Acute Cardiogenic Pulmonary Oedema

Clinical Practice Guideline Assignment

Ambulance Services across Australia and the world have clinical practice guidelines or protocols which outline the treatment and management of specific patient presentations. These guidelines vary greatly in everything from how they look, to what they include and the treatment they describe. Some ambulance services have guidelines which are well-defined and easier to follow and understand than others. Some include a lot of detail and background information, whereas others simply list treatment options. Also, the management of certain patient conditions may be clearer when expressed in a specific layout (e.g. flow- chart or diagrams).

Whilst there is great variance in the format and detail in guidelines across different ambulance services, each organisation no doubt would defend their documents as being current best practice and the correct way things should be done! The one thing that is in common between most ambulance service guidelines however, is the lack of evidence justifying the content. Usually there are no references supporting the subject matter at all. So are they really based on current best practice?


Your task is to design a clinical practice guideline/treatment pathway for a specific condition which has been allocated to you. You must decide on the layout and format which best suits the condition, and describe the paramedic management in an out-of-hospital context.

You will need to research the condition, to find out what is the current best practice, and provide references which support the treatment you describe. You may review guidelines which already exist for the condition you have been allocated, but these should not be copied or dictate the management you explain (use journal articles instead).

You have free-range over the design of your guideline, but consider it should be 2-3 pages in length. Include some background information on the condition and issues for paramedics to reflect on. Highlight potential ‘time-critical’ situations and difficulties with patient assessment. You may also want to consider some overall patient safety statements such as “all unconscious patients should be transported to hospital regardless of the cause” etc.

The guideline should also include explicit details around drugs to administer, including the dose and how often. You may suggest the use of drugs which are currently not common place in the prehospital setting, provided there is evidence supporting their use and it would be reasonable to carry these drugs in an ambulance (e.g. does not require a fridge). There is no need to segregate different levels of practitioner (e.g. Intensive Care Paramedic) – your guideline would be used by every paramedic regardless of their skills.

Marking Rubric:

Criteria Comments Marks
Design (4 marks):

•    Diagrams and figures used effectively to 
support text

•    Well set-out, clear, easy to read and 
understand – layout is appropriate for 

•    Grammatical and spelling accuracy

•    Main points clearly identified, in a logical 
and sequential manner

Content (4 marks):

•    Provides a background preamble to the 

•    Potential ‘risks’ or ‘red flags’ taken into 

•    Gives definitions and explanations of 
concepts where required

•    Lists associated signs and symptoms of condition somewhere in guideline

Management (4 marks):

•    Paramedic management clearly defined

•    The indications, dosages and timings of 
drugs included

•    Management for condition is correct

•    Differential diagnoses and alternate 
pathways considered

Evidence (8 marks):

•    Extensive use of primary references (e.g. 
studies/trials) to support work

•    All treatment and management options 
supported by evidence

•    Choice of referencing style fits in with 
design of guideline

•    Reference list provided

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