Updates:

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

Updates:

• Ambulance Officer scope
• Ambulance Transport Medic scope
• Event Ambulance Officer (EAO) reference

Include reference to paediatric patients

Updates:

• Ambulance Officer scope
• Ambulance Transport Medic scope
• Event Ambulance Officer (EAO) reference

Various Updates:

• Removed reference to laryngeal mask airway (LMA)
• ETI de-emphasised
• Ventilation rewording

• Oxygenation with SMART BVM
• SpO2 monitoring included for breathing patients

Updates:

• 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

Updates:

• Introduction - reworded and removed references to gold standard.
• Removed support for Kiwi grip

• Remove reference to classic LMA
• Minor wording updates

Updates:

• 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

• NEW skill

• Clarified wording around COVID-19 / Febrile Respiratory Illness precautions/advice and favouring MDI+Spacer over nebuliser unless patient condition requires

• Include links to new guidelines as relevant

• New Guideline

• New Guideline

• Removed "Changes" block as now reflected in Clinical Response page

• Withdrawn, replaced by guidance on the Patient Clinical Management page

• Emphasis on left lateral position for pregnant patients

• Added COVID-19 / Febrile Respiratory Illness information

• Added COVID-19 / Febrile Respiratory Illness information
  

• 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

• Clarified contraindication around erectile dysfunction medications
• Added COVID-19 / Febrile Respiratory Illness information
• Minor wording changes

• 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

• Added COVID-19 / Febrile Respiratory Illness information
  
• Minor wording changes

• Withdrawn, replaced with new Quick Reference Guide

• New guideline

• New design to make accessing content easier for operational staff

• 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)

• 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.