• Updates

•  Added comment on SASA's and CEO sign off

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

• Indications - Reworded to include younger persons
• Risk Assessment - prompt re determining likely cause
• Treatment - Added 12 Lead ECG

• Added statement: "Do not provide asynchronous ventilation"

• Incl. reference to Voluntary Assisted Dying

• Updated reference to SVT presentation & rates

• 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)

• Indications - reworded with key points highlighted
• Reinforced use in unstable pelvic injuries
• Consider distracting injuries

NEW CPG

• Transferred from pathophysiology section of Clinical Resources

• APGAR times updated

• Allow repeat dosages to achieve normal glycaemia.

• Added reference and images to Ducanto catheter (where avail)

• 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

• Added Reference to i-STAT
  

• Reworded indications
• Thresholds for ASMA
• Reinforced bilateral in traumatic arrest
• Reinforced use of Angio-Cath

• Indications - reworded to align with CPG
• Procedure - reworded to simplify and align with revised images
• Revised images to demonstrate correct placement

NEW Skill

• Updating of GCS table for patients <2 years

• Edited contra-indication

• NEW - Repeat doses included to align with ARC
• NEW - Note to advise incompatible with NaCl

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)

• Revised indication - contaminated wounds
• Updated reference image
• Revised dilution concentration (100mcg/ml)

• Included guidance - TXA administration should prompt transport to major trauma centre in Metropolitan area
• Clarity on infusion use

• Increase in MDI dosing to 4-12 for adults, 2-6 for paediatrics
• Addition of palpitations and headache under special considerations
• Minor wording changes

• 500mcg presentation added for CCP ONLY

• Allow repeat dosages to achieve normal glycaemia

• Introducing IN Naloxone for volunteers, as well as “Take Home Naloxone”

• 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

• Updated to version 6.0, moved to Clinical Resources from Connect

• Update to accommodate & standardise levels across various areas

• 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.

• Age <85 years is no longer a criteria for the STEMI inclusion criteria.

• Complete re-write of the Clinical Practice Guideline
• New flowchart for Clinical Practice Guideline

• New Clinical Practice Guideline

• New skill: Spinal assessment & associated Clinical Decision Rule flowchart

• Updated imagery to include FreeStyle Optium BGL Monitor
• Inclusion of preferred neonatal lancing site

• Removed all instances/references to the Phillips MRx

• Renamed to Oxygen Delivery
• Included 'nasal cannula' as method of delivery

• 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

• Removed volume of blood required per draw (in line with changes from PathWest)

• 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.
  

• New Clinical Skill to accommodate changes to Clinical Skill Matrix (primarily targeted at Event Health Services presentations)

• Removal of ages from Intranasal Administration chart, focusing on weight-based dosages only

• Clarified method of administration to Adult, Child & Neonate/Infant

• New management for crush injury for Critical Care & Special Operations Paramedics

• Contraindications updated for clarity (pertaining to Oral Wafer administration)

• New management for crush injury for Critical Care & Special Operations Paramedics

• New guideline, indicated for crush injury for Critical Care & Special Operations Paramedics

• New guideline, indicated for crush injury for Critical Care & Special Operations Paramedics

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.

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.