Clinical Conversations
A podcast aimed at paramedics and anyone involved in out-of-hospital care that is critical, urgent, or unplanned. Hosted by James Oswald, a paramedic and clinical guideline developer, and Associate Professor David Anderson, the Medical Director. It explores topics such as prehospital critical care, retrieval medicine, ambulance operations, and helicopter emergency medical services. Designed for first responders, EMTs, and emergency medical professionals seeking practical clinical insights.
Episodes
Clinical Updates: August 2026
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
Clinical Updates: July 2026
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 opp
AI in paramedicine
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 acc
Clinical Update: June 2026
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, tru
Clinical Updates: May 2026
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 exte
Clinical Updates: March 2026
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 opportunities
Paramedics DO diagnose: diagnostic safety with A/Professor Carmel Crock
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
Clinical Updates: February 2025
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
Non-Invasive Ventilation (CPAP and BiPAP)
In this episode of Clinical Conversations, James Oswald and Ambulance Victoria Medical Director Dr David Anderson unpack non-invasive ventilation (NIV) for prehospital care.They explain the key physiology (oxygenation vs ventilation), the practical difference between CPAP and BiPAP, and how this guides use in COPD, acute pulmonary oedema, COVID, asthma, and undifferentiated dyspnoea. The discussio
Clinical Updates: December 2025
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 su
Clinical Conversations: Medical Director Live Q&A
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 cr
Clinical Updates: November 2025
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
Clinical Updates: October 2025
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 Soon02:20 – IFS Retirement & Paediatric RSI Feedback07:05 – STEMI Performance Update08:50 – Free Birth: Paramedic Implications11:50 – PANDA Trial Update13:50 – Patient Safety: Cognitive bias & discounting concerning sy
Clinical Updates: Paediatic intubation special
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 - PaediatricsA/Prof David Anderson – AV Medical Director Get in touchclinicalguidelines@ambulance.vic.gov.auDavid: @expensivecare | @expen
Clinical Updates: September 2025
Your monthly clinical update from James Oswald (Clinical Practice Guideline Specialist) and A/Prof Ben Meadley (Director of Paramedicine):Clinical UpdateWarm IV fluid (13:38): Stop warming IV fluids in overhead compartments or with hot water bottles. Risks scalding/superheating. Store in equipment towers only.Paediatric distraction (03:26): kits available now. Evidence-based, non-digital active to
Cardiogenic shock
This month James and David look at cardiogenic shock: recognition and classification, oxygen targets, fluid resuscitation, vasopressors, inotropes, and the possibility of shock centres in the future. They're joined by Professor Dion Stub, an interventional cardiologist, prolific researcher, professor at Monash University, member of the Australian Resuscitation Council, and medical advisor to
Clinical Updates: August 2025
Your monthly clinical update covering:Mandatory VVED Consults for Infants <28 Days – trends, rationale for policy, clarifications, and case example demonstrating impact.Stroke updates - performing ACT-FAST on all MASS positive patients, changes to VACIS and a plug for IV access.Complex Paediatric Respiratory Patients – Managing patients on home non-invasive ventilation, maintaining continuity o
Q&A: Sedation, trauma, why we need to change and the future of paramedicine.
In this special Q&A episode of Clinical Conversations, James Oswald and Dr. David Anderson respond to the most common — and most complex — questions we've received on sedation, CPG implementation, and the evolving role of paramedics. We also reflect on why clinical guidelines are becoming more detailed, how to balance complexity with emergency care, and what the future holds for paramedic
Clinical Updates: July 2025
Your monthly update on clinical issues including:Clinical Practice Care and Control Powers (02:38 – 07:10)Overview of section 232 and 241 powers. Documentation: VACIS + RiskMan entries are essential.More info: See Mental Health Crisis Reform on OneAV. Verification of Death (07:10 – 08:48)Verifying death is voluntary for paramedics.Review WinOps 025 for current processes.AV is working with VicPol t
Paediatric acute behavioural disturbance
In this episode of Clinical Conversations, we explore the complexities of managing acute behavioural disturbance (ABD) in children and adolescents—a small but increasingly common and high-risk cohort. Host James Oswald and AV Medical Director Dr. David Anderson are joined by paediatric emergency physician Dr. Claire Wilkin, who brings deep expertise in paediatric critical care. Together, they disc
Clinical Update
Your monthly clinical update covering:Clinical Practice 03:10 – Respiratory CPG Update: Pulmonary edema, COVID, ILI, paediatric asthma changes coming soon.04:00 – First Responder Analgesia: Supply challenges beingaddressed; updates coming. 05:10 – Button Batteries: New blue dye marker—importantvisual sign but not universally present.06:00 – Mushroom Season Warning: Watch for toxidromes; VPIC suppo
Paediatric assessment, consultation and virtual emergency care
James Oswald and Dr David Anderson explore how consultation has evolved from a perceived weakness to a hallmark of clinical maturity. They discuss the growing role of virtual emergency care, particularly the Victorian Virtual Emergency Department (VVED), in supporting paramedics with decision-making—especially when assessing young infants. Joined by pediatric emergency specialist Dr Harith Al-Rawi
Clinical Updates: April 2025
Your monthly clinical update covering:VVED Consultations for small infantsNew requirement: VVEDconsultation for non-transport of infants ≤28 daysStrong recommendation for 29days–3 monthsDriven by patient safety reviewand expert consensusNot about removing autonomy —it’s about adding clinical supportRSI Checklist UpdateAddition of a pop-off valve checkfollowing a critical safety eventPrevents misdi
Sedation safety for acute behavioural disturbance (Part 2)
In Part 2 of their sedation safety conversation, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) cover preparation for sedation and how to recognize and respond to deterioration. They break the problem into three evidence‑backed pillars:Prevent deterioration (have a listen to Part 1)Prepare for side‑effects – if you
Clinical Updates: March 2025
Your monthly clinical update covering:Cardiac arrest outcomes An update on the sedation safety guidelineLessons learned from the patient safety team: appropriate use of the CT-6 traction splint and having a high index of suspicion for spinal and head injuries in older adults followingstanding height falls BVM blow off valve reminderPaper of the month: Prehospital antibiotics in sepsisMiller blade
Sedation safety for acute behavioural disturbance
In this episode of Clinical Conversations, hosts James Oswald (paramedic and clinical guidelines specialist) and Dr. David Anderson (Medical Director of Ambulance Victoria) dive into one of the most ethically and clinically complex areas of pre-hospital care—the questions of safety for during sedation for acute behavioural disturbance (ABD). They explore the ethical and legal considerations surrou
Clinical Updates: February 2025
James and Ben cover the latest clinical news from across Ambulance Victoria, including:Intranasal Fentanyl Update – Using IV preparation for intranasal use.Other guidelines updates: Extrication monitoring, shoulder reduction, wilderness pain relief.Blood Administration – New pre-hospital blood transfusion training coming.Rocuronium Storage – Heat-related potency issues; rotate every 30 days.Commun
"He's going to die" - Breaking bad news
In this episode of Clinical Conversations, James Oswald (Paramedic and Clinical Practice Guidelines Specialist) and Dr. David Anderson (Ambulance Victoria Medical Director) tackle one of the most challenging aspects of paramedicine—delivering bad news. Joined by guest Liz Perry (MICA Paramedic), they explore the difficulties paramedics face when communicating death and critical updates to families
Clinical Updates: January 2025
James Oswald and Director of Paramedicine Dr Ben Meadley discuss the important clinical messages for January 2025: patient safety during sedation and the importance of planning for resuscitation; the exploration of low acuity pathways; and they review a significant research paper on physician-led teams in pre-hospital care. The episode also covers equipment updates, professional development op
Pain (Part 3) - Systems issues and special circumstances
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 3, we look at challenges in building a system that leads to good pain relief as well as some special circumstances in
Clinical Updates: December 2024
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Overview1. Clinical Practice Updates•CPG App Update Details: oSecondary triage review oChanges to pediatric analgesia guidelines oStacked shock CWI updates oMinor error corrections•Pediatric Cannulation: oALS IV access is supported for: Major trauma and traumatic arrest (all ages), and Pain r
Pain (Part 2) - Management
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 2, we look at best practice in the management of pain. Further resourcesAcute Pain Management: Scientific Evidence:
Clinical Updates: November 2024
A monthly summary of clinical information from the Ambulance Victoria Office of the Medical Director. Quick summary (0:30)Patient Safety (1:30)Discussing the lessons from specific adverse events is challenging due to patient privacy/consent, crew psychological safety, and investigation timelines. We need to find a way to collectively share these lessons in a safe way. Plans for quarterly clinical
Pain (Part 1) - Assessment, bias and disparities in care
Pain is one of the most common reasons people seek help from paramedics and other healthcare professionals. Do we take it seriously? Could we be doing better? James sits down with paramedicine luminary and pain researcher A/Prof Bill Lord for a three-part series on pain. In Episode 1, we look at assessment, bias, and disparities in pain care. In the coming months, we’ll bring you the rest of our d
Clinical Updates: October 2024
This is the first in a new series of monthly clinical updates for Ambulance Victoria clinical staff. Director of Paramedicine A/Prof Ben Meadley and Clinical Guideline Specialist James Oswald summarise the need-to-know clinical information, all in one spot. This month: New CPG updates, trends in our patient safety data, and new cardiac monitors. Times stamps:2:00 New CPG updates4:40 Snakebite6:30
The Future of Paramedicine
In this episode, James speaks with critical care paramedic, academic, and newly appointed Director of Paramedicine, Associate Professor Ben Meadley. We discuss strategic clinical leadership and the future of the profession. X / TwitterDavid: @expensivecareJames: @JamesOz1Ben: @ben_meadley
Sepsis (Part 2) - Management
Part 2 of David's discussion with Associate Professor Andrew Udy on Sepsis Management. Get in touchclinicalguidelines@ambulance.vic.gov.au X / TwitterDavid: @expensivecareJames: @JamesOz1Resources mentioned[PHANTASI trial] Alam N, Oskam E, Stassen PM, Exter Pv, van de Ven PM, Haak HR, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.
Sepsis (Part 1) - Assessment and diagnosis
Sepsis is arguably the most common time critical emergency we face as paramedics. This is the first of a two part series on sepsis with Professor Andrew Udy. Andrew is Head of Research at The Alfred ICU, and Deputy Director, Australian and New Zealand Intensive Care Research Centre. He was involved in the development of the recently released Ambulance Victoria Sepsis and Infection guideline. In th
Penetrating trauma
In Australia, penetrating truncal trauma is rare and the care of these patients involves a quite different mindset than we're used to. This is a cohort where our stay-and-play approach can do harm. James and David discuss the evidence relating to penetrating trauma and practical recommendations for your practice.Further resourcesOver view of major traumatic injury in Australia–Implications fo
National clinical practice guidelines - are they the future?
Clinical practice varies between the different state ambulance services in Australia. Yet we all claim to be evidence-based. So why is this, how big of a problem is it and what should we do about it? Are national guidelines the answer? James speaks with paramedic and PhD candidate Matt Wilkinson-Stokes to find out, while David shares his perspective on national guidelines. Further resourcesMatt&ap
Tranexamic acid
For over a decade after a large study showed a mortality benefit, this drug remained controversial. David and James look at the TXA saga.
We're back: Why a podcast?
Clinical conversations is back. But where have we been, what have we been doing and what do we have planned for the future?
OMI vs STEMI
We’re all familiar with the concept of STEMI. But the definition is built around a single ECG sign – not the underlying problem itself. Is that the best way to do it? Should we be thinking about this in a totally different way? Is Occlusive Myocardial Infarction (OMI) the new STEMI? NotesOMI ManifestoAmal Mattu on YouTubeSubtle STEMI iOS appThe Ancient Scholar
Capnography
Capnography plays a crucial role in the treatment of a range of life-threatening conditions. Its central role following intubation is undeniable and it's also an important part of our approach to cardiac arrest and sedated patients of all kinds. Yet it is not always as straightforward as it might seem. In this episode, David and James speak with Matt Humar (intensive care paramedic, acting pa
Shock
Shock is the quintessential critical illness. Bread and butter for everyone involved in prehospital and critical care. But do we really understand it? Could we be doing better for these patients?James is joined by Assoc. Prof. David Anderson, intensivist and Ambulance Victoria Medical Director, for a... shocking discussion.
Acute Behavioural Disturbance
People experiencing acute behavioral disturbance are some of the most vulnerable patients we treat. It’s a deeply distressing situation for the patient and extremely confronting for clinicians and carers. In this episode, we speak with psychiatrist Dr Alison Taylor about important changes we're making to improve care for these patients.
Family violence
Family violence is a deeply confronting and serious problem that occurs across all ages, genders, and socioeconomic groups. It has a profound impact on the health and well-being millions of people across the globe. How can we identify family violence? How should we respond to a disclosure of family violence? How can we help victim survivors? Ambulance Victoria Safe Guarding Care Lead Amber Smith j
Withholding or ceasing resuscitation
The decision to withhold or cease resuscitation is one of the most impactful and also one of the more confronting decisions that paramedics make in the field. AV Medical Director Associate Professor David Anderson discuss Dr Natalie Anderson, PhD discuss the decision making process and how to better approach these difficult cases. MyGriefToolbox - Great Canadian resource for all paramedics, with
Pain Relief and Intranasal Ketamine
Ambulance Victoria recently introduced intranasal ketamine for the treatment of moderate and severe pain. It has proven to be effective but we have identified opportunities to do better.Clinical Practice Development Specialist James Oswald and Medical Director David Anderson discuss the new Clinical Practice Guideline and some of the lessons we've learned along the way.
Recommended
Ultima Thule Ambient Music
Kids Ministry & Leadership Podcast
Mastering Intensive Care
The Daily Home Edit
You’re Gonna Want To Hear This
Zacharias's Podcast
The Parent-Teacher Project
Locked In with Kane Cornes
Off The Bench
Flight Training Australia Podcast
In Black and White
Learning While Working Podcast
