Clinical Conversations

When is a clinical examination reliable enough to clear the spine? In this first episode of our spinal series, James and David unpack clinical spinal clearance - stable and unstable injuries, challenge common assumptions about neurological deterioration, compare NEXUS with the Canadian C-Spine Rule, and work through the modified NEXUS approach used in Victoria. We also explain why low-energy falls, older age and bone-weakening conditions deserve particular caution.
 
 
Further resources 

• Hoffman et al. (2000), Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. The landmark multicentre validation of the five NEXUS low-risk criteria.  

• Stiell et al. (2001), The Canadian C-Spine Rule for radiography in alert and stable trauma patients. The derivation study describing the rule's three-step structure.  

• Stiell et al. (2003), The Canadian C-Spine Rule versus the NEXUS low-risk criteria in patients with trauma. A prospective head-to-head comparison of the two decision rules.  

• Vaillancourt et al. (2009), The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Prospective evidence on paramedic application of the Canadian C-Spine Rule.  

• Domeier et al. (2005), Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. A four-year prospective EMS study of 13,357 patients evaluating a NEXUS-like selective immobilisation protocol; sensitivity was 92% for any spine injury, and no non-immobilised patient had a spinal cord injury.  

• Paykin et al. (2017), The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. In patients aged 65 years and older with cervical spine fractures, NEXUS had 94.8% sensitivity, supporting caution when applying the rule to older adults.  

• Denver et al. (2015), Falls and Implementation of NEXUS in the Elderly (The FINE Study). A prospective study of patients older than 65 years after low-level falls; NEXUS sensitivity was 88.9% for clinically significant cervical spine injury.  

• Delaney et al. (2022), Prevalence of midline cervical spine tenderness in the non-trauma population. Useful context for interpreting midline tenderness and its limited specificity. 
• Oto et al. (2015), Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature. A systematic review examining the incidence, timing and causes of secondary neurological deterioration after blunt spinal trauma, including deterioration associated with unstable injuries, delayed diagnosis and subsequent patient movement. 

Get in touch 

⁠[email protected]⁠ 

Socials 

David: ⁠@expensivecare⁠ |@expensivecare.bsky.social | LinkedIn 

James: https://linktr.ee/ClinicalConversations 

Your monthly clinical update from Ambulance Victoria covering: 

• Clinical Practice Update:
  • 2026 CPG changes  
  • Respiratory illness  
  • Avian influenza 
  • Calcium gluconate precipitation 
  • Dual sequential and vector change defibrillation 
• Patient safety update: 
  • Shortened RSI checklist  
  • Cutting the bougie for cricothyroidotomy
• Guideline monitoring: Evaluation of sedation for acute behavioural disturbance 
• Paper of the month: STEMI care in Victoria 
  • Temporal improvements in prehospital systems-of-care for ST-elevation myocardial infarction patients in Victoria, Australia: a retrospective study | BMC Emergency Medicine | Springer Nature Link 
• Equipment update
• Professional development opportunities 
• Small steps to transform your practice

Clinical Podcasts Reccomendations:

Australian 

• Prehospital Nerds — Hosted by MICA flight paramedic and an ED doctor, covering clinical pearls, cases, gear, procedures and prehospital decision-making.
• Clinical Practice Radio (CPR) — St John WA's podcast, hosted by their Deputy Director of Paramedicine Andy Bell with clinical leads Megan Currie and Nick Overington, using current evidence and subject matter experts.
• The Australasian College of Paramedicine podcasts — The Debrief, Student Talk and the Talking Research series. 

UK 

• The Resus Room — Absolute classic. Emergency medicine built on evidence-based medicine. Papers of the Month is the efficient way to keep up.  
• PHEMCAST — Prehospital emergency medicine specifically.  
• St Emlyn's — a UK emergency medicine podcast for anyone working in emergency care, from a team of educators and clinicians focused on evidence-based education. Best of the group on human factors and broadening our thinking beyond paramedicine in Australia.   

North America 

• FOAMfrat — prehospital emergency and critical care from Tyler Christifulli and Sam Ireland. Strong on underlying physiology.  
• EMCrit — Scott Weingart. The OG. His passion is easy to listen to.  

 
 
Get in touch

[email protected] 

Linkedin 

James 

Ben 

Producer: Liam Mylebry 

Your monthly clinical update from Ambulance Victoria covering:

• Paediatric anaphylaxis and asthma – a message from Safer Care Victoria
• Pre-hospital blood products
• Patient safety update: CSO Matt Shepard on paediatric airway management
• Guideline monitoring: Head injury guideline
• Paper(s) of the month: 
  Torniquet use for severe bleeding | Pre-hospital vital signs
• Equipment update
• Professional development opportunities
• Small steps to transform your practice

Resources

Paediatric Anaphylaxis: Acute Paediatric Asthma and Anaphylaxis – Practice point | Safer Care Victoria

Pre-hospital Blood Products:

• BloodSafe eLearning Australia: Clinical Transfusion Practice: Pre-hospital and Retrieval
• RePHILL Trial: Resuscitation with blood products in patients with trauma-related haemorrhagic shock…
• Prehospital Whole Blood in Traumatic Haemorrhage: Randomised Controlled Trial (NEJM)
• Mitra et al. (2023), Pre-hospital Freeze-Dried Plasma for Critical Bleeding After Trauma: A Pilot R…

System and Sustainability Considerations

• Young PP, Wood D, Holcomb JB, Jenkins DH, Levy MJ. Scaling of Prehospital Blood: A Model Describing…

Whole Blood Research

• Hadley J, Conner J, Thomas C, et al. Whole Blood First Resuscitation and Association of Blood Produ…

Ambulance Victoria Resources: Blood Component Access

• WIN/OPS/404 Blood Component Access from Air Ambulance Victoria: Essendon Fields. Describes pathways for metropolitan and inner regional access to blood components through AAV. 
• WIN/OPS/405 Blood Component Access from a Health Service. Describes pathways for regional and remote access to blood components via health services and Adult Retrieval Victoria. 

Positioning Infants for Airway Management (video)

Hear more from Matt Shepard in the Prehospital Nerds podcast: Website | TikTok

Paper(s) of the month:

• Prehospital tourniquet use and associated outcomes in a low-resource conflict setting
• Prehospital physiologic instability and in-hospital mortality among non-trauma patients with low-ri…

Get in touch

[email protected]

Linkedin

James

Ben

Producer: Liam Mylebry

Can a machine diagnose, triage, document a case, or show empathy? AI is everywhere and the pace of change makes it difficult to know when to stop and take stock. In this episode, we explain how AI works for clinicians, what the evidence shows, what the risks and benefits are in healthcare, and what it means for our clinical practice. 

 
Disclaimer: While we did our best to ensure the content was accurate, we don’t script everything  and sometimes we do make mistakes. If you hear something in this episode that you disagree with, we want to hear from you, so please get in touch.  

Further resources 

AI-Assisted Decision Trees for Emergency Call Classification: The IAppel Project | Springer Nature Link 

Transforming Health Care Through Chatbots for Medical History-Taking and Future Directions: Comprehensive Systematic Review - PubMed 

Clinical Reasoning of a Generative Artificial Intelligence Model Compared With Physicians - PMC 

A systematic review and meta-analysis of diagnostic performance comparison between generative AI and physicians - PubMed 

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial 

Assessing the potential of GPT-4 to perpetuate racial and gender biases in health care: a model evaluation study 

Comparing ambient scribes: a randomized crossover clinical trial addressing ambient scribe technologies’ impact on physician burnout 

Ambient AI Scribes in Clinical Practice: A Randomized Trial 

Get in touch 

⁠[email protected]⁠ 

Socials 

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn 

James: https://linktr.ee/ClinicalConversations 

Producer: Liam Mylebry 

Your monthly clinical update covering:

· Clinical Practice Update:
Forthcoming CPG changes including AF referral pathways, low‑risk chest pain risk scoring, and paediatric gastro guideline 

Ebola bulletin and CHO advisory

Cardiac Arrest Team Performance Report: insights and practical takeaways for improving CPR quality

PANDA trial update

· Patient safety update: Non-transport decisions, assessment, trusting our equipment

· Paper of the month: 

Naloxone and Clinical Outcomes in Suspected Opioid-Associated Out-of-Hospital Cardiac Arrests | Emergency Medicine | JAMA Network Open | JAMA Network 

Naloxone for Out-of-Hospital Cardiac Arrest Due to Opioid Toxicity | Emergency Medicine | JAMA Network Open | JAMA Network 

· Equipment update: Hypothermia, auxiliary purchase list updates, and giving sets

· Professional development opportunities:

Expression of Interest - 2026 CAA Congress Attendance 

Grand Round | 23 June 2026 

· Small steps to improve your practice

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Get in touch 

[email protected] 

Linkedin 

James 

Ben 

Producer: Liam Mylebry

Your monthly clinical update covering:

·  CPG updates: New measles CPG + updated CPP for ACOs & CERTs 

·  Hand hygiene refresher: Back to basics in challenging environments 

·  Cardiac arrest outcomes: Conversation with Ziad Nehme on recent improvements 

·  Survey plug: Clinical & Operational Service Delivery Plan 

·  Patient safety: Case review – consulting via the Clinician when engaging external agencies (e.g. PIPER) 

·  Tourniquets: Balancing risks and benefits 

·  Paper of the month: Ambulance offload delays and causes of ramping 

·  Equipment update 

·  Professional development highlights 

·  Small steps: Practical changes to transform your practice

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CPG update: CPG update – April 2026

VOD update: Updated guidance - Requests for Verification of Death (VOD)

Hand hygiene:
Take Five for Hand Hygiene
Transmission based precautions clinical work instruction

CWI OPS 184 Infection Prevention and Control Transmission Based Precautions.pdf

Paper of the month: Initiatives to reduce ambulance offload delays in emergency departments: a scoping review - PubMed

Professional development:
Fast Tracked Higher Education Pathway for AV Clinical Instructors – Now Open for Mid-Year Intake
Clinical Insights: Issue 8 now available

The Australasian College of Paramedicine Conference | ACPIC26

CAA Congress | The Council of Ambulance Authorities Inc.

Trauma 2026 Conference - Trauma Conference

SAS Events – Safe Airway Society

Clinical Technology and Equipment Committee Idea Sharing: Clinical Technology and Equipment Committee / [email protected] 

Get in touch: [email protected]

Linkedin

James

Ben

Producer

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).

This month's episode covers:

• Planned updates to CPGs in 2026
• Posterior Stroke
• Patient Care Records
• Evaluation data of droperidol and dexamethasone as antiemetics
• Paper of the Month: IV vs IO in cardiac arrest
• Equipment update
• Professional development opportunities
• Small steps to transform your practice

Paper of the Month Vascular access by paramedics during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: A retrospective study of insertion success rates and survival outcomes of intravenous versus intraosseous route

 https://www.sciencedirect.com/science/article/abs/pii/S0735675726000628 

Professional Development Opportunities

The Australasian College of Paramedicine | Primary Care Conference 2026

ACP 2026 Education Grants: 2026 Education Grants Open

Posterior Stroke

Not so FAST: pre-hospital posterior circulation stroke - PMC

Get in touch

[email protected]

X / Twitter 

James: ⁠⁠⁠@JamesOz1⁠⁠ 

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben

Producer: Liam Hennebry

In this episode of Clinical Conversations, we're joined by Associate Professor Carmel Crock (Director of the Emergency Department at the Royal Victorian Eye and Ear Hospital and Chair of the Quality & Patient Safety Committee at the Australasian College of Emergency Medicine) to unpack what diagnosis is, how diagnostic error happens, and how we can make diagnosis safer. We explore common pitfalls like premature closure and diagnostic momentum, and practical ways to improve diagnostic safety.

Get in touch

⁠[email protected]⁠

Socials

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn

James: https://linktr.ee/ClinicalConversations

Producer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).

• Cardiac Arrest Update with AV Resuscitation Coordinator Steve Musgrave
• Patient Safety Update: Stroke Assessment and Elderly Falls
• Alpine and Wilderness Response Alagaesia
• Toxicology Evaluation
• Alcohol Withdrawal Guideline
• Equipment Update: Syringe Drivers

Paper of the Month

Prehospital transesophageal echocardiography versus conventional advanced life support in out-of-hospital cardiac arrest (PHTEE–OHCA) – a randomized controlled pilot study: https://link.springer.com/article/10.1186/s13054-025-05805-w

Professional Development Opportunities

Fast-Tracked Higher Education Pathway for AV Clinical Instructors:  https://ambulancevic.sharepoint.com/sites/OneAV-news-and-updates/SitePages/Exciting-Opportunity-Fast-Tracked-Higher-Education-Pathway-for-AV-Clinical-Instructors.aspx?web=1 

ACP Primary Care Conference Canberra: 21-22 May 

ACPIC Melbourne : 8-11 September

EMS Asia Singapore 7-13 November 

Grad Cert MH: https://victoriauniversity.online/ppc/graduate-certificate-mental-health 

https://www.latrobe.edu.au/courses/graduate-certificate-in-mental-health#/overview?location=ON&studentType=dom&year=2026 

https://online.scu.edu.au/online-courses/graduate-certificate-mental-health 

https://handbook.monash.edu/2024/courses/m4039 

AICG: Clinical Governance, Effective Leadership, Clinical Education, Clinical Feedback.  https://www.aicg.edu.au/education/online-courses/ 

Get in touch

[email protected]

X / Twitter 

James: ⁠⁠⁠@JamesOz1⁠⁠ 

Ben: ⁠@ben_meadley⁠

Linkedin

James

Ben

Producer: Liam Hennebry 

In this episode of Clinical Conversations, James Oswald and Ambulance Victoria Medical Director Dr David Anderson unpack non-invasive ventilation (NIV) for prehospital care.

They explain the key physiology (oxygenation vs ventilation), the practical difference between CPAP and BiPAP, and how this guides use in COPD, acute pulmonary oedema, COVID, asthma, and undifferentiated dyspnoea. The discussion also covers patient coaching, mask fit troubleshooting, essential monitoring, and how to recognise early success vs failure—including when to escalate and call for help.

Get in touch

⁠[email protected]⁠

Socials

David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn

James: https://linktr.ee/ClinicalConversations

Producer: Liam Hennebry