Clinical Conversations

The Ambulance Victoria Office of the Medical Director
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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. 1d ago

    Spinal Injury: Clinical Clearance (Part 1)

    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  ⁠clinicalguidelines@ambulance.vic.gov.au⁠    Socials  David: ⁠@expensivecare⁠ |@expensivecare.bsky.social | LinkedIn  James: https://linktr.ee/ClinicalConversations

  2. Sep 3

    Clinical Updates: August 2026

    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 cricothyroidotomyGuideline 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 updateProfessional 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 clinicalguidelines@ambulance.vic.gov.au  Linkedin  James  Ben      Producer: Liam Mylebry

  3. Aug 6

    Clinical Updates: July 2026

    Your monthly clinical update from Ambulance Victoria covering: Paediatric anaphylaxis and asthma – a message from Safer Care VictoriaPre-hospital blood productsPatient safety update: CSO Matt Shepard on paediatric airway managementGuideline monitoring: Head injury guidelinePaper(s) of the month:  Torniquet use for severe bleeding | Pre-hospital vital signsEquipment updateProfessional development opportunitiesSmall steps to transform your practiceResources 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 RetrievalRePHILL 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 settingPrehospital physiologic instability and in-hospital mortality among non-trauma patients with low-ri…  Get in touch clinicalguidelines@ambulance.vic.gov.au Linkedin James Ben Producer: Liam Mylebry

    Clinical Updates: July 2026

  4. Jul 28

    AI in paramedicine

    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  ⁠clinicalguidelines@ambulance.vic.gov.au⁠    Socials  David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn  James: https://linktr.ee/ClinicalConversations    Producer: Liam Mylebry

  5. Jun 19

    Clinical Update: June 2026

    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 ======= Get in touch  clinicalguidelines@ambulance.vic.gov.au  Linkedin  James  Ben      Producer: Liam Mylebry

    Clinical Update: June 2026

  6. May 11

    Clinical Updates: May 2026

    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  ======= 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 / CTEC@ambulance.vic.gov.au  Get in touch: clinicalguidelines@ambulance.vic.gov.au Linkedin James Ben     Producer

    Clinical Updates: May 2026

  7. Mar 27

    Clinical Updates: March 2026

    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 2026Posterior StrokePatient Care RecordsEvaluation data of droperidol and dexamethasone as antiemeticsPaper of the Month: IV vs IO in cardiac arrestEquipment updateProfessional development opportunitiesSmall steps to transform your practicePaper 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 clinicalguidelines@ambulance.vic.gov.au X / Twitter  James: ⁠⁠⁠@JamesOz1⁠⁠  Ben: ⁠@ben_meadley⁠ Linkedin James Ben Producer: Liam Hennebry

    Clinical Updates: March 2026

  8. Mar 1

    Paramedics DO diagnose: diagnostic safety with A/Professor Carmel Crock

    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 ⁠clinicalguidelines@ambulance.vic.gov.au⁠   Socials David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn James: https://linktr.ee/ClinicalConversations Producer: Liam Hennebry

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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 - 2026
  • Episodes
    50
  • Rating
    Clean
  • Copyright
    © 2026 Clinical Conversations
  • Show Website
    Clinical Conversations

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