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Hi there loyal prehospital practitioner….

Just a quick note….

I’m not dead, neither is this blog.

At the moment, and for most of the last 12 months, I’ve had lot of professional and personal commitments and major life changes that have taken up most of my time. As such, it’s been hard to dedicate time to the blog.

The intent of this blog was and is, to discuss contemporary prehospital and critical care practice. I have to admit, a lot of that work is being done exceptionally by others, and I don’t have too much more to add other than some Twitter banter.

For the moment, please feel free to keep following me on Twitter @prehospitalpro and of course, all the other great prehospital and critical care folk around the place.

When time allows, I’ll be back here to add my two cents.



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Check out this great presentation by respected ED Physician and researcher A/Prof Anne-Maree Kelly



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Air Support – the vital link, 25th ASA+FNA scientific meeting, 2013

Can’t wait to see Minh and his RFDS team in SimWARS!

Air Support – the vital link, 25th ASA+FNA scientific meeting, 2013.

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A big week of PHARM, and lots to come.

Hi all,

It’s been a busy week for me, and an exciting one with three days in Sydney at SMACC 2013.

It was a great chance to catch up and listen to the gurus of #FOAMed including but not limited to Scott Weingart (EMcrit.org), Cliff Reid (resus.me), Minh Le Cong (PHARM Blog prehospitalmed.com) and many many others. There was some inspirational content, and a lot of it is, or will be podcast over at the official website SMACC 2013 . A few songs, some wrestling, paramedics abseling from the auditorium roof, SonoWARS, SimWARS, tears and laughter. I’ve never experienced a conference quite like it.

Try and get along to SMACC 2014, which is in Brisbane, March 2014. You won’t regret it!

A mate who is a MICA Paramedic from Melbourne, Rob Simpson, was there promoting MICA and his new blog, AmboFOAM – check it out AmboFOAM - there’s some fantastic content.

Dr. Doug Lynch, a ‘champion’ Retrieval Doc from RFDS Cairns (formerly ARV Vic), did a vod and podcast with me and others whilst I was at SMACC, check them out here:

Short interview with Doug

Google Hangout with Minh, Doug, Anne, Stefan and Toby

Straight back from Sydney and I was into 2 days of assessments for new for MICA Flight Paramedic candidates, and that was hard work but there was some excellent clinical care demonstrated. There’s a chance some of the content of those days will appear at SimWARS at Aeromed 2013, which is being held at the Sofitel Hotel in Melbourne, this August 28-30. Come one, come all! You don’t have to be a flight paramedic, nurse or physician to come; everyone is welcome. There’ll be plenty of pertinent information for all levels of practice. Check out the official website, and please consider submitting an abstract, and promote your study or service! Aeromed conference 2013

I’m back to reality with some road MICA shifts for four weeks; none of this cushy fly-boy stuff. After that I’m off to the UK for 2 weeks of chatting and experience with UK paramedics. I’m talking at the UK TraumaCare 2013 conference, and also sharing MICA practice with a whole lot of UK paramedics, thanks to a partnership between College of Paramedics UK and Paramedics Australasia . A couple of the places I’ll visit include Great Western Air Ambulance (GWAAC), South Western Ambulance Service NHS Foundation Trust study day (SWAST), Welsh Ambulance Service study day, (Welsh Ambulance), South East Coast Ambulance Service (South East Coast Ambulance) and East of England Ambulance Service (East England Ambulance).

I can’t wait to learn from my international colleagues, and also share the Victorian experience with them. Thanks to my host John wood for dutifully organising my itinerary.

Somewhere in there i’ve got to shift my whole family 150km down the road into a brand new house that I haven’t seen much of, but life’s boring without challenges hey?

Stay tuned for some updated content, and remember to follow me on Twitter for more #PHARMpearls, as I negotiate my way through the real ambulance world of chest pain, rapid AF and long ED queues over the next for weeks.

Thanks for following.


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Originally posted on PHARM:


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Originally posted on EMDutch:

Welcome back on EMDutch, the blog by Dutch emergency physicians, for emergency physicians worldwide!

So far we have discussed morphine and NTG in Acute Heart Failure (AHF) and now it’s diuretics’ turn! And before we go on I want to make clear that we are discussing patients with Acute Pulmonary Edema (APE) without hypotension and not the patients with swollen ankles and no severe dyspnea or the patients in cardiogenic shock.

Diuretics in APE for me as a resident was something you didn’t think about and clearly works, just like thrombolysis in ischemic stroke, steroids in sepsis and acenocoumarol in small PE (YEAH…RIGHT!). But when you join the #FOAMed family and really start thinking about (evidence-based) medicine nothing is what it seemed to be.

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OHCA and advanced airways

More evidence for BVM only in OHCA…a study from Japan.

My thoughts: – the data supporting intra-arrest advanced airway management is looking pretty thin on the ground. The Japanese model of prehospital care is not similar to Australasian PHC models. Again, I don’t necessarily think that this study can be used as a basis for change to worldwide prehospital practice.

For example, for prehospital services that provide prehospital therapeutic cooling, ETI is essential. So I guess the question is, should such services consider BVM during arrest, and if ROSC is achieved, RSI or “cold tube” and then sedate/paralyse/cool? As far as I know, there aren’t many studies looking at advanced airway Mx in the ROSC/cooling component of overall OHCA management. The authors acknowledge that it is difficult to establish a link to prehospital advanced airway management and poor outcomes.

Anyway, this is a well designed study out of Japan. Have a look.

JAMA OHCA Advanced Airways


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