App Updates
Date Title Brief description
Search button
  • Made search accessible from home screen for mobile users both in-app and online.
Login button
  • Made login/profile button more accessible from Home Screen.
App Updates
  • Added the 'App Update' tracker and added applied changes retrospectively.
Web-app Capability
  • Adding to an "iOS Home Screen" will pre-populate with app title and icon, as well as removing standard Safari user interface (making it more 'app' like).
Medication Calculator
  • Updated Medication Calculator user experience (Adult / Paed) and brought Observations Table in-line with site styling.
Updates & Changes
  • Added 'Expand All' / 'Collapse All' buttons to Updates & Changes foor easier / more complete access/reading.
Medication Protocols (SASA)
  • Moved Dilution / Preparation from sidebar to main content, ensuring it will show in the main body just prior to Management (formerly in mobile mode, it would appear at the very bottom due to order of items).
  • Set tables to alternate background-colour by default, to make differentiating data in large tables easier.
  • Updated Templates (Clinical Practice Guidelines, Clinical Skills and Medication Protocols) to be more responsive to extra content.
  • Document Control template updated to be more in-line with site styling.
  • Applied icons to Templates to improve user experience in identifying sections.
  • Implemented 'modal' engine to allow for in-page, full-screen display of images & captions; first item: Eye injuries CPG.
  • Enabled CMS Forms widget, allowing collection of information such as broken links, suggested articles, etc. from credentialed staff
Metropolitan Operations
  • Enabled access for credentialed users to access "Metropolitan Operations" links, navigating to documents stored on Connect
Single Sign-On
  • Integrated CMS with SJWA single sign-on system to allow users to credential themselves as St John WA staff.
  • Updated accordion engine to transition smoothly in/out, improves user experience. Updated icons from +/- to arrows.
  • Improved Home Page user experience:
    • Updated images
    • Included thumbnails and controls
    • Created separate section for "Welcome to Clinical Resources" (and able to be closed/hidden)
    • Added links to Google Play / iOS App Store to St John Resources app
    • Sliders to showcase latest updates and changes
Extended Care
  • Provided an option to turn "Extended Care" sections on/off due to the increased burden of additional information to other scopes.
  • Made 'References' a part of all templates (moving from sidebar to main body), providing ability to turn the content block on/off.
Skills Matrix & Medication Schedule
  • Updated from simple coloured cells, to ✔ / ✘ to indicate whether skill/medication is within scope of practice.
  • Updated JS for easier editing by Clinical Services staff (applying background-color to cell based upon presence of ✔ / ✘).
Decision Tree
  • Implemented the 'Decision Tree' engine to allow for point-of-care decision-tree assist tools; first item: Sepsis
  • Added feature where anchors, when clicked, would highlight for brief period of time to bring readers attention to correct section.

Clinical Updates

SectionTitleDetails of Change
Updates and Changes
January 2024
  • Update table to reflect changes
Clinical Practice Guidelines
OverviewClinical Handover
  • Revised guideline introducing IMIST-AMBO for clinical handover between clinicians
OverviewDisability Awareness
  • NEW guideline 
OverviewUncomplicated wound pathway
  • Updated inclusion/exclusion criteria
  • Updated to include a recommendation for repeat of nebulised adrenaline at 15 minutes if no improvement in patient condition
CirculationCardiac Arrest - Adult
  • New section on persistent shockable rhythms (refractory VF/pVT)
  • New section on single responder resuscitation
  • New section on mechanical CPR
  • New section on CPR Induced Consciousness (CPRIC)
TraumaSpinal trauma
  • Inclusion of SPEED assessment
  • SPEED score of 1 or less being indicative of a need to divert to the relevant major trauma service (RPH or PCH) where clinically appropriate
ToxicologyPoisons and Overdoses
  • Updated guideline to include toxidromes
ToxicologyTricyclic Antidepressant Overdose
  • NEW guideline
ToxicologySerotonin toxicity
  • NEW guideline
ToxicologyAlcohol withdrawal
  • NEW guideline
  • Updates to consider use of anti-emetic
  • Addition of assessment of PIT bandage already applied prior to SJWA arrival for effectiveness
  • Updated to change any references to EpiPen® to the generic term "adrenaline auto-injector" noting availability of both EpiPen® and Anapen® within SJWA practice
EnvironmentalHeat stroke
  • Recommendation to consider anti-emetics
EnvironmentalRadiation exposure
  • Cyclic review updating introduction, clinical presentation, the importance of a risk assessment and PSO involvement
Clinical Skills
AssessmentSecondary and CNS survey
  • Remove recommendation to "spring" the pelvis during assessment
AssessmentSpinal assessment
  • Inclusion of SPEED assessment in addition to NEXUS assessment
AirwayLateral position
  • Reinforce the risks of leaving patients supine and why the lateral position is important
  • Contraindication: Patients in spinal precautions/with spinal considerations, use lateral trauma position instead
  • New section in Procedure - "Key Principles"
AirwayOropharyngeal airway
  • Added new patient factors/considerations
  • Introduction of refractory VF/VT management, primarily addition of vector change to anterior-posterior pad placement post 3 shocks.
    • Introduction of double sequential defibrillation for trained and specifically authorised clinicians only
CirculationPeripheral IV Access
  • Include references to J-Loop
  • Addition highlighting importance of cord clamping in cord rupture
TraumaCombat application tourniquet
  • Updates from State Trauma Service to include consultation with CSPSOC where transport times (or time from application of CAT to definitive care) will exceed 1 hour
  • Reference to new CAT application sticker to alert receiving facilities to CAT (sticker roll-out to follow guideline release)
TraumaTrauma bandages
  • NEW guideline
TraumaMinor wound management
  • NEW guideline
TraumaSlishman traction splint
  • NEW guideline for introduction of Slishman traction splint to SJWA practice
Medication Protocols
SASAAdrenaline Auto-injector
  • Inclusion of AnaPen® into St John WA clinical practice
  • Clarification of indication for aspirin administration
  • Addition to highlight poor activity against gram-negative bacilli
  • Additional contraindications
  • New precaution/note highlighting importance of early prophylactic antibiotic administration where surgical procedures are being performed
  • New indication in cardiac arrest where patient has not responded to maximal doses of Amiodarone (clinical exception required via CSP on scene or CSPSOC)
SASASuxamethonium Chloride
  • WITHDRAWN from practice
SASATranexamic acid
  • Removal of infusion route of administration


SectionTitleDetails of Change
  • Skills Matrix
  • Included reference to Paramedic Intern in reference table
Clinical Practice Guidelines

Determination of Death (TOR/ROLE)

  • Inserted wording reflecting a requirement to contact CSP and/or ASMA for termination of resus in patients with a PEA presenting with a narrow complex and/or a rate of 40 beats per minute or higher
CirculationIMPACT CPR
  • Wording change to include joules in standard language / phrasing of charging statement (eg., "charging to 200 joules, continue compressions")
Medication Protocols
Clinical Skills

Infection Prevention & Control
  • Reminder banner regarding mask wearing directive from Department of Health


SectionTitleDetails of Change
  • Fluarix Tetra moved from Interim Guidelines to Medications
  • Influenza Vaccination moved from Interim Guidelines to Skills - Medications
Clinical Practice Guidelines
  • Info
  • Info
Medication Protocols
  • Updated to 2023 influenza vaccine
Clinical Skills
  • Updated to 2023 influenza vaccine
Infection Prevention & Control
  • Info
  • Info


SectionTitleDetails of Change
GeneralClinical Distribution Matrix
  • Updated to reflect WA DoH Amendments
  • Updated interface to provide better access to information
Medication Protocols
SASAGlyceryl Trinitrate (GTN)
  • Two additional contraindications


SectionTitleDetails of Change
Updates and Changes
March 2023
  • Update table to reflect changes
Skills MatrixEye Washing and Irrigation
  • Updated scopes to align with updated skill
Clinical Practice Guidelines
OverviewRecognising and Responding to Acute Deterioration
  • Added action to consider sepsis for AMBER and RED escalation levels - no change to practice, trigger already exists in Sepsis guideline
OverviewPatient Charter
  • Updated in line with the second addition of the Australian Charter of Healthcare Rights
TraumaMajor Trauma Guidelines
  • The inclusion of a physiological parameter criteria for all age groups
  • The inclusion of an older adult guideline
  • Changed the heading "mechanism" to "High Risk Criteria" and used more descriptive terminology separated into patient cohorts
  • Changed the heading "Anatomical Citeria" to "Injury Criteria" and used more descriptive terminology
  • Changed the transport time from 20 minutes on a priority one to 45 minutes from a Major Trauma Centre driving under normal conditions
  • Includes a decision calculator and easy to follow flow charts
TraumaEye Injury
  • New guideline
  • Added further details around patient positioning and risk of mobilisation post Adrenaline administration.
CirculationCardiogenic Shock
  • Expanded clinical presentation, risk assessment and management
CirculationCardiac Arrest - Adult
  • Addition of option for 3 stacked shocks in paramedic witnessed arrest
CirculationCardiac Arrest - Paediatric
  • Removal of 30:2 ventilation option, all ventilation to be performed at 15:2 ratio
Clinical Skills
TraumaEye Washing & Irrigation
  • The inclusion of a general best practice principals for eye washing and irrigation
Vascular AccessPeripheral IV Access
  • Revised and updated to align with aseptic technique framework.
  • New additions:
    • PIVA score
    • DIVA score
    • Accidental arterial cannulation
    • Removal of PIVC
Vascular AccessIntraosseous Access
  • Updated and revised to align with aseptic technique framework
  • Minor wording changes to indication
  • Addition of contraindication “directly over, or distal to burns, cellulitis, infection or injury
  • Updates to patient factors and considerations 
Vascular AccessExternal Jugular


  • Updated and revised to align with aseptic technique framework
  • Updates to patient factors and considerations
  • New addition of PIVA score
  • New addition of removal of PIVC
Vascular AccessPre-hospital Blood Sample Collection



  • Updated and revised to align with aseptic technique framework
  • Update to contraindications - “where blood collection will delay lifesaving treatment”
Advanced Airway ManagementCricothyrotomy (vertical)


  • NEW Skill (for clinicians who has completed SJWA training in this skill and have the required equipment on hand)
    • Addition of vertical incision and move to size 6 ET tube.
    • Move to scalpel-finger-bougie technique.
Medication Protocols
SASAGlucose 10% (Intravenous)
  • Minor wording update to clarify dosing, no change to administration.
  • Updated presentation and administration for new dispersible tablet, no change to dosage or other practice
  • Changed the paediatric age group from 6-15 to 6-16 as it aligns with the ASMA requirement for this patient cohort
  • Halved the dose of Droperiol in combination with alcohol
Infection Prevention & Control
  • Removal of the requirement to wear face masks and eye protection for all patient contact


Medication Protocols
Infection Prevention and ControlInvasive group A streptococcus infection (iGAS)
  • New interim guideline 
  • New indication for CCPs: Ventricular fibrillation
  • New contraindication for CCPs: Cardiomyopathy
  • Special Considerations: Phlebitis
  • Contraindicated age changed from 12yo to 16yo
  • Contraindications to also include insulinoma & glucagonoma
  • Precautions: Instructions to administer complex carbohydrates to prevent recurrence
  • Updated management guidelines to focus on administration of IV glucose if able
  • Updated paediatric guidelines to focus on weight based dosages, not age-based.
SASAHeparin Sodium
  • Reworded / updated contraindication pertaining to active bleeding
  • Special Considerations: 2x new conditions; hyperkalaemia, thrombocytopenia
SASAMetaraminol Tartrate
  • 1x new indication, plus 2x additions / clarification to existing indications
  • 3x new precautions
SASAMorphine Sulphate
  • Indication changed from "Analgesia" to "Severe Pain"
  • Contraindication: Clarified hypersensitivity
  • New Contraindication: Renal impairment / failure
  • Precautions: Clarified dilution & dosing adjustments for elderly / frail
  • Management: Adjusted layout for clarity
SASAParacetamol (Acetaminophen)
  • Addition of IV Paracetamol for Critical Care Paramedics
  • Clarification of Paediatric dosing for clarity
SASASodium Bicarbonate
  • New Indication: Ventricular dysrhythmias post-Ropivacaine administration
SASARopivacaine 0.75%
  • New Medication Protocol for Critical Care Paramedics
GeneralSkills Matrix
  • Updated to reflect Critical Care skills
GeneralMedication Schedule
  • Updated to reflect Critical Care medications
NeurologicalStroke (Cerebrovascular Accident)
  • Introduced RACE Assessment tool


SectionTitleDetails of Change
Clinical Practice Guidelines
  • Consolidated into one document. Minor changes to the clinical management of patients to align with national guidance and existing CPGs recognising and responding to acute deterioration (use of NEWS2 and Early warning score) and sepsis.


SectionTitleDetails of Change
Clinical Practice Guidelines
NeurologicalDisturbed & Abnormal Behaviours
  • Comprehensive review and amendments
  • Introduction of Sedative Warnings
  • Crew Safety
  • Flowchart updates
  • Cross Services Terminology
Clinical Skills
ObstetricsPost-Partum Haemorrhage
  • Clarified Fundal Massage procedure
Medication Protocols
SASAOlanzapine ODT
  • Alignment to DAAB updates
  • Standardised age-related requirements
  • RASS Score update
  • Alignment to DAAB updates
  • Mental Health related practices
  • Atypical presentation management
  • Required ASMA Consults
  • Dosages Updated
  • Alignment to DAAB updates
  • Mental Health related practices
  • Polypharmacy interactions
  • Age-related requirements
  • ETOH interactions
  • Required ASMA Consults
  • Dosages Updated – including therapeutic range
  • Use in Non-Traumatic pain updates
  • ​​​​​​​Route of administration (for Sedation purposes)
  • Required ASMA Consults
SASAMagnesium Sulphate
  • New Medication Protocol
Infection Prevention & Control
Infection Prevention and ControlAseptic Technique
  • New document
Infection Prevention and ControlLaundering of Uniform
  • New document
Infection Prevention and ControlWaste Management
  • Renamed from Sharps Management
  • Expands / includes general clinical and sharps waste
Infection Prevention and ControlReprocessing of Reusable Equipment
  • Renamed from Cleaning of Reusable Equipment and Surfaces
  • Minor revisions
Infection Prevention and ControlLinen Management
  • New document
COVID-19COVID-19 Personal Protective Equipment
  • Step-down to surgical masks for all patient contacts
COVID-19COVID-19 Quick Reference Guide
  • Step-down to surgical masks for all patient contacts
COVID-19COVID-19 Clinical Response
  • Step-down to surgical masks for all patient contacts


SectionTitleDetails of Change
 Authority to Practice
  • Acting Chief Executive Officer
  • Acting Medical Executive Director
Clinical Practice Guidelines
CirculationAcute Cardiogenic Pulmonary Oedema
  • Management: Critical & Extended Care
CirculationAutonomic Dysreflexia
  • Management: Critical & Extended Care
CirculationChest Pain / Acute Coronary Syndrome
  • Management: Critical & Extended Care
Circulation > ShockHypovolemic Shock
  • Management: Critical & Extended Care
Circulation > ShockNeurogenic Shock
  • Management: Critical & Extended Care
  • Management: Critical & Extended Care
  • Management: Critical & Extended Care
Clinical Practice GuidelinesSepsis
  • Management: Critical & Extended Care
ToxicologyPoisons & Overdoses
  • Management: Critical & Extended Care
TraumaCrush Injury
  • Management: Critical & Extended Care
  • Management: Critical & Extended Care
TraumaTraumatic Brain Injury
  • Management: Critical & Extended Care
Clinical Skills
 Rapid Antigen Testing
  • Indications
Medication Protocols
  • New Protocol
 Glyceryl Trinitrate (GTN)
  • Infusion instructions for Critical Care Paramedics
 Hypertonic Saline 3%
  • New Protocol
  • New Protocol
  • New Protocol
Infection Prevention & Control
Infection Prevention and ControlMonkeypox
  • New interim guideline
Infection Prevention and ControlCOVID-19 Clinical Response
  • Updated to blue state-wide alert level
  • Updated signs and symptoms


SectionTitleDetails of Change
Clinical Practice Guidelines
GeneralVirtual Emergency Medicine
  • Added RGH, and PTS crews
Interim guidelineInfluenza vaccination
  • New CPG
Interim guidelineFluarix Tetra
  • New CPG


SectionTitleDetails of Change
Clinical Practice Guidelines
TraumaBurn Trauma
  • Changes to fluid regime, addition of debridement, minor wording changes 
ObstetricsShoulder Dystocia
  • Wording changes and clarification
ObstetricsPostpartum haemorrhage
  • Wording changes and clarification
ObstetricsPreterm Labour and Birth
  • Wording changes and clarification
ObstetricsPre-eclampsia and eclampsia
  • Wording changes and clarification
ObstetricsNormal birth
  • Wording changes and clarification
ObstetricsHaemorrhage during pregnancy/antepartum haemorrhage
  • Wording changes and clarification/title change
ObstetricsEctopic Pregnancy
  • New CPG
ObstetricsEarly pregnancy bleeding
  • New CPG
ObstetricsManagement of Obstetrics emergencies
  • Wording changes and clarification
Medication Protocols
MedicationsNormal Saline
  • Change of fluid regime to match Burns Trauma CPG
  • Third-degree atrioventricular (AV) block moved to precaution, removed from contraindication
Infection Prevention & Control
Infection Prevention and ControlVehicle Cleaning and Spills Management
  • Replaces WORKPLACE INSTRUCTION (WIAMB 23) Operational Vehicle Cleaning.
  • Content restructured.
  • Reduction in the time a vehicle is required to air – this has been reduced from 30 minutes to 15 minutes (for droplet/airborne precautions).
  • Addition of a “hot swap” clean section.


SectionTitleDetails of Change
 Authority to Practice


  • Ambulance Officers (AO)
  • Ambulance Transport Medics (ATM)
  • Event Ambulance Officer (EAO) reference
 Medications Matrix


  • Ambulance Officer scope
  • Ambulance Transport Medic scope
  • Event Ambulance Officer (EAO) reference
 Patient not Transported (PnT)

Include reference to paediatric patients

 Skills Matrix


  • Ambulance Officer scope
  • Ambulance Transport Medic scope
  • Event Ambulance Officer (EAO) reference
 Suspected AbuseNew CPG
  Falls Prevention GuidelineNew CPG
Clinical Practice Guidelines
OverviewPatient AssessmentReference made to calculating an Early Warning Score (EWS) under Vital Signs
OverviewRecognising and Responding to Acute Deterioration New CPG
MetabolicRenal Dialysis EmergenciesAlign with new sepsis guideline (refers to Septic shock CPG in additional information)
Circulation: ShockSepsisNew CPG
RespiratoryTracheostomy / Laryngectomy Airway EmergenciesNew CPG
Clinical Skills
AirwayAdvanced Airway Management

Various Updates:

  • Removed reference to laryngeal mask airway (LMA)
  • ETI de-emphasised
  • Ventilation rewording
AirwayBasic Airway ManagementChange Basic to “Essential”
BreathingBag Valve Mask Ventilation
  • Oxygenation with SMART BVM
  • SpO2 monitoring included for breathing patients
Advanced Airway ManagementCricothyrotomy


  • Include use of Bougie
  • Subtle rewording in Introduction section to include word 'oxygenation'.
  • Procedure Section - included reference to Bougie and amended the instruction to include bougie facilitated placement and new reference to include EtCO2 monitoring
Advanced Airway ManagementEndotracheal Intubation (ETI)


  • Introduction - reworded and removed references to gold standard.
  • Removed support for Kiwi grip
Advanced Airway ManagementFailed intubation drill
  • Remove reference to classic LMA
  • Minor wording updates
Advanced Airway ManagementSupraglottic Airway (SGA)Spelling fixed
Advanced Airway ManagementSuction - TracheostomyNew CPG
AirwaySuctionHyperlink to new Tracheostomy Suction skill
AirwayNasopharyngeal Airway (NPA)Change Basic to "Essential"
Supporting Resources
 NEWS 2 Online CalculatorSupporting resource for new CPG
 NEWS 2 QRG ParamedicSupporting resource for new CPG
 NEWS 2 QRG EHSSupporting resource for new CPG
 NEWS 2 QRG PTS/VolunteerSupporting resource for new CPG
 NEWS 2 Scoring chartSupporting resource for new CPG
 Sepsis Decision TreeSupporting resource for new CPG
Medication Protocols
 Atropine Sulphate Remove erroneous line in Introduction section - removed reference to presentation


  • Precautions to give greater direction around EMT scope + hyperlink to existing Connect article
  • Inclusion of doses in Management section for IN Nyxoid® sprays
  • Inclusion of dispensing doses/qualities under Special THN section
 NoradrenalineAlign with new sepsis guideline - Indications updated: "Primarily distributive shock such as septic shock, neurogenic shock, drug-induced"
 Tranexamic AcidIndications Updated: Post Tonsillectomy Bleed, PPH
 Distributive ShockAlign with new sepsis guideline


SectionTitleDetails of Change
Clinical Skills (07/02/2022)
  • Clarified wording around COVID-19 / Febrile Respiratory Illness precautions/advice and favouring MDI+Spacer over nebuliser unless patient condition requires
Clinical Skills (10/02/2022)
AssessmentRapid Antigen Testing
  • NEW skill
COVID-19 Interim Guidelines
 Quick Reference Guide
  • Include links to new guidelines as relevant
 Clinical Response
  • New Guideline
 Patient Clinical Management
  • New Guideline
 Personal Protective Equipment
 Patient not Transported (PnT)


SectionTitleDetails of Change

Clinical Practice Guidelines
  • Emphasis on left lateral position for pregnant patients
Clinical Skills
BreathingOxygen Delivery
  • Added COVID-19 / Febrile Respiratory Illness information
  • Added COVID-19 / Febrile Respiratory Illness information
Medication Protocols
  • Clarified precaution around walking patients post adrenaline administration
  • Aligned anaphylaxis dose for pregnant females with normal adult doses per ASCIA guidelines and Anaphylaxis Critical Care standard
  • Minor wording changes
 Glyceryl Trinitrate (GTN)
  • Clarified contraindication around erectile dysfunction medications
  • Added COVID-19 / Febrile Respiratory Illness information
  • Minor wording changes
 Ipratropium Bromide
  • Dose change for Adult MDI from 12 puffs to 8 puffs
  • Added COVID-19 / Febrile Respiratory Illness information
  • Minor wording changes
  • Added COVID-19 / Febrile Respiratory Illness information
 Salbutamol Sulphate
  • Added COVID-19 / Febrile Respiratory Illness information
  • Minor wording changes
COVID-19 Interim Guidelines
 Graded Assessment and Approach
  • Withdrawn, replaced with new Quick Reference Guide
 Quick Reference Guide
  • New guideline
 Personal Protective Equipment
  • New design to make accessing content easier for operational staff
 Medications and skills
  • Medications and skills affected by Interim Guideline advice has been moved to the respective primary medication or skill page to reduce the number of places to find information (see items above)


SectionTitleDetails of Change
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.

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
MetabolicAdrenal Insufficiency


  • Transferred from pathophysiology section of Clinical Resources
  • APGAR times updated
  • Allow repeat dosages to achieve normal glycaemia.
Clinical Skills
  • 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
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
  • NEW - Repeat doses included to align with ARC
  • NEW - Note to advise incompatible with NaCl
 DroperidolNEW medicine (Paramedic)

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

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)
  • 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
  • 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
 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
 NaloxoneNew contraindication, update in precautions & dosages 
 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
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
  • 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
  • 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
  • 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
  • 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


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


  • 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


  • 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.


  • 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
    Clinical Practice Guidelines
    Clinical Skills
    Medication Protocols
    Infection Prevention & Control


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