Clinical Conversations

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 practice
Further 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
[email protected]
X / Twitter 
James: ⁠⁠⁠@JamesOz1⁠⁠ 
Ben: ⁠@ben_meadley⁠
Linkedin
James
Ben
Producer: Liam Hennebry

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
⁠[email protected]⁠
 
Socials
David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn
James: https://linktr.ee/ClinicalConversations

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 
⁠[email protected]⁠
James: https://linktr.ee/ClinicalConversations
Ben: ⁠@ben_meadley⁠ , Ben - Linkedin 
Producer: Liam Hennebry

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

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 - Paediatrics
A/Prof David Anderson – AV Medical Director
 
Get in touch
⁠[email protected]⁠
David: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedIn
James: https://linktr.ee/ClinicalConversations