Clinical Conversations

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

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 cricothyroidotomy

Guideline 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 update
Professional 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

Your monthly clinical update from Ambulance Victoria covering:
Paediatric anaphylaxis and asthma – a message from Safer Care Victoria
Pre-hospital blood products
Patient safety update: CSO Matt Shepard on paediatric airway management
Guideline monitoring: Head injury guideline
Paper(s) of the month: 
Torniquet use for severe bleeding | Pre-hospital vital signs
Equipment update
Professional development opportunities
Small steps to transform your practice
Resources
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 Retrieval
RePHILL 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 setting
Prehospital 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

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

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