Clinical Practice Radio (CPR)

In this episode, the team explores the evolving approach to patient extrication, with insights from DFES rescue officer Andrew “Strunky” Strunk. They unpack the evidence behind the Extrication in Trauma (EXIT) project, challenging long-held practices, particularly the low incidence of spinal cord injury, and the shift away from movement minimisation toward faster, patient-focused extrication. A practical look at what’s changing on the ground, and how closer collaboration between paramedics and rescue crews is improving outcomes by getting patients to definitive care sooner. References: Nutbeam, T., Fenwick, R., Haldane, C., Leech, C., Foote, E., Todd, S., & Lockey, D. (2025). Extrication following a motor vehicle collision: a consensus statement on behalf of The Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 3. Nutbeam, T., Fenwick, R., May, B., Stassen, W., Smith, J. E., Wallis, L., ... & Shippen, J. (2021). The role of cervical collars and verbal instructions in minimising spinal movement during self-extrication following a motor vehicle collision-a biomechanical study using healthy volunteers. Scandinavian journal of trauma, resuscitation and emergency medicine, 29(1), 108. Nutbeam, T., Fenwick, R., Marritt, I., Lee, B., Staveley-Wadham, L., Lang, N., ... & Leech, C. (2025). Optimising the care of the trapped patient following a motor vehicle collision: A UK-Based Delphi consensus study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 137. Hawkridge, K., Ahmed, I., & Ahmed, Z. (2022). Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. European Journal of Trauma and Emergency Surgery, 48(1), 647-657.

In this episode, the team tackles some of the most enduring myths in emergency medical services and asks a simple question: are we still doing things because they work, or because it’s how they’ve always been done? Topics include analgesia and pain management, soft tissue injuries and the RICE principle, oxygen use in COPD patients, ketamine and haemodynamic effects, tourniquet use, and other long-held assumptions in pre-hospital care. Through evidence, physiology and reflective practice, the conversation highlights how clinical practice continues to evolve and why staying curious and adapting to new evidence is essential for delivering high-quality patient care. A thought-provoking listen for clinicians at any stage of their career. References: April, M. D., Arana, A., Schauer, S. G., Davis, W. T., Oliver, J. J., Fantegrossi, A., ... & NEAR Investigators. (2020). Ketamine versus etomidate and peri‐intubation hypotension: a national emergency airway registry study. Academic Emergency Medicine, 27(11), 1106-1115. Kamran, H., Salciccioli, L., Kumar, P., Pushilin, S., Namana, V., Trotman, S., & Lazar, J. (2010). The relation between blood pressure changes induced by passive leg raising and arterial stiffness. Journal of the American Society of Hypertension, 4(6), 284-289. ICED! The illusionary treatment option. Gary Rein Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72-73. Walsh B, Cone DC, Meyer EM, Larkin GL. Paramedic attitudes regarding prehospital analgesia. Prehosp Emerg Care. 2013 Jan-Mar;17(1):78-87. doi: 10.3109/10903127.2012.717167. Epub 2012 Sep 12. PMID: 22971168. Oxygen and Carbon Dioxide Retention in COPD • LITFL • CCC Respiratory Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012 Oct 29;16(5):323. doi: 10.1186/cc11475. PMID: 23106947; PMCID: PMC3682248. https://doi.org/10.1016/j.ajem.2023.08.040 Morgan MM, Perina DG, Acquisto NM, Fallat ME, Gallagher JM, Brown KM, Ho J, Burnett A, Lairet J, Rowe D, Gestring ML. Ketamine Use in Prehospital and Hospital Treatment of the Acute Trauma Patient: A Joint Position Statement. Prehosp Emerg Care. 2021 Jul-Aug;25(4):588-592. doi: 10.1080/10903127.2020.1801920. Epub 2020 Aug 27. PMID: 32776812. Xacur-Trabulce A, Casas-Fuentes G, Ruiz-Vasconcelos V, Reitz MM, Henry SM, Scalea TM, Ribeiro MAF Jr. Tourniquet-related complications in extremity injuries: a scoping review of the literature. World J Emerg Surg. 2025 Jun 25;20(1):57. doi: 10.1186/s13017-025-00625-3. PMID: 40556023; PMCID: PMC12188649. Pascoe B, Weinrauch P. Timeline effects of tourniquets used in trauma care. JHTAM. 2024;6(2):26-32

In this episode, the team is joined by Jason Belcher, Resuscitation Improvement Specialist at St John WA, to explore what makes the biggest difference in surviving an Out-of-Hospital Cardiac Arrest (OHCA). With a background in paramedicine, research and education, Jason’s work focuses on strengthening the entire chain of survival, from community recognition and bystander CPR through to high-performance resuscitation and clinical decision-making in the field. Together, the team discusses the critical role of early recognition, the impact of community defibrillators and first responder apps, and why mastering the fundamentals of CPR remains the most powerful intervention for saving lives. Whether you’re a student, volunteer, or experienced clinician, this episode offers practical, evidence-based insights to help you deliver the best possible outcomes for patients in cardiac arrest. References: Science of CPR with Peter Kudenchuk, MD How likely is the patient to be in cardiac arrest? Caller breathing descriptors in ambulance calls that were dispatched as cardiac arrest - ScienceDirect Lifesaving Cardiopulmonary Resuscitation: A Pilot Evaluation of a Targeted Educational Intervention to Improve Cardiopulmonary Resuscitation Provision in Volunteer Surf Lifesavers - Journal of Emergency Medicine Neurological outcome in adult out-of-hospital cardiac arrest – Not all doom and gloom! - ScienceDirect Smartphone‐activated volunteer responders and survival to discharge after out‐of‐hospital cardiac arrests in Victoria, 2018–23: an observational cohort study - Delardes - 2025 - Medical Journal of Australia - Wiley Online Library https://news.stjohnwa.com.au/wp-content/uploads/2025/10/OHCA25_Annual-Report_Digital.pdf

Trigger Warning: This episode discusses birth experiences, including potentially distressing or sensitive content. Listener discretion is advised. In this episode, the team is joined by the incredible Mel Gardiner, a highly experienced paramedic with over 20 years on the road and a passion for improving maternal care in the pre-hospital space. Mel talks through the nuances of maternal assessment, highlighting the unique challenges paramedics face when providing care to mothers and babies outside of hospital. The team dive into STORC (State Obstetrics Referral Call) — an innovative program Mel has helped develop. STORC connects paramedics with registered midwives trained specifically in pre-hospital care, offering immediate expert support, guidance, and even life-saving interventions over the phone. With WA’s vast and often remote geography, this program has been a game-changer for families and clinicians alike, bridging gaps between the community, paramedics, and maternity wards. Whether you’re a paramedic, student, or simply curious about how critical maternal care is delivered in the field, this episode provides practical insights, valuable learning, and an inspiring look at how collaboration can transform patient outcomes. References Findlay, H. J., Anderson, J. K., Francis, K. L., Clegg, L. M., & Maria, S. J. (2023). The significance of paramedic communication during women’s birth experiences: A scoping review. Women and Birth, 36(5), e491–e501. https://doi.org/10.1016/j.wombi.2023.02.003 Hill, M., Miles, A., Flanagan, B., Mills, B., & Hopper, L. (2022). Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: A scoping review protocol. BMJ Open, 12(5), e062313. https://doi.org/10.1136/bmjopen-2022-062313 Keedle, H., Keedle, W., & Dahlen, H. G. (2022). Dehumanized, violated, and powerless: An Australian survey of women's experiences of obstetric violence in the past 5 years. Violence Against Women, 30(9), 2162–2184. https://doi.org/10.1177/10778012221140138

In this episode, the team unpack the vital topic of human factors—the skills and attributes beyond the technical that shape effective clinical performance. They explore how elements like situational awareness, communication, stress management, and decision-making influence paramedic practice in unpredictable environments. The conversation dives into the cognitive load faced on scene, how preparation and routine can enhance performance, and the importance of stress inoculation and reflective practice. Listeners will gain insight into how experienced clinicians filter variables more efficiently, why adaptability is key, and how good habits—like staying hydrated, being physically prepared, and knowing your kit—can reduce mental strain. The team also highlights how human factors can be developed through deliberate practice and how leadership style must flex to support team members’ different learning and feedback needs. Whether you’re new to the field or a seasoned paramedic, this episode offers practical strategies and relatable reflections to sharpen your non-technical skills and support better patient care.