Clinical Conversations

The Ambulance Victoria Office of the Medical Director
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  • EVERY TWO MONTHS

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.

  1. Clinical Updates: December 2025

    23/12/2025

    Clinical Updates: December 2025

    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine). Hear from Louise Reynolds (Victoria’s Chief Paramedic Officer) on the women’s pain inquiry findings—and what it means for paramedic practice.Spotlight the VVED back pain pathway: for many patients, opioids + ED isn’t the answer—community physio support can be surprisingly effective.Adam Ho (AV Senior Pharmacist) answers the most common medication questions.Paper of the Month: a must-read on post-intubation hypotension.Ben runs through key professional development opportunities for 2025 and what’s coming in 2026.Equipment update.And we wrap with small steps to transform your practiceFurther resources VVED Back pain pathway presentation (AV employees only): https://engage.cloud.microsoft/main/threads/eyJfdHlwZSI6IlRocmVhZCIsImlkIjoiMzU5OTQ5NzU4NzMzNTE2OCJ9?trk_copy_link=V1 AI Professional Development Courses Free micro-skill course in AI: https://www.australianindustrygroup.com.au/education-training/centre-for-education-and-training/blog/free-introduction-to-artificial-intelligence-microskill-course Digital health 101: https://digitalhealthworkforce.org.au/education-and-resources/ Australian Institute of Digital Health AI essentials: https://cpd.digitalhealth.org.au/course/ai-essentials   AI Podcasts NEJM AI Grand rounds (AI Podcast): https://store.nejm.org/signup/ai/podcasts Beyond the prompt (AI podcast): https://www.beyondtheprompt.ai/ Paper of the month Prehospital Postintubation Hypotension and Survival in Severe Traumatic Brain Injury: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2841682 Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults: https://www.nejm.org/doi/abs/10.1056/NEJMoa2511420 Get in touch clinicalguidelines@ambulance.vic.gov.au X / Twitter  James: ⁠⁠⁠@JamesOz1⁠⁠  Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

    38 min

  2. 22/12/2025

    Clinical Conversations: Medical Director Live Q&A

    In our first ever live episode of Clinical Conversations, James Oswald (CPG specialist and paramedic) is joined by Ambulance Victoria Medical Director Dr David Anderson for an end-of-year Q&A on the latest CPG updates. We work through staff questions on the “why” behind key changes—including respiratory care and oxygen targets, NIV expansion and mask issues, airway and RSI updates (including crash induction and consultation for single-responder MICA), and several medication updates such as magnesium compatibility, levetiracetam after midazolam, IV GTN in APO, and opioid choice and multimodal analgesia. They also cover practical operational issues like VVED wait times and what to do when access delays are affecting crews. Get in touch ⁠clinicalguidelines@ambulance.vic.gov.au⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations

    49 min

  3. 03/12/2025

    Clinical Updates: November 2025

    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine): 02:10 – CPG Update Released • Highlights major 2025 CPG changes, app issues, and expected three-month transition period (IFS ceases immediately).  • Emphasis on professional judgment, understanding over memorisation, and upcoming live Q&A.  • Request for staff feedback on new learning methods. 05:42 – Women’s Pain Inquiry Findings • Large Victorian inquiry confirms women’s pain is frequently dismissed; implications for paramedic practice. 06:58 – Registration & Professional Capabilities • Registration season brings opportunity to review Paramedicine Board capabilities: communication, cultural safety, risk management, lifelong learning. 08:05 – Paper 1: AI ECG for STEMI • AI ECG analysis outperforms clinicians in complex cases and may reduce cath lab false activations; human–AI collaboration is the future. 10:20 – Paper 2: Community Paramedicine Study • Time-and-motion study shows community paramedicine is a thinking-intensive role with few interventions. 13:40 – Paper 3: Methoxy vs Fentanyl vs Morphine • Methoxyfluorane provides fastest early analgesia; supports multimodal pain management with methoxy as a strong first-line option. 17:56 – Equipment Update • Reminder not to pre-connect sensitive devices (e.g., EtCO₂ adapters, Yankauer) due to temperature and contamination risks. 19:54 – AI Professional Development Workshop • Upcoming Monash workshop on trustworthy generative AI for healthcare, available in-person and virtually. Resources   Inquiry into women’s pain: https://www.health.vic.gov.au/inquiry-into-womens-pain  Gender disparities in EMS care: https://pubmed.ncbi.nlm.nih.gov/36369725/  Sex Differences in Patients With Acute Chest Pain:  https://www.sciencedirect.com/science/article/pii/S0735109723000839  Professional capabilities: https://www.paramedicineboard.gov.au/Professional-standards/Professional-capabilities-for-registered-paramedics.aspx    Papers of the month  Community paramedicine: https://www.sciencedirect.com/science/article/pii/S2588994X25000909?via%3Dihub  Pain relief study: https://www.sciencedirect.com/science/article/abs/pii/S0140673625015752  AI-Enabled ECG Analysis: https://www.jacc.org/doi/10.1016/j.jcin.2025.10.018  Professional development  Building Trustworthy GenAI for Healthcare Innovation: https://shop.monash.edu/masterclass-building-trustworthy-genai-for-healthcare-innovation.html  Get in touch  ⁠clinicalguidelines@ambulance.vic.gov.au⁠ James: https://linktr.ee/ClinicalConversations Ben: ⁠@ben_meadley⁠ , Ben - Linkedin  Producer: Liam Hennebry

    23 min
  4. Clinical Updates: October 2025

    02/11/2025

    Clinical Updates: October 2025

    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine): 01:40 – 2025 Clinical Update Coming Soon 02:20 – IFS Retirement & Paediatric RSI Feedback 07:05 – STEMI Performance Update 08:50 – Free Birth: Paramedic Implications 11:50 – PANDA Trial Update 13:50 – Patient Safety: Cognitive bias & discounting concerning symptoms 19:20 – Missing PCRs in Severe Adverse Events 21:50 – Guideline Monitoring: Minor Head Injury & VVED Outcome Data 22:50 – Paper of the Month & New Cardiac Arrest Guidelines 25:45 – Equipment Updates 26:59 – Professional Development Opportunities 28:15 – Small Steps to Transform Your Practice Further resources Freebirth - Position statement | Safer Care Victoria EMCRIT episode on paediatric FONA: https://emcrit.org/emcrit/pediatric-tracheotomy/  ERC 2025 Guidelines: https://www.erc.edu/science-research/guidelines/guidelines-2025/guidelines-2025-english/ AHA 2025 Guidelines: https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines Opinion piece - Iain Beardsell: https://www.bmj.com/content/390/bmj.r2051  ACP Regional Paramedic Symposium: https://paramedics.org/events/rps-2025?tab=About Emergency, Trauma & Critical Care Conference: https://www.fltr-ed.com/    Get in touch X / Twitter / Bluesky James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

    29 min
  5. Clinical Updates: Paediatic intubation special

    07/10/2025

    Clinical Updates: Paediatic intubation special

    James Oswald is joined by an expert panel to discuss the background, evidence and rationale behind the retirement of intubation facilitated by sedation: Richard Armour – MICA paramedic, PhD candidate, CPG specialist.Dr Claire Wilkin – PEM, AV Medical Advisor - PaediatricsA/Prof David Anderson – AV Medical Director  Get in touch ⁠clinicalguidelines@ambulance.vic.gov.au⁠ David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations

    40 min
  6. Clinical Updates: September 2025

    19/09/2025

    Clinical Updates: September 2025

    Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine): Clinical Update Warm IV fluid (13:38): Stop warming IV fluids in overhead compartments or with hot water bottles. Risks scalding/superheating. Store in equipment towers only.Paediatric distraction (03:26): kits available now. Evidence-based, non-digital active tools work best. Order via iProc. Document use in VACIS.Paediatric NIV (9:20): pathways with RCH/Monash/PIPER. Use patient device if feasible; alternatives include Flow-Safe and Zoll Z-Vent. More guidance coming.Patient safety Low acuity, high risk (12:32): Some high-risk patients sit in apparently low acuity cases. Advocate, self-upgrade when risk warrants. Lodge cases in RiskMan.Standing height falls (14:49): Standing-height falls in older adults: great feedback from the field, we discuss common themes.Paper of the Month (19:26): measurable “hyperacute T-wave” definition predicts OMI even without STEMI criteria. Equipment (21:40): new neonatal BVMs; syringe-holder prototypes to separate RSI meds. CPD (24:21): short courses and LinkedIn Learning suggestions. Further resources Occlusion myocardial infarction and artificial intelligenceHyperacute T-wave definitionhttps://journals.sagepub.com/doi/full/10.1177/27536386251371078https://shortcourses.rmit.edu.au/collections/allhttps://mbs.edu/short-courseshttps://www.monash.edu/business/corporate-education/short-coursesLinkedin.com/learning/ Get in touch James: https://linktr.ee/ClinicalConversations Ben: X/Twitter⁠ | Linkedin clinicalguidelines@ambulance.vic.gov.au

    27 min

  7. 16/09/2025

    Cardiogenic shock

    This month James and David look at cardiogenic shock: recognition and classification, oxygen targets, fluid resuscitation, vasopressors, inotropes, and the possibility of shock centres in the future. They're joined by Professor Dion Stub, an interventional cardiologist, prolific researcher, professor at Monash University, member of the Australian Resuscitation Council, and medical advisor to Ambulance Victoria. Further resources Avoid trial: https://www.ahajournals.org/doi/10.1161/circulationaha.114.014494 DETO2XAMI:  https://www.nejm.org/doi/full/10.1056/NEJMoa1706222#:~:text=The%20Determination%20of%20the%20Role,not%20have%20hypoxemia%20at%20baseline.  EXACT pilot trial: Concerns regarding the safety of prehospital titrated oxygen in post-cardiac arrest patients  https://pubmed.ncbi.nlm.nih.gov/29684433/ PANDA Trial (AV Staff) https://ambulancevic.sharepoint.com/sites/OneAVQualityandClinicalInnovation/SitePages/PANDA-TRIAL-(.aspx Get in touch ⁠clinicalguidelines@ambulance.vic.gov.au⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations

    49 min
  8. Clinical Updates: August 2025

    08/08/2025

    Clinical Updates: August 2025

    Your monthly clinical update covering: Mandatory VVED Consults for Infants 28 Days – trends, rationale for policy, clarifications, and case example demonstrating impact. Stroke updates - performing ACT-FAST on all MASS positive patients, changes to VACIS and a plug for IV access. Complex Paediatric Respiratory Patients – Managing patients on home non-invasive ventilation, maintaining continuity of care, and upcoming resources. Trauma Updates – Blood component therapy expansion and compliance requirements.STAB-5 mnemonic and minimising scene time in major trauma.PANDA trial enrolment reminder.Standing-Height Falls in Elderly – Missed spinal injury cases, cultural pendulum shift, guideline review, and call for feedback. Manual Handling & Patient Safety in ED Cohorting – Safe movement of high-risk patients and preventing deterioration during cohorting. Paper of the Month – Danish machine learning study outperforming NEWS2 for predicting deterioration from first-five-minute vitals, with explainable AI. Equipment Committee Updates – New traction splints, medication safety devices via 3D printing, thermal blanket effectiveness, and syringe driver software updates. Professional Development & Resources – Coroner’s Communiques, ACP International Conference, new paramedic podcasts. Small Steps to Transform Practice – Treat elderly standing-height falls as potential spinal injuries.Minimise scene time for major trauma unless safety or critical intervention requires it. Further resources ACP Conference Thermal blanket study Machine learning study STAB-5 Coroner's communique  Get in touch clinicalguidelines@ambulance.vic.gov.au X / Twitter / Bluesky James: ⁠⁠⁠@JamesOz1⁠⁠ | @jamesoz1.bsky.social Ben: ⁠@ben_meadley⁠ Linkedin James Ben

    30 min
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About

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.

Information

  • Creator
    The Ambulance Victoria Office of the Medical Director
  • Years Active
    2021 - 2025
  • Episodes
    40
  • Rating
    Clean
  • Copyright
    © 2025 Clinical Conversations
  • Show Website
    Clinical Conversations

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