update: Pulmonary edema, COVID, ILI, paediatric asthma changes coming soon. 04:00 – First Responder Analgesia: Supply challenges beingaddressed; updates coming. 05:10 – Button Batteries: New blue dye marker—importantvisual sign but not universally present. 06:00 – Mushroom Season Warning: Watch for toxidromes; VPIC support emphasized. 06:40 – VVED changes: Easier access to emergency physicians. Patient Safety 08:30 ...
Jun 12, 2025•27 min
James Oswald and Dr David Anderson explore how consultation has evolved from a perceived weakness to a hallmark of clinical maturity. They discuss the growing role of virtual emergency care, particularly the Victorian Virtual Emergency Department (VVED), in supporting paramedics with decision-making—especially when assessing young infants. Joined by pediatric emergency specialist Dr Harith Al-Rawi, the episode dives into the challenges of remote pediatric assessment, the value of collaboration b...
May 28, 2025•58 min
Your monthly clinical update covering: VVED Consultations for small infants New requirement: VVEDconsultation for non-transport of infants ≤28 days Strong recommendation for 29days–3 months Driven by patient safety reviewand expert consensus Not about removing autonomy —it’s about adding clinical support RSI Checklist Update Addition of a pop-off valve checkfollowing a critical safety event Prevents misdiagnosis of failedventilation Reinforces value of checklists,even for experienced clinicians ...
May 02, 2025•31 min
In Part 2 of their sedation safety conversation, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) cover preparation for sedation and how to recognize and respond to deterioration. They break the problem into three evidence‑backed pillars: Prevent deterioration (have a listen to Part 1) Prepare for side‑effects – if you plan to sedate, you must plan to resuscitate Recognise & Respond when things go wrong Further ...
Apr 10, 2025•32 min
Your monthly clinical update covering: Cardiac arrest outcomes An update on the sedation safety guideline Lessons learned from the patient safety team: appropriate use of the CT-6 traction splint and having a high index of suspicion for spinal and head injuries in older adults followingstanding height falls BVM blow off valve reminder Paper of the month: Prehospital antibiotics in sepsis Miller blade use for ALS paramedics Resources ACP Critical Care Summit Get in touch X / Twitter / Bluesky Jam...
Mar 27, 2025•22 min
In this episode of Clinical Conversations , hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) dive into one of the most ethically and clinically complex areas of pre-hospital care—the questions of safety for during sedation for acute behavioural disturbance (ABD). They explore the ethical and legal considerations surrounding the use of sedation, the significant clinical risks, and real-world cases that highlight the ...
Mar 18, 2025•54 min
James and Ben cover the latest clinical news from across Ambulance Victoria, including: Intranasal Fentanyl Update – Using IV preparation for intranasal use. Other guidelines updates: Extrication monitoring, shoulder reduction, wilderness pain relief. Blood Administration – New pre-hospital blood transfusion training coming. Rocuronium Storage – Heat-related potency issues; rotate every 30 days. Communication Book – New tool for patients with communication disabilities. MICA targeted Dispatch – ...
Feb 28, 2025•20 min
In this episode of Clinical Conversations , James Oswald (Paramedic and Clinical Practice Guidelines Specialist) and Dr. David Anderson (Ambulance Victoria Medical Director) tackle one of the most challenging aspects of paramedicine—delivering bad news. Joined by guest Liz Perry (MICA Paramedic), they explore the difficulties paramedics face when communicating death and critical updates to families in the pre-hospital setting. We talk personal experiences, theoretical models like SPIKES, and pra...
Feb 25, 2025•54 min
James Oswald and Director of Paramedicine Dr Ben Meadley discuss the important clinical messages for January 2025: patient safety during sedation and the importance of planning for resuscitation; the exploration of low acuity pathways; and they review a significant research paper on physician-led teams in pre-hospital care. The episode also covers equipment updates, professional development opportunities, and practical steps for paramedics to enhance their practice. Time stamps: 0:45 Rapid summa...
Jan 28, 2025•22 min
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 3, we look at challenges in building a system that leads to good pain relief as well as some special circumstances including opioid dependence and chronic pain. Further resources Acute Pain Management: Scientific Ev...
Jan 17, 2025•44 min
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 ...
Dec 19, 2024•23 min
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 2, we look at best practice in the management of pain. Further resources Acute Pain Management: Scientific Evidence: 5th Edition Ketamine for the treatment of prehospital acute pain: a systematic review of benefit ...
Dec 18, 2024•52 min
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Quick summary (0:30) Patient Safety (1:30) Discussing the lessons from specific adverse events is challenging due to patient privacy/consent, crew psychological safety, and investigation timelines. We need to find a way to collectively share these lessons in a safe way. Plans for quarterly clinical forums (2025) to foster psychologically safe discussions. Clinical Updates (4:52) IV Cannulation f...
Dec 16, 2024•21 min
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 1, we look at assessment, bias, and disparities in pain care. In the coming months, we’ll bring you the rest of our discussion covering best practice pain relief, system issues, myths about opioids, and special circum...
Nov 21, 2024•50 min
This is the first in a new series of monthly clinical updates for Ambulance Victoria clinical staff. Director of Paramedicine A/Prof Ben Meadley and Clinical Guideline Specialist James Oswald summarise the need-to-know clinical information, all in one spot. This month: New CPG updates, trends in our patient safety data, and new cardiac monitors. Times stamps: 2:00 New CPG updates 4:40 Snakebite 6:30 Acute coronary syndrome and activating the cath lab 7:35 Patient safety trends 10:20 Dislocation ...
Oct 29, 2024•18 min
In this episode, James speaks with critical care paramedic, academic, and newly appointed Director of Paramedicine, Associate Professor Ben Meadley. We discuss strategic clinical leadership and the future of the profession. X / Twitter David: @expensivecare James: @JamesOz1 Ben: @ben_meadley
Oct 24, 2024•42 min
Part 2 of David's discussion with Associate Professor Andrew Udy on Sepsis Management. Get in touch clinicalguidelines@ambulance.vic.gov.au X / Twitter David: @expensivecare James: @JamesOz1 Resources mentioned [PHANTASI trial] Alam N, Oskam E, Stassen PM, Exter Pv, van de Ven PM, Haak HR, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Respiratory Medicine. 2018;6(1):40-50. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE...
Sep 26, 2024•44 min
Sepsis is arguably the most common time critical emergency we face as paramedics. This is the first of a two part series on sepsis with Professor Andrew Udy. Andrew is Head of Research at The Alfred ICU, and Deputy Director, Australian and New Zealand Intensive Care Research Centre. He was involved in the development of the recently released Ambulance Victoria Sepsis and Infection guideline. In this episode, Ambulance Victoria Medical Director A/Prof David Anderson and Andrew discuss the assessm...
Sep 26, 2024•46 min
In Australia, penetrating truncal trauma is rare and the care of these patients involves a quite different mindset than we're used to. This is a cohort where our stay-and-play approach can do harm. James and David discuss the evidence relating to penetrating trauma and practical recommendations for your practice. Further resources Over view of major traumatic injury in Australia–Implications for trauma system design The evil of good is better: Making the case for basic life support transport for...
Sep 23, 2024•51 min
Clinical practice varies between the different state ambulance services in Australia. Yet we all claim to be evidence-based. So why is this, how big of a problem is it and what should we do about it? Are national guidelines the answer? James speaks with paramedic and PhD candidate Matt Wilkinson-Stokes to find out, while David shares his perspective on national guidelines. Further resources Matt's presentation on the differences between state ambulance service guidelines Comparisons of clinical ...
Aug 08, 2024•45 min
For over a decade after a large study showed a mortality benefit, this drug remained controversial. David and James look at the TXA saga.
Jul 10, 2024•39 min
Clinical conversations is back. But where have we been, what have we been doing and what do we have planned for the future?
Jul 10, 2024•15 min
We’re all familiar with the concept of STEMI. But the definition is built around a single ECG sign – not the underlying problem itself. Is that the best way to do it? Should we be thinking about this in a totally different way? Is Occlusive Myocardial Infarction (OMI) the new STEMI? Notes OMI Manifesto Amal Mattu on YouTube Subtle STEMI iOS app The Ancient Scholar...
Jul 16, 2023•34 min
Capnography plays a crucial role in the treatment of a range of life-threatening conditions. Its central role following intubation is undeniable and it's also an important part of our approach to cardiac arrest and sedated patients of all kinds. Yet it is not always as straightforward as it might seem. In this episode, David and James speak with Matt Humar (intensive care paramedic, acting patient safety review lead at Ambulance Victoria, and secretary of the safe airway society) about matters c...
Mar 14, 2023•43 min
Shock is the quintessential critical illness. Bread and butter for everyone involved in prehospital and critical care. But do we really understand it? Could we be doing better for these patients? James is joined by Assoc. Prof. David Anderson, intensivist and Ambulance Victoria Medical Director, for a... shocking discussion.
Dec 15, 2022•38 min
People experiencing acute behavioral disturbance are some of the most vulnerable patients we treat. It’s a deeply distressing situation for the patient and extremely confronting for clinicians and carers. In this episode, we speak with psychiatrist Dr Alison Taylor about important changes we're making to improve care for these patients.
Jul 31, 2022•44 min
Family violence is a deeply confronting and serious problem that occurs across all ages, genders, and socioeconomic groups. It has a profound impact on the health and well-being millions of people across the globe. How can we identify family violence? How should we respond to a disclosure of family violence? How can we help victim survivors? Ambulance Victoria Safe Guarding Care Lead Amber Smith joins James and David to discuss this important issue. MARAM Family violence practice guide...
Aug 22, 2021•31 min
The decision to withhold or cease resuscitation is one of the most impactful and also one of the more confronting decisions that paramedics make in the field. AV Medical Director Associate Professor David Anderson discuss Dr Natalie Anderson, PhD discuss the decision making process and how to better approach these difficult cases. MyGriefToolbox - Great Canadian resource for all paramedics, with helpful modules covering decision-making, patient death and grief. Breaking bad news in the ED - Noti...
Apr 08, 2021•50 min
Ambulance Victoria recently introduced intranasal ketamine for the treatment of moderate and severe pain. It has proven to be effective but we have identified opportunities to do better. Clinical Practice Development Specialist James Oswald and Medical Director David Anderson discuss the new Clinical Practice Guideline and some of the lessons we've learned along the way.
Feb 22, 2021•24 min•Ep. 1
