UNCONTROLLED WHEN PRINTED
SectionTitleDetails of Change
General
GeneralVoluntary Assisted DyingNEW guidance
GeneralVirtual Emergency MedicineNEW guidance
GeneralSkills and Medications Matrices
  • Updates
GeneralAuthority to Practice
  •  Added comment on SASA's and CEO sign off
Clinical Practice Guidelines
NeurologicalDisturbed & Abnormal Behaviour

Comprehensive Review of CPG including;

  • Terminology
  • NEW Sedation scale added (RASS)
  • Risks - positional asphyxia / air hunger
  • Mandatory agreement - estimated pt weight
  • Mandatory agreement - need for sedation / agent choice
  • Mandatory monitoring - Pulse oximetry and end tidal
  • NEW visual aide on agent choice for presentation
  • NEW sedation agents added Olanzapine (OLZ) & Droperidol (DRO)
  • Reviewed indications for Midazolam (MDZ) and Ketamine (KET)
  • NEW Monitoring requirements incl. pulse oximetry and end tidal
NeurologicalTransient Loss of Consciousness (Syncope)
  • Indications - Reworded to include younger persons
  • Risk Assessment - prompt re determining likely cause
  • Treatment - Added 12 Lead ECG
CirculationCardiac Arrest - Paediatric
  • Added statement: "Do not provide asynchronous ventilation"
CirculationDetermination of Death (ROLE/TOR)
  • Incl. reference to Voluntary Assisted Dying
CirculationCardiac Dysrhythmia
  • Updated reference to SVT presentation & rates
CirculationChest Pain/Acute Coronary Syndrome
  • Risk assessment regarding low threshold for ECGs/ repeat ECG's.
TraumaPneumothorax

Comprehensive Review of CPG including;

  • Revised introduction
  • Clinical features now tabular for ease of reference
  • Revised risk assessment section
  • Revised advanced care section

Review intended to align with ILCOR and FPHC (RCSEd)

TraumaPelvic Trauma
  • Indications - reworded with key points highlighted
  • Reinforced use in unstable pelvic injuries
  • Consider distracting injuries
TraumaRapid Sequence / Delayed Sequence InductionNEW CPG - CCP
TraumaVAPOXNEW CPG - CCP
MetabolicAdrenal Insufficiency

NEW CPG

  • Transferred from pathophysiology section of Clinical Resources
ObstetricsChildbirth
  • APGAR times updated
MetabolicHypoglycaemia
  • Allow repeat dosages to achieve normal glycaemia.
Clinical Skills
AirwaySuction
  • Added reference and images to Ducanto catheter (where avail)
BreathingBag Valve Mask
  • Statement: AMBU vs SMART BVM transition
  • Updated indication for end tidal CO2 regardless of adjunct
  • Included bacterial filter requirement
  • Expanded guidance for asynchronous ventilation timing
  • Included reference to Smart-Bag BVM flow restrictor and timing light
  • Updated images to reflect SMART BVM only
Breathing
Non-Invasive Ventilation
  • Added Reference to i-STAT
BreathingEnd Tidal CO2 Waveform CapnographyNEW Skill
TraumaNeedle Thoracocentesis
  • Reworded indications
  • Thresholds for ASMA
  • Reinforced bilateral in traumatic arrest
  • Reinforced use of Angio-Cath
TraumaPelvic Splints
  • Indications - reworded to align with CPG
  • Procedure - reworded to simplify and align with revised images
  • Revised images to demonstrate correct placement
TraumaUnconscious Lateral Trauma Position

NEW Skill

AssessmentGlasgow Coma Scale
  • Updating of GCS table for patients <2 years
Medication Protocols
 Adrenaline Auto-Injector (EpiPen®)
  • Edited contra-indication
 Amiodarone
  • NEW - Repeat doses included to align with ARC
  • NEW - Note to advise incompatible with NaCl
 DroperidolNEW medicine (Paramedic)
 Ketamine

Comprehensive Review of CPG including;

  • Indications - added IM first line severely agitated (RASS 4)
  • Removed - active psychiatric unless MDZ already given
  • NEW wording-  rapid tranquilisation RASS 4 (sedation)
  • NEW dosing for rapid tranquilisation - 4mg/kg ideal body weight
  • NEW <16 years or RASS <4 prompts ASMA consult for rapid tranquilisation
 Midazolam

Comprehensive Review of CPG including;

  • Removed - First line agent for sedation
  • Removed - IM for sedation
  • NEW - Second line agent for IV maintenance of sedation
  • CCP indication reworded
  • NEW - <16 years prompts ASMA consult (sedation)
  • MDZ after KET requires ASMA consult
  • Seizures separated from sedation 
  • NEW - Maintenance of sedation (IV only) & revised dosing
  • Removed preparation into 10 ml syringe
  • NEW - Only prepare in 20 ml labelled syringe (15mg/15ml)
 OlanzapineNEW medicine (Paramedic)
 Cephazolin
  • Revised indication - contaminated wounds
  • Updated reference image
  • Revised dilution concentration (100mcg/ml)
 NoradrenalineNEW medicine (CCP)
 Tranexamic Acid
  • Included guidance - TXA administration should prompt transport to major trauma centre in Metropolitan area
  • Clarity on infusion use
 Midazolam & Morphine NEW medicine - re-filled syringe (CCP)
 Salbutamol Sulphate
  • Increase in MDI dosing to 4-12 for adults, 2-6 for paediatrics
  • Addition of palpitations and headache under special considerations
  • Minor wording changes
 Fentanyl 500 micrograms
  • 500mcg presentation added for CCP ONLY
 Glucose 10%
  • Allow repeat dosages to achieve normal glycaemia
 Naloxone
  • Introducing IN Naloxone for volunteers, as well as “Take Home Naloxone”
Infection Prevention & Control
 Standard and Transmission Based Precautions
  • Clarification on PPE requirements for OHCA and on aerosol generating behaviours
  • Updated to reflect the use of P2/N95 respirators for both droplet and airborne precaution
SectionTitleDetails of Change
General
 Skill MatrixClarified EMR/EMA roles; merged EHS volunteer roles
GeneralPatient Not TransportedMinor improvement to VIRCA criteria (to address Patient Capacity & Consent)
Clinical Practice Guidelines
 AnaphylaxisWording & definition from ASCIA
TraumaBurn TraumaCCP Only: MEQU Blood & Fluid Warmer
OverviewClinical HandoverNew guideline
TraumaHaemorrhageCCP Only: MEQU Blood & Fluid Warmer
EnvironmentalHypothermiaCCP Only: MEQU Blood & Fluid Warmer
OverviewInterfacility TransfersSignificant improvement
OverviewPatient Capacity & ConsentSignificant improvement & Capacity Assessment Tool
TraumaPelvic TraumaClarity of indications & risk assessment
OverviewRelief of PainAddressing ramped patients
TraumaSpinal TraumaClarity of what 'spinal precautions' entails; inclusion of thoracic & lumbar spine
Clinical Skills
AirwayForeign Body Airway ObstructionInclusion of Laryngoscope/Magill Forceps for paramedics
MedicationsMEQU Fluid & Blood WarmerNew CCP Skill
BreathingNon-invasive Positive Pressure VentilationNew CCP Skill
CirculationPressure Immobilisation Technique (P.I.T)Inclusion of new snakebite bandage
TraumaPelvic SplintsNew indication, inclusive of Pelvic Binder decision tool
Medication Protocols
 CophenylcaineMaximum dosages not to be repeated within 24 hours
 FentanylCautious use in ramped patients
 HydrocortisoneNew Medication Protocol
 KetamineCautious use in ramped patients
 Packed Red Blood CellsCCP Only: MEQU Blood & Fluid Warmer
 Intravenous Crystalloid Solutions (Normal Saline)CCP Only: MEQU Blood & Fluid Warmer
Infection Prevention & Control
 COVID-19Moved from Connect to Clinical Resources

 

SectionTitleDetails of Change
General
GeneralPatient Care Record Completion
  • Updated to version 6.0, moved to Clinical Resources from Connect
GeneralSkills Matrix
  • Update to accommodate & standardise levels across various areas
Clinical Practice Guidelines
NeurologicalStroke (cerebrovascular accident)
  • Time of symptom onset extended to < 9 hours
  • Wake-up Stroke: If the patient has woken with stroke symptoms but was asymptomatic prior to sleeping, time starts from waking up.
  • Transient Ischaemic Attack (TIA); transport to an Acute Stroke Centre, under normal road conditions.
  • Destination; Joondalup Health Campus is now a destination for FAST+ patients with RACE ≤4.
CirculationChest Pain / Acute Coronary Syndrome
  • Age <85 years is no longer a criteria for the STEMI inclusion criteria.
TraumaSpinal Trauma
  • Complete re-write of the Clinical Practice Guideline
  • New flowchart for Clinical Practice Guideline
TraumaCrush Injury
  • New Clinical Practice Guideline
Clinical Skills
AssessmentSpinal assessment
  • New skill: Spinal assessment & associated Clinical Decision Rule flowchart
AssessmentBlood Glucose Monitor
  • Updated imagery to include FreeStyle Optium BGL Monitor
  • Inclusion of preferred neonatal lancing site
AssessmentElectrocardiography
  • Removed all instances/references to the Phillips MRx
BreathingOxygen Masks
  • Renamed to Oxygen Delivery
  • Included 'nasal cannula' as method of delivery
CirculationPressure Immobilisation Technique (P.I.T)
  • In accordance with Australian Resuscitation Council, included the line:
    The bandage should be firm and tight, you should be unable to easily slide a finger between the bandage and the skin
CirculationDefibrillation
  • Removed all instances/references to the Phillips MRx
Vascular AccessPrehospital Blood Sample Collection
  • Removed volume of blood required per draw (in line with changes from PathWest)
Vascular AccessIntraosseous Access
  • Updated, higher resolution imagery
  • Studies show that the humeral IO route is comparable to central venous drug delivery during CPR and should be selected in most non-paediatric cases. The tibial route is less effective and is de-emphisised.
  • Additional information pertaining to the battery indicator, depth markers and manual insertion of the EZIO trocar.
TraumaMinor Wounds
  • New Clinical Skill to accommodate changes to Clinical Skill Matrix (primarily targeted at Event Health Services presentations)
Medication Protocols
 Fentanyl
  • Removal of ages from Intranasal Administration chart, focusing on weight-based dosages only
 Glucose Oral Gel
  • Clarified method of administration to Adult, Child & Neonate/Infant
 Intravenous Crystalloid Solutions (Normal Saline)
  • New management for crush injury for Critical Care & Special Operations Paramedics
 Ketamine
  • Contraindications updated for clarity (pertaining to Oral Wafer administration)
 Salbutamol Sulphate
  • New management for crush injury for Critical Care & Special Operations Paramedics
 Sodium Bicarbonate
  • New guideline, indicated for crush injury for Critical Care & Special Operations Paramedics
 Calcium Gluconate
  • New guideline, indicated for crush injury for Critical Care & Special Operations Paramedics
Infection Prevention & Control
   

 

New Guidelines/Skills

SectionSubsection TitleOverview
Clinical Practice GuidelinesCirculation Autonomic Dysreflexia A new CPG that details the background, clinical presentation and management of Autonomic Dysreflexia
Clinical SkillsTraumaQuikClot Combat Gauze New skill for Clinical Support and Critical Care Paramedics

 

Infection Prevention & Control Guidelines

Title Overview
Standard & Transmission Based PrecautionsIncorporates the lessons learned from COVID-19 into standard practice with respect to transmission based precautions, aerosol generating procedures and PPE requirements.
Personal Protective Equipment (PPE)

 

Clinical Practice Guidelines - Paramedic Management

Section UpdatedDetails of Change
Circulation Chest Pain / Acute Coronary Syndrome STEMI Protocol flow chart – Expanded the Inclusion criteria to advocate for older patients on a case by case basis.
Trauma Pneumothorax

Pneumothorax
Changes:

  • Removed – Indication: Needle thoracocentesis no longer indicated for asthma

Changes:

  • Removed – Indication: Needle thoracocentesis no longer indicated for asthma
  • Removed – Contraindication: Major traumatic injuries incompatible with life, such as:
    • Decapitation, incineration, evisceration of brain or thoracic organs
    • Hemicorporectomy or trans-lumbar amputation.
    • Cardiac arrest with no ROSC > 20 minutes 
  • More detail in ‘Description’
  • Indication simplified to: Decompression for suspected pneumothorax in: Patients with suspected tension pneumothorax with severe respiratory and/or haemodynamic compromise.
  • Updated clinical Signs and symptoms
  • Unilateral or bilateral decompression supported
  • SMART acronym introduced in management
  • Precautions – addition of advice regarding high risk of blood/body fluid exposure.

 

Clinical Practice Guidelines - Volunteer Management

Section UpdatedDetails of Change
Circulation Chest Pain / Acute Coronary Syndrome

Description

  • Generally reworded to align with paramedic CPG including ‘exertion’ as being notable, and shortness of breath without chest pain. Symptoms bullet pointed for ease of reference.

Indications

  • Added line: shortness of breath without focus.

Information Needed –

  • Pain – Restructured to a SOCRATES format from a previously unstructured list.
  • Minor rewording.

    Management –

    • AIRWAY – removed reference to placement of adjuncts (covered in airway skills or unconscious or cardiac arrest CPG).
    • BREATHING – removed reference to ventilation (refer to ventilation skill or cardiac arrest CPG).
    • BASIC TREATMENT – Oxygen – expanded.
    • MANAGEMENT – added Consent. Reworded ‘cardiac monitor’ to ‘ECG’. Added reference to 12-lead ECG. Replaced ‘Administer’ to ‘Consider’ for medicines.
    • TRANSPORT – Added ‘Consider’ to P1 drive. Added ‘safely’.
    • Added caution and vigilance for Cardiac Arrest.
    • Precautions / Notes – Merged, reworded and re-ordered. Added 12 lead. No other major changes
    • Critical points for PCRF – replaced ‘Arrhythmia’ with ‘Dysrhythmia’. Added shortness of breath.
      Flowchart – general rewording to align with above changes in document.

     

    Medication Protocols

    TitleDetails of Change
    Atropine Sulphate An added scope for Special Operations Paramedics, authorising the sequential doubling of atropine dosages for the management of organophosphate poisoning
    Fentanyl Presentation of intranasal fentanyl has been adjusted to reflect the recent change to 450mcg in 1.5mL
    Glucagon Rewording the indications for Glucagon for clarity
    IV Glucose 10% Rewording the indications for IV glucose for clarity.
    Glyceryl Trinitrate (GTN) Indications – Added Autonomic Dysreflexia
    Management – Added dosage for management of Autonomic Dysreflexia (0.4mg (1 spray) sublingually. Repeat doses at 5 minute intervals until symptoms resolve or systolic BP < 160mmHg.)
    Ketamine Added Ketamine 25mg Sublingual Wafer (Wafermine)

     

    Clinical Skills

    TitleDetails of Change
    Needle Thoracocentesis Indications updated permitting procedure to be performed by Critical Care, Clinical Support and Special Operations Paramedics
    Spinal Immobilisation Wording added to precautions to reduce emphasis on rolling of the patient

     


    SectionTitleDetails of Change
    General
       
    Clinical Practice Guidelines
      
    Clinical Skills
       
    Medication Protocols
       
    Infection Prevention & Control
       

     


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