Clinical Updates: December 2024

Clinical Conversations

A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director.

Overview

1. Clinical Practice Updates

• CPG App Update Details:

o Secondary triage review

o Changes to pediatric analgesia guidelines

o Stacked shock CWI updates

o Minor error corrections

• Pediatric Cannulation:

o ALS IV access is supported for:

Major trauma and traumatic arrest (all ages), and

Pain relief (12-15 years).

o Avoid IV access in younger patients unless necessary; consider IN route for pain relief in children.

• Joint Reduction Adverse Event:

o Important that we share the outcomes of adverse events openly but without blame.

o Recent adverse event involved shoulder reduction that was not indicated.

o Our main focus is on the system issues: we’re looking at making the indications clearer.

o In the meantime, we’d like to raising awareness of the indication for reduction at the start of the CPG

• Amiodarone & Ondansetron:

o VT following Ondansetron administration only contraindicated if the drug is suspected to be the cause.

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2. Patient Safety Review

• Scene Safety vs. Patient Care:

o Both paramedic and patient safety are important. No easy answers.

o We encourage reflection on the best way to optimize the balance of risks rather than to be overly simplistic.

• Manual Handling of Bariatric Patients:

o Risks and benefits of asking patients with high BMI to move themselves to minimize manual handling injuries.

o Importance of recognizing strained physiology and the need for careful risk assessment in every case.

• Ambulation Risk Assessment:

o Shout out to this guideline, which highlights risk factors in patient extrication.

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3. Research Update

• Video Assisted Technology:

o Study on EMS providers in New York using smart glasses for live-streaming cases to medical control.

o Limited adoption so far, but promising developments for future use in 2025. Stay tuned for more in this space at AV.

• Intraosseous Access:

o New research indicates IO access has minimal long-term complications (e.g., osteomyelitis, osteonecrosis) and should remain a viable option when IV access isn't possible.

• Cardiac Arrest Survival Rates:

o Study shows a three-fold increase in survival to hospital discharge from 2003-2022 in Victoria.

o Post-COVID recovery efforts and ongoing strategies for improving cardiac arrest survival rates.

o Please consider attending a HPCPR refresher session if possible.

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4. Equipment Updates

• Ketone Strips: New bags for separating ketone strips from glucose strips in response to feedback.

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5. Professional Development Opportunities

• Institute for Healthcare Improvement & Australian Institute of Clinical Governance:

o Courses, memberships, and qualifications focusing on clinical governance, leadership, and patient safety.

• Australasian College of Paramedicine:

o Upcoming Critical Care Summit in May 2024, focusing on clinical excellence.

• Critical Care Reviews Conference:

o Dissecting randomized control trials in medicine and pre-hospital care.

o Also a great opportunity to learn how feedback can be delivered and received positively.

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Resources

A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design StudyAn assessment of long-term complications following prehospital intraosseous access: A nationwide study

Out-of-hospital cardiac arrests in Victoria, 2003–2022: retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data

⁠Cardiac arrest improvement strategy

External development opportunities

Australasian Institute of Clinical Governance

IHI Open School

ACP Critical Care Summit

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