Clinical Update: June 2026

Your monthly clinical update covering:Clinical practice update:-          Needle sizes for IM injections-          New clinician health channel and forthcoming CSO forum-          Prehospital whole bloodPatient safety update: What we can learn the Coroner’s inquest into the death of Philip Walton-          Inquest into the death of Phillip Walton-          Transport requests for definitive medical care - paramedic responsibilities-          WIN/OPS/015 Operational Workforce Key Response RequirementsPaper of the month: Prehospital Point-of-Care GFAP for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma | Emergency Medicine | JAMA Network Open | JAMA Network Paramedicine Editorial: Who gets to be sick? Equipment update: Fentanyl 100 mcg/2 mL ampoules – Inconsistent ampoule breakage with Hameln brand Professional development opportunities:Improving Diagnosis SymposiumAustralian & New Zealand Society of Palliative Medicine (ANZSPM) - Paramedicine Palliative Care Study Day Red Dirt Resus 2026  AWEMS Conference Imaginal simulation/mental rehearsal:https://pubmed.ncbi.nlm.nih.gov/38244027/https://paramedics.org/recordings/rs24-mental-rehearsal-in-paramedicine-an-acceptability-study   Get in [email protected]  Producer: Liam Mylebry 

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 ⁠[email protected]⁠  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 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 [email protected] Linkedin James Ben   Producer: Liam Mylebry 

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 practiceResourcesPaediatric Anaphylaxis: Acute Paediatric Asthma and Anaphylaxis – Practice point | Safer Care VictoriaPre-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 ConsiderationsYoung PP, Wood D, Holcomb JB, Jenkins DH, Levy MJ. Scaling of Prehospital Blood: A Model Describing…Whole Blood ResearchHadley J, Conner J, Thomas C, et al. Whole Blood First Resuscitation and Association of Blood Produ…Ambulance Victoria Resources: Blood Component AccessWIN/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 touchclinicalguidelines@ambulance.vic.gov.auLinkedinJamesBenProducer: 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 ⁠[email protected]⁠  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 advisoryCardiac Arrest Team Performance Report: insights and practical takeaways for improving CPR qualityPANDA 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 [email protected] Linkedin James Ben   Producer: Liam Mylebry

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 2026VOD update: Updated guidance - Requests for Verification of Death (VOD) Hand hygiene: Take Five for Hand Hygiene Transmission based precautions clinical work instructionCWI 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 - PubMedProfessional development:Fast Tracked Higher Education Pathway for AV Clinical Instructors – Now Open for Mid-Year IntakeClinical Insights: Issue 8 now availableThe Australasian College of Paramedicine Conference | ACPIC26CAA Congress | The Council of Ambulance Authorities Inc.Trauma 2026 Conference - Trauma ConferenceSAS Events – Safe Airway SocietyClinical Technology and Equipment Committee Idea Sharing: Clinical Technology and Equipment Committee / [email protected] Get in touch: [email protected]  Producer

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 OpportunitiesThe Australasian College of Paramedicine | Primary Care Conference 2026ACP 2026 Education Grants: 2026 Education Grants OpenPosterior StrokeNot so FAST: pre-hospital posterior circulation stroke - PMCGet in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry

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[email protected]⁠ SocialsDavid: ⁠@expensivecare⁠ | @expensivecare.bsky.social | LinkedInJames: https://linktr.ee/ClinicalConversationsProducer: Liam Hennebry 

Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine).Cardiac Arrest Update with AV Resuscitation Coordinator Steve MusgravePatient Safety Update: Stroke Assessment and Elderly FallsAlpine and Wilderness Response AlagaesiaToxicology EvaluationAlcohol Withdrawal GuidelineEquipment Update: Syringe DriversPaper of the MonthPrehospital transesophageal echocardiography versus conventional advanced life support in out-of-hospital cardiac arrest (PHTEE–OHCA) – a randomized controlled pilot study: https://link.springer.com/article/10.1186/s13054-025-05805-wProfessional Development OpportunitiesFast-Tracked Higher Education Pathway for AV Clinical Instructors:  https://ambulancevic.sharepoint.com/sites/OneAV-news-and-updates/SitePages/Exciting-Opportunity-Fast-Tracked-Higher-Education-Pathway-for-AV-Clinical-Instructors.aspx?web=1 ACP Primary Care Conference Canberra: 21-22 May ACPIC Melbourne : 8-11 SeptemberEMS Asia Singapore 7-13 November Grad Cert MH: https://victoriauniversity.online/ppc/graduate-certificate-mental-health https://www.latrobe.edu.au/courses/graduate-certificate-in-mental-health#/overview?location=ON&studentType=dom&year=2026 https://online.scu.edu.au/online-courses/graduate-certificate-mental-health https://handbook.monash.edu/2024/courses/m4039 AICG: Clinical Governance, Effective Leadership, Clinical Education, Clinical Feedback.  https://www.aicg.edu.au/education/online-courses/ Get in [email protected] / Twitter James: ⁠⁠⁠@JamesOz1⁠⁠ Ben: ⁠@ben_meadley⁠LinkedinJamesBenProducer: Liam Hennebry