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 Practice Guidelines
Clinical Skills
AssessmentRapid Antigen Testing
  • NEW skill
Medication Protocols
Infection Prevention & Control
COVID-19 Interim Guidelines


SectionTitleDetails of Change

Clinical Practice Guidelines
Clinical Skills
  • Clarified wording around COVID-19 / Febrile Respiratory Illness precautions/advice and favouring MDI+Spacer over nebuliser unless patient condition requires
Medication Protocols
Infection Prevention & Control
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


    St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

    Privacy Policy | Copyright Statement & Disclaimer