Clinical Conversations by The Ambulance Victoria Office of the Medical Director

December 19, 2024 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:

oSecondary triage review

oChanges to pediatric analgesia guidelines

oStacked shock CWI updates

oMinor error corrections

•Pediatric Cannulation:

oALS IV access is supported for:

Major trauma and traumatic arrest (all ages), and

Pain relief (12-15 years).

oAvoid IV access in younger patients unless necessary; consider IN route for pain relief in children.

•Joint Reduction Adverse Event:

oImportant that we share the outcomes of adverse events openly but without blame.

oRecent adverse event involved shoulder reduction that was not indicated.

oOur main focus is on the system issues: we’re looking at making the indications clearer.

oIn the meantime, we’d like to raising awareness of the indication for reduction at the start of the CPG

•Amiodarone & Ondansetron:

oVT following Ondansetron administration only contraindicated if the drug is suspected to be the cause.

___________________________

2. Patient Safety Review

•Scene Safety vs. Patient Care:

oBoth paramedic and patient safety are important. No easy answers.

oWe encourage reflection on the best way to optimize the balance of risks rather than to be overly simplistic.

•Manual Handling of Bariatric Patients:

oRisks and benefits of asking patients with high BMI to move themselves to minimize manual handling injuries.

oImportance of recognizing strained physiology and the need for careful risk assessment in every case.

•Ambulation Risk Assessment:

oShout out to this guideline, which highlights risk factors in patient extrication.

___________________________

3. Research Update

•Video Assisted Technology:

oStudy on EMS providers in New York using smart glasses for live-streaming cases to medical control.

oLimited adoption so far, but promising developments for future use in 2025. Stay tuned for more in this space at AV.

•Intraosseous Access:

oNew 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:

oStudy shows a three-fold increase in survival to hospital discharge from 2003-2022 in Victoria.

oPost-COVID recovery efforts and ongoing strategies for improving cardiac arrest survival rates.

oPlease 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:

oCourses, memberships, and qualifications focusing on clinical governance, leadership, and patient safety.

•Australasian College of Paramedicine:

oUpcoming Critical Care Summit in May 2

...more

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