Clinical Updates: December 2024
Description
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
Cardiac arrest improvement strategy
External development opportunities
Australasian Institute of Clinical Governance
Get in touch
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James: @JamesOz1
Ben: @ben_meadley
Bluesky Social
James: @jamesoz1.bsky.social
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