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 paramedics.

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⁠clinicalguidelines@ambulance.vic.gov.au⁠

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David: ⁠@expensivecare⁠ | @expensivecare.bsky.social| LinkedIn

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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 to improve processes.

Encourage local discussion with TM/CSO about your approach.

Resus Ready Campaign (08:48 –10:34)

Aims to boost preparedness for cardiac arrest.

Includes: equipment checks, airway readiness, skills rehearsal.

Backed by patient safety reviews and cardiac arrest strategy.

Goal: Ensure every paramedic is ready regardless of experience/frequency.

Case 1: Pediatric respiratory case attended with only adult equipment.

Reflect on the potential trajectory of cases with reference to the balance of between taking all equipment vs minimising manual handling risk

Case 2: Chest rise/fall insufficient alone to assess ventilation.

Use waveform capnography early and consistently.

Case 3: CO₂ of 6mmHg was the only clue of incorrect tube placement in intubated asthma patient.

Always consider full clinical picture and question if data doesn’t make sense.

Paper of the month (14:46 – 20:55)

Parental Concern in Pediatric Deterioration

Asking "Are you worried your child is getting worse?" adds predictive value.

Parents who said “yes” had children:

• 4x more likely to go to ICU/be ventilated.
• More likely to be admitted or have longer stays.

Concern was a stronger predictor than abnormal vital signs.

Recommendation: Make carer concern an active, routine part of pediatric assessment.

Equipment Update (20:55 – 22:55)

New absorbent transfer sheet ("large bluey") improves:

• Patient hygiene and comfort.
• Paramedic safety.

Part of AV's broader equipment strategy under new Clinical Technology & Equipment Committee.

Professional Development: Postgraduate Study (22:55 – 24:59)

Encouragement for paramedics to pursue study outside paramedicine:

• Public health, digital health, systems leadership, etc.

Builds capability to:

• Lead teams, influence policy, improve care.
• Resource guide in show notes; feedback encouraged.

Small Steps to Transform Practice (24:59 – 26:42)

Ben’s tip: Don’t rely on chest rise alone—use capnography toassess ventilation.

James’s tip: Proactively ask parents if they’re worried their child is deteriorating.

Resources

Association between caregiver concern for clinicaldeterioration and critical illness in children presenting to hospital: a prospective cohort study https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00098-7/abstract

Clinical Technology andEquipment Committee

https://ambulancevic.sharepoint.com/sites/OneAV-resource-hub/_layouts/15/viewer.aspx?sourcedoc={1633f009-99d3-4d08-9805-d5fb409fec3b}

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 discuss the causes of ABD in younger patients, differences from adult presentations, principles of de-escalation, the role of sedation, and how to assess and manage risk.

Get in touch

⁠clinicalguidelines@ambulance.vic.gov.au⁠

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David: ⁠@expensivecare⁠ | @expensivecare.bsky.social

James: ⁠⁠⁠@JamesOz1⁠⁠ |

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