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 for STEMI:Avoid sites near the radial artery to support PCI access.

Extrication Monitoring: Monitoring is sometimes removed during extrication, especially self-extrication. Associated with adverse events. We need to emphasise monitoring (especially ECG/pulse oximetry) during extrication.

Ectopic Pregnancy: Patient safety Assume ectopic pregnancy for women of childbearing age with abdominal pain and shock.

Cardiac Arrest:

Always prioritize high-performance CPR over antiarrhythmics.

Clarification on stacked shocks and their intended use. CWI out soon.  

ALS paramedics encouraged to consult for post-ROSC hypotension management.

Guideline Monitoring (12:36)

Success of expanded croup guidelines: increased dexamethasone use and reduced hospital transports.

Research Updates (14:20)

PANDA Trial: Comparing noradrenaline and adrenaline in cardiogenic shock.

IV vs IO Access: Preference for IV first in cardiac arrest; IO as backup.

ROSC Blood Pressure: Minimum diastolic pressure of 35mmHg linked to better outcomes.

Equipment Notices (19:20)

Normal saline shortages persist; substitute with Hartmann’s or PlasmaLite.

New ketone strips now available—use carefully.

Professional Development (20:11)

CPD resources from the Australasian College of Paramedicine and Victorian Ambulance Union.

Links to registration standards and CPD tools in the show notes.

Resources

PARAMEDIC 3Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes

PANDA trial - If you want to learn more about the study or have any questions, search for PANDA on the AV intranet or contact the team at [email protected].

Pain research with Monash - Get involved:Paramedic confidence & barriers to paediatric pain management

External development opportunities

https://www.paramedicineboard.gov.au/professional-standards/faq/faq-cpd.aspx

https://paramedics.org/