IntroductionThis article aims to summarise and categorise the current types of frontline paramedics in Australia and New Zealand, their relative scopes of practice, their qualifications and training, and the titles used in each jurisdictional ambulance service. Methods Each of the 10 jurisdictional ambulance services were contacted and their current clinical roles discussed with a manager or senior paramedic between June and October 2020. Information was summarised in tables and text.  ResultsMinimum qualifications for paramedics range from a diploma to an undergraduate degree, with graduate programs ranging from six to 18 months’ duration. Additional minimum qualifications for Extended Care Paramedics range from no minimum qualifications to a nursing degree. Additional minimum qualifications for Intensive Care Paramedics range from no minimum qualifications to a postgraduate diploma. Additional minimum qualifications for Retrievalists range from no minimum qualifications to a master degree. Helicopter emergency medical services (HEMS) teams range from primarily physician-led in four services to autonomous paramedics in five services. Armed offender paramedics exist in four services; urban search and rescue paramedics exist in five services; wilderness paramedics exist in five services; CBRNE paramedics exist in three services; mental health paramedics exist in three services. Special Operations variously refers to HEMS, USAR, CBRNE or armed offender. Critical Care variously refers to Intensive Care, HEMS in a physician-led team and autonomous HEMS. Advanced life support refers to paramedics and intensive care. Rescue Paramedic refers to road crash extrication or wilderness paramedics. Flight Paramedic refers to Paramedics or Intensive Care Paramedics, either HEMS or fixed wing. ConclusionThe jurisdictional ambulance services are heterogenous in the structure, qualifications, training and terminology for their frontline paramedic roles. Due to this lack of consistency, roles for paramedics in Australasia are currently largely incomparable between services, rendering shared titles inoperable from intranational and international perspectives.

Introduction There are 10 emergency paramedic services in Australia and New Zealand (Australasia), referred to as jurisdictional ambulance services (JASs). All 10 of the JASs in Australasia produce their own clinical practice guidelines (CPGs). With differing approaches to their review and implementation of new evidence, there is opportunity for differences to arise between guidelines. This article outlines a new series that will aim to identify interjurisdictional differences in CPGs and paramedic scopes of practice, and consequently differences in patient treatment depending on which jurisdiction a patient is geographically located within at the time of their complaint. Methods The current CPGs of each JAS will be obtained from each JAS, and content extracted by registered paramedics. The scope of practice for each intervention presented in the guideline will be classified as being at the level of ‘paramedic’, ‘intensive care paramedic’ (or equivalent, as titles vary by jurisdiction), or ‘restricted’. Each paper will be provided to each JAS for optional verification of content before publication, and the results of this will be stated. Conclusion This series will aim to provide a contemporary overview of Australasian JAS clinical practice guidelines and scopes of practice.

Objective: This systematic review will aim to summarize and evaluate the literature describing the evidence regarding adverse events from the administration of nitrates during right ventricular myocardial infarction. Introduction: Withholding nitrates in the setting of right ventricular myocardial infarction is currently recommended by the American Heart Association, European Society of Cardiology, and in the Australian Journal of General Practice, due to the risk that decreasing preload in the setting of already compromised right ventricular ejection fraction may reduce cardiac output and precipitate hypotension or exacerbate cardiogenic shock. The original evidence from 1989 underpinning these recommendations displays methodological weaknesses including low sample size and confounding interventions. More recent and comprehensive research from 2014, 2016, 2018, and 2019 conflicts with the conclusions from the 1989 study, suggesting instead that nitrate administration during right ventricular myocardial infarction results in no significant difference in the rate of adverse events. The combination of recommended practice based on 30-year-old evidence and the emergence of recent challenging evidence suggest that this topic merits systematic review. Inclusion criteria: The study will include both experimental and observational (descriptive and analytical) study designs that discuss the occurrence of adverse events from the administration of nitrates during a known right ventricular myocardial infarction. Methods: Six databases will be systematically searched: the Cochrane CENTRAL Register, PubMed, Embase, MEDLINE Complete, CINAHL, and Google Scholar. Identified studies will be independently assessed for inclusion by two investigators using JBI critical appraisal tools. Data will be extracted for narrative and tabular synthesis. Systematic review registration number: PROSPERO CRD42020172839

IntroductionThis review aims to summarise the literature regarding the ability of commercial smartwatch products to produce an electrocardiograph of diagnostic quality for interpreting Einthoven and precordial leads. Methods PubMed, Embase, MEDLINE Complete, Web of Science, and Scopus were systematically searched. Articles were screened by a sole investigator against the inclusion criteria – first by title, then abstract, then full text. The reference lists of included articles were also screened. The inclusion criteria were: discussion of smartwatch-acquired tracing of Einthoven or precordial lead accuracy, and demonstrating sufficient rigor when undergoing critical appraisal using the Joanna Briggs Institute evaluation tools. A synopsis of results was provided in a summary of information table. ResultsTwelve articles were identified for inclusion, nine of which had physician (cardiology or emergency specialty) evaluation of tracings, one of which had statistical comparison of wave duration and amplitude, and two of which were expert commentary. Only evaluations of Apple Watch products were discovered during the literature search. All leads in all studies were considered suitable for interpretation, with no clinically significant differences. Four studies found that 100% of patients were able to accurately use a smartwatch as an electrocardiogram after a brief tutorial. ConclusionThe current early evidence, based largely on visual evaluations by cardiologists during the previous year, suggests that electrocardiograph abnormality recorded by this technology is sufficiently precise to be presumed accurate until proven otherwise.

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