Updates & Changes

UNCONTROLLED WHEN PRINTED

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).
	Tables	Set tables to alternate background-colour by default, to make differentiating data in large tables easier.
	Templates	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.
	Icons	Applied icons to Templates to improve user experience in identifying sections.
	Modals	Implemented 'modal' engine to allow for in-page, full-screen display of images & captions; first item: Eye injuries CPG.
	Forms	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.
	Accordion	Updated accordion engine to transition smoothly in/out, improves user experience. Updated icons from +/- to arrows.
	Home	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.
	References	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
	anchorlight.js	Added feature where anchors, when clicked, would highlight for brief period of time to bring readers attention to correct section.
	Location

Clinical Updates

Section	Title	Details of Change
General
Updates and Changes	January 2024	Update table to reflect changes
Clinical Practice Guidelines
Overview	Clinical Handover	Revised guideline introducing IMIST-AMBO for clinical handover between clinicians
Overview	Disability Awareness	NEW guideline
Overview	Uncomplicated wound pathway	Updated inclusion/exclusion criteria
Respiratory	Croup	Updated to include a recommendation for repeat of nebulised adrenaline at 15 minutes if no improvement in patient condition
Circulation	Cardiac 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)
Trauma	Spinal 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
Toxicology	Poisons and Overdoses	Updated guideline to include toxidromes
Toxicology	Tricyclic Antidepressant Overdose	NEW guideline
Toxicology	Serotonin toxicity	NEW guideline
Toxicology	Alcohol withdrawal	NEW guideline
Toxicology	Snakebite	Updates to consider use of anti-emetic Addition of assessment of PIT bandage already applied prior to SJWA arrival for effectiveness
	Anaphylaxis	Updated to change any references to EpiPen® to the generic term "adrenaline auto-injector" noting availability of both EpiPen® and Anapen® within SJWA practice
Environmental	Heat stroke	Recommendation to consider anti-emetics
Environmental	Radiation exposure	Cyclic review updating introduction, clinical presentation, the importance of a risk assessment and PSO involvement
Clinical Skills
Assessment	Secondary and CNS survey	Remove recommendation to "spring" the pelvis during assessment
Assessment	Spinal assessment	Inclusion of SPEED assessment in addition to NEXUS assessment
Airway	Lateral 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"
Airway	Oropharyngeal airway	Added new patient factors/considerations
Circulation	Defibrillation	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
Circulation	Peripheral IV Access	Include references to J-Loop
Obstetrics	Childbirth	Addition highlighting importance of cord clamping in cord rupture
Trauma	Combat 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)
Trauma	Trauma bandages	NEW guideline
Trauma	Minor wound management	NEW guideline
Trauma	Slishman traction splint	NEW guideline for introduction of Slishman traction splint to SJWA practice
Medication Protocols
SASA	Adrenaline Auto-injector	Inclusion of AnaPen® into St John WA clinical practice
SASA	Aspirin	Clarification of indication for aspirin administration
SASA	Cefazolin	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
SASA	Lignocaine	New indication in cardiac arrest where patient has not responded to maximal doses of Amiodarone (clinical exception required via CSP on scene or CSPSOC)
SASA	Suxamethonium Chloride	WITHDRAWN from practice
SASA	Tranexamic acid	Removal of infusion route of administration

Section	Title	Details of Change
General
General	Skills Matrix	Included reference to Paramedic Intern in reference table
Clinical Practice Guidelines
Circulation	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
Circulation	IMPACT 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
	COVID-19	Reminder banner regarding mask wearing directive from Department of Health

Section	Title	Details of Change
General
General	Fluarix Tetra Influenza Vaccination	Fluarix Tetra moved from Interim Guidelines to Medications Influenza Vaccination moved from Interim Guidelines to Skills - Medications
Clinical Practice Guidelines
SASA	Info	Info
Medication Protocols
SASA	Fluarix Tetra	Updated to 2023 influenza vaccine
Clinical Skills
SASA	Influenza Vaccination	Updated to 2023 influenza vaccine
Infection Prevention & Control
SASA	Info	Info

Section	Title	Details of Change
General
General	Clinical Distribution Matrix	Updated to reflect WA DoH Amendments Updated interface to provide better access to information
Medication Protocols
SASA	Glyceryl Trinitrate (GTN)	Two additional contraindications

Section	Title	Details of Change
General
Updates and Changes	March 2023	Update table to reflect changes
Skills Matrix	Eye Washing and Irrigation	Updated scopes to align with updated skill
Clinical Practice Guidelines
Overview	Recognising 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
Overview	Patient Charter	Updated in line with the second addition of the Australian Charter of Healthcare Rights
Trauma	Major 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
Trauma	Eye Injury	New guideline
	Anaphylaxis	Added further details around patient positioning and risk of mobilisation post Adrenaline administration.
Circulation	Cardiogenic Shock	Expanded clinical presentation, risk assessment and management
Circulation	Cardiac Arrest - Adult	Addition of option for 3 stacked shocks in paramedic witnessed arrest
Circulation	Cardiac Arrest - Paediatric	Removal of 30:2 ventilation option, all ventilation to be performed at 15:2 ratio
Clinical Skills
Trauma	Eye Washing & Irrigation	The inclusion of a general best practice principals for eye washing and irrigation
Vascular Access	Peripheral IV Access	Revised and updated to align with aseptic technique framework. New additions: PIVA score DIVA score Accidental arterial cannulation Removal of PIVC
Vascular Access	Intraosseous 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 Access	External 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 Access	Pre-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 Management	Cricothyrotomy (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
SASA	Glucose 10% (Intravenous)	Minor wording update to clarify dosing, no change to administration.
SASA	Aspirin	Updated presentation and administration for new dispersible tablet, no change to dosage or other practice
SASA	Droperidol	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
COVID	COVID-19	Removal of the requirement to wear face masks and eye protection for all patient contact

Medication Protocols
Infection Prevention and Control	Invasive group A streptococcus infection (iGAS)	New interim guideline
SASA	Amiodarone	New indication for CCPs: Ventricular fibrillation New contraindication for CCPs: Cardiomyopathy Special Considerations: Phlebitis
SASA	Aspirin	Contraindicated age changed from 12yo to 16yo
SASA	Glucagon	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.
SASA	Heparin Sodium	Reworded / updated contraindication pertaining to active bleeding Special Considerations: 2x new conditions; hyperkalaemia, thrombocytopenia
SASA	Metaraminol Tartrate	1x new indication, plus 2x additions / clarification to existing indications 3x new precautions
SASA	Morphine 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
SASA	Paracetamol (Acetaminophen)	Addition of IV Paracetamol for Critical Care Paramedics Clarification of Paediatric dosing for clarity
SASA	Sodium Bicarbonate	New Indication: Ventricular dysrhythmias post-Ropivacaine administration
SASA	Ropivacaine 0.75%	New Medication Protocol for Critical Care Paramedics
General	Skills Matrix	Updated to reflect Critical Care skills
General	Medication Schedule	Updated to reflect Critical Care medications
Neurological	Stroke (Cerebrovascular Accident)	Introduced RACE Assessment tool

Section	Title	Details of Change
Clinical Practice Guidelines
COVID-19	COVID-19	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.

Section	Title	Details of Change
Clinical Practice Guidelines
Neurological	Disturbed & Abnormal Behaviours	Comprehensive review and amendments Introduction of Sedative Warnings Crew Safety Flowchart updates Cross Services Terminology
Clinical Skills
Obstetrics	Post-Partum Haemorrhage	Clarified Fundal Massage procedure
Medication Protocols
SASA	Olanzapine ODT	Alignment to DAAB updates Standardised age-related requirements RASS Score update
SASA	Droperidol	Alignment to DAAB updates Mental Health related practices Atypical presentation management Required ASMA Consults Dosages Updated
SASA	Ketamine	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
SASA	Midazolam	Route of administration (for Sedation purposes) Required ASMA Consults
SASA	Magnesium Sulphate	New Medication Protocol
Infection Prevention & Control
Infection Prevention and Control	Aseptic Technique	New document
Infection Prevention and Control	Laundering of Uniform	New document
Infection Prevention and Control	Waste Management	Renamed from Sharps Management Expands / includes general clinical and sharps waste
Infection Prevention and Control	Reprocessing of Reusable Equipment	Renamed from Cleaning of Reusable Equipment and Surfaces Minor revisions
Infection Prevention and Control	Linen Management	New document
COVID-19	COVID-19 Personal Protective Equipment	Step-down to surgical masks for all patient contacts
COVID-19	COVID-19 Quick Reference Guide	Step-down to surgical masks for all patient contacts
COVID-19	COVID-19 Clinical Response	Step-down to surgical masks for all patient contacts

Section	Title	Details of Change
General
	Authority to Practice	Acting Chief Executive Officer Acting Medical Executive Director
Clinical Practice Guidelines
Circulation	Acute Cardiogenic Pulmonary Oedema	Management: Critical & Extended Care
Circulation	Autonomic Dysreflexia	Management: Critical & Extended Care
Circulation	Chest Pain / Acute Coronary Syndrome	Management: Critical & Extended Care
Circulation > Shock	Hypovolemic Shock	Management: Critical & Extended Care
Circulation > Shock	Neurogenic Shock	Management: Critical & Extended Care
Metabolic	Hyperglycaemia	Management: Critical & Extended Care
Neurological	Seizures	Management: Critical & Extended Care
Clinical Practice Guidelines	Sepsis	Management: Critical & Extended Care
Toxicology	Poisons & Overdoses	Management: Critical & Extended Care
Trauma	Crush Injury	Management: Critical & Extended Care
Trauma	Haemorrhage	Management: Critical & Extended Care
Trauma	Traumatic Brain Injury	Management: Critical & Extended Care
Clinical Skills
	Rapid Antigen Testing	Indications
Medication Protocols
	Fibrinogen	New Protocol
	Glyceryl Trinitrate (GTN)	Infusion instructions for Critical Care Paramedics
	Hypertonic Saline 3%	New Protocol
	Insulin	New Protocol
	Levetiracetam	New Protocol
Infection Prevention & Control
Infection Prevention and Control	Monkeypox	New interim guideline
Infection Prevention and Control	COVID-19 Clinical Response	Updated to blue state-wide alert level Updated signs and symptoms

Section	Title	Details of Change
Clinical Practice Guidelines
General	Virtual Emergency Medicine	Added RGH, and PTS crews
Interim guideline	Influenza vaccination	New CPG
Interim guideline	Fluarix Tetra	New CPG

Section	Title	Details of Change
Clinical Practice Guidelines
Trauma	Burn Trauma	Changes to fluid regime, addition of debridement, minor wording changes
Obstetrics	Shoulder Dystocia	Wording changes and clarification
Obstetrics	Postpartum haemorrhage	Wording changes and clarification
Obstetrics	Preterm Labour and Birth	Wording changes and clarification
Obstetrics	Pre-eclampsia and eclampsia	Wording changes and clarification
Obstetrics	Normal birth	Wording changes and clarification
Obstetrics	Haemorrhage during pregnancy/antepartum haemorrhage	Wording changes and clarification/title change
Obstetrics	Ectopic Pregnancy	New CPG
Obstetrics	Early pregnancy bleeding	New CPG
Obstetrics	Management of Obstetrics emergencies	Wording changes and clarification
Medication Protocols
Medications	Normal Saline	Change of fluid regime to match Burns Trauma CPG
Medications	Atropine	Third-degree atrioventricular (AV) block moved to precaution, removed from contraindication
Infection Prevention & Control
Infection Prevention and Control	Vehicle 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.

Section	Title	Details of Change
General
	Authority to Practice	Updates: Ambulance Officers (AO) Ambulance Transport Medics (ATM) Event Ambulance Officer (EAO) reference
	Medications Matrix	Updates: Ambulance Officer scope Ambulance Transport Medic scope Event Ambulance Officer (EAO) reference
	Patient not Transported (PnT)	Include reference to paediatric patients
	Skills Matrix	Updates: Ambulance Officer scope Ambulance Transport Medic scope Event Ambulance Officer (EAO) reference
	Suspected Abuse	New CPG
	Falls Prevention Guideline	New CPG
Clinical Practice Guidelines
Overview	Patient Assessment	Reference made to calculating an Early Warning Score (EWS) under Vital Signs
Overview	Recognising and Responding to Acute Deterioration	New CPG
Metabolic	Renal Dialysis Emergencies	Align with new sepsis guideline (refers to Septic shock CPG in additional information)
Circulation: Shock	Sepsis	New CPG
Respiratory	Tracheostomy / Laryngectomy Airway Emergencies	New CPG
Clinical Skills
Airway	Advanced Airway Management	Various Updates: Removed reference to laryngeal mask airway (LMA) ETI de-emphasised Ventilation rewording
Airway	Basic Airway Management	Change Basic to “Essential”
Breathing	Bag Valve Mask Ventilation	Oxygenation with SMART BVM SpO2 monitoring included for breathing patients
Advanced Airway Management	Cricothyrotomy	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
Advanced Airway Management	Endotracheal Intubation (ETI)	Updates: Introduction - reworded and removed references to gold standard. Removed support for Kiwi grip
Advanced Airway Management	Failed intubation drill	Remove reference to classic LMA Minor wording updates
Advanced Airway Management	Supraglottic Airway (SGA)	Spelling fixed
Advanced Airway Management	Suction - Tracheostomy	New CPG
Airway	Suction	Hyperlink to new Tracheostomy Suction skill
Airway	Nasopharyngeal Airway (NPA)	Change Basic to "Essential"
Supporting Resources
	NEWS 2 Online Calculator	Supporting resource for new CPG
	NEWS 2 QRG Paramedic	Supporting resource for new CPG
	NEWS 2 QRG EHS	Supporting resource for new CPG
	NEWS 2 QRG PTS/Volunteer	Supporting resource for new CPG
	NEWS 2 Scoring chart	Supporting resource for new CPG
	Sepsis Decision Tree	Supporting resource for new CPG
Medication Protocols
	Atropine Sulphate	Remove erroneous line in Introduction section - removed reference to presentation
	Naloxone	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
	Noradrenaline	Align with new sepsis guideline - Indications updated: "Primarily distributive shock such as septic shock, neurogenic shock, drug-induced"
	Tranexamic Acid	Indications Updated: Post Tonsillectomy Bleed, PPH
Library
	Distributive Shock	Align with new sepsis guideline

Section	Title	Details of Change
Clinical Skills (07/02/2022)
Medications	Nebuliser	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)
Assessment	Rapid 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	Removed "Changes" block as now reflected in Clinical Response page
	Patient not Transported (PnT)	Withdrawn, replaced by guidance on the Patient Clinical Management page

Section	Title	Details of Change
General

Clinical Practice Guidelines
	Anaphylaxis	Emphasis on left lateral position for pregnant patients
Clinical Skills
Breathing	Oxygen Delivery	Added COVID-19 / Febrile Respiratory Illness information
Medications	Nebuliser	Added COVID-19 / Febrile Respiratory Illness information
Medication Protocols
	Adrenaline	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
	Oxygen	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)

Section	Title	Details of Change
General
General	Voluntary Assisted Dying	NEW guidance
General	Virtual Emergency Medicine	NEW guidance
General	Skills and Medications Matrices	Updates
General	Authority to Practice	Added comment on SASA's and CEO sign off
Clinical Practice Guidelines
Neurological	Disturbed & 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
Neurological	Transient Loss of Consciousness (Syncope)	Indications - Reworded to include younger persons Risk Assessment - prompt re determining likely cause Treatment - Added 12 Lead ECG
Circulation	Cardiac Arrest - Paediatric	Added statement: "Do not provide asynchronous ventilation"
Circulation	Determination of Death (ROLE/TOR)	Incl. reference to Voluntary Assisted Dying
Circulation	Cardiac Dysrhythmia	Updated reference to SVT presentation & rates
Circulation	Chest Pain/Acute Coronary Syndrome	Risk assessment regarding low threshold for ECGs/ repeat ECG's.
Trauma	Pneumothorax	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)
Trauma	Pelvic Trauma	Indications - reworded with key points highlighted Reinforced use in unstable pelvic injuries Consider distracting injuries
Trauma	Rapid Sequence / Delayed Sequence Induction	NEW CPG - CCP
Trauma	VAPOX	NEW CPG - CCP
Metabolic	Adrenal Insufficiency	NEW CPG Transferred from pathophysiology section of Clinical Resources
Obstetrics	Childbirth	APGAR times updated
Metabolic	Hypoglycaemia	Allow repeat dosages to achieve normal glycaemia.
Clinical Skills
Airway	Suction	Added reference and images to Ducanto catheter (where avail)
Breathing	Bag 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
Breathing	End Tidal CO2 Waveform Capnography	NEW Skill
Trauma	Needle Thoracocentesis	Reworded indications Thresholds for ASMA Reinforced bilateral in traumatic arrest Reinforced use of Angio-Cath
Trauma	Pelvic Splints	Indications - reworded to align with CPG Procedure - reworded to simplify and align with revised images Revised images to demonstrate correct placement
Trauma	Unconscious Lateral Trauma Position	NEW Skill
Assessment	Glasgow 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
	Droperidol	NEW 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)
	Olanzapine	NEW medicine (Paramedic)
	Cephazolin	Revised indication - contaminated wounds Updated reference image Revised dilution concentration (100mcg/ml)
	Noradrenaline	NEW 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

Section	Title	Details of Change
General
	Skill Matrix	Clarified EMR/EMA roles; merged EHS volunteer roles
General	Patient Not Transported	Minor improvement to VIRCA criteria (to address Patient Capacity & Consent)
Clinical Practice Guidelines
	Anaphylaxis	Wording & definition from ASCIA
Trauma	Burn Trauma	CCP Only: MEQU Blood & Fluid Warmer
Overview	Clinical Handover	New guideline
Trauma	Haemorrhage	CCP Only: MEQU Blood & Fluid Warmer
Environmental	Hypothermia	CCP Only: MEQU Blood & Fluid Warmer
Overview	Interfacility Transfers	Significant improvement
Overview	Patient Capacity & Consent	Significant improvement & Capacity Assessment Tool
Trauma	Pelvic Trauma	Clarity of indications & risk assessment
Overview	Relief of Pain	Addressing ramped patients
Trauma	Spinal Trauma	Clarity of what 'spinal precautions' entails; inclusion of thoracic & lumbar spine
Clinical Skills
Airway	Foreign Body Airway Obstruction	Inclusion of Laryngoscope/Magill Forceps for paramedics
Medications	MEQU Fluid & Blood Warmer	New CCP Skill
Breathing	Non-invasive Positive Pressure Ventilation	New CCP Skill
Circulation	Pressure Immobilisation Technique (P.I.T)	Inclusion of new snakebite bandage
Trauma	Pelvic Splints	New indication, inclusive of Pelvic Binder decision tool
Medication Protocols
	Cophenylcaine	Maximum dosages not to be repeated within 24 hours
	Fentanyl	Cautious use in ramped patients
	Hydrocortisone	New Medication Protocol
	Ketamine	Cautious use in ramped patients
	Naloxone	New contraindication, update in precautions & dosages
	Packed Red Blood Cells	CCP Only: MEQU Blood & Fluid Warmer
	Intravenous Crystalloid Solutions (Normal Saline)	CCP Only: MEQU Blood & Fluid Warmer
Infection Prevention & Control
	COVID-19	Moved from Connect to Clinical Resources

Section	Title	Details of Change
General
General	Patient Care Record Completion	Updated to version 6.0, moved to Clinical Resources from Connect
General	Skills Matrix	Update to accommodate & standardise levels across various areas
Clinical Practice Guidelines
Neurological	Stroke (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.
Circulation	Chest Pain / Acute Coronary Syndrome	Age <85 years is no longer a criteria for the STEMI inclusion criteria.
Trauma	Spinal Trauma	Complete re-write of the Clinical Practice Guideline New flowchart for Clinical Practice Guideline
Trauma	Crush Injury	New Clinical Practice Guideline
Clinical Skills
Assessment	Spinal assessment	New skill: Spinal assessment & associated Clinical Decision Rule flowchart
Assessment	Blood Glucose Monitor	Updated imagery to include FreeStyle Optium BGL Monitor Inclusion of preferred neonatal lancing site
Assessment	Electrocardiography	Removed all instances/references to the Phillips MRx
Breathing	Oxygen Masks	Renamed to Oxygen Delivery Included 'nasal cannula' as method of delivery
Circulation	Pressure 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
Circulation	Defibrillation	Removed all instances/references to the Phillips MRx
Vascular Access	Prehospital Blood Sample Collection	Removed volume of blood required per draw (in line with changes from PathWest)
Vascular Access	Intraosseous 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.
Trauma	Minor 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

Section	Subsection	Title	Overview
Clinical Practice Guidelines	Circulation	Autonomic Dysreflexia	A new CPG that details the background, clinical presentation and management of Autonomic Dysreflexia
Clinical Skills	Trauma	QuikClot Combat Gauze	New skill for Clinical Support and Critical Care Paramedics

Infection Prevention & Control Guidelines

Title	Overview
Standard & Transmission Based Precautions	Incorporates 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	Updated	Details 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.

Section

Updated

Details 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	Updated	Details 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.

Section

Updated

Details 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

Title	Details 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

Title	Details 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

Section	Title	Details of Change
General

Clinical Practice Guidelines

Clinical Skills

Medication Protocols

Infection Prevention & Control

Clinical Resources Website

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