Roles of the Rural Paramedic Practitioner in Australia - Essay Example

? The roles of the rural paramedic practitioner: case study of Australia School: The roles of the rural paramedic practitioner: case study of Australia Introduction The sight of an ambulance attending to emergency cases is familiar to all people. In itself, it demonstrates the work of a paramedic practitioner who attends to the injured or the acutely ill. However, in recent times, the scope of the paramedic’s work is expanding. In particular, the duties of the rural paramedic are expanding, which is evident from their active engagement in primary health care and the wider community focus. From the paramedic’s scope of practice, like it is defined by the CAA (Australian Council of Ambulance Authorities), the role of the rural paramedic covers different areas. These areas include emergency care, rural community engagement, primary health care and practice extension. The definition specifies that the rural paramedics will work together with ambulance volunteers, but they are not necessarily a member of the primary response team, like the volunteers. In many cases, the rural paramedic will work together with the volunteer staffs, like a member of the primary response crew. Background and Rationale Due to the changing focus of the job of the rural paramedic, the focus of work is changing from that of an emergency practitioner, to that of a community-based healthcare personnel; the paramedic is working, more closely with the practitioners from other disciplines. The expanding role of the paramedic is similar in other countries, including the USA and UK. The expansion in the duties of the paramedic has led to the development of an information base, used as a guide for the postgraduate qualification of Australian practitioners at the James Cook University (Andersson, Lennox & Petersen, 2003). The development of courses of that type is a step ahead, towards the future of the practice of the rural paramedics in Australian. Following the light of this discussion, this paper will explore, whether the role of the rural paramedic is different from that of the urban paramedic practitioner. This paper will explore the practice of a paramedic from a rural perspective, towards determining whether their practice is different, and whether specific rural-based education may be required. Summary of Literature The available literature gives little information on the differences between the role of the rural and the urban paramedic. Some sources give a comparison of urban and rural practice in terms of the practical skills featured in their work (Brown et al., 1996). These skills include intubation, and the focus is channeled towards, exploring whether rural paramedics are able to perform their duties, to similar standards as their urban counterparts (Jemmett et al., 2003). The inexperience of rural paramedics, with different types of patients has also been discussed through past literature (Burton, 2003). One case discussed is their inexperience with pediatric patients (Stevens & Alexander, 2005). Other studies discussed the differences of rural and urban practice, which is evident from different trauma levels, citing the longer transport distances; more trauma cases were exposed among rural paramedic practice, than from the case of urban practitioners (Huang et al., 2001). The different sources show that focus of past literature is on the differences in the cases attended to, or the practical skills held by the different groups of practitioners. The available literature shows that, there is little literature exposing the differences between urban and rural practice, in the area of the interactions of the practitioner, with the community (Burton, 2003). There is also little information covering the differences in the interactions between paramedics and other health personnel, with whom they often work together. For these reasons, there is little information on the skills and the roles that may be unique to the working of the rural paramedic practitioner (McAllister et al., 1998). Towards developing this information, the differences in the practice of the rural and the urban paramedic, will be explored from the perspective of the paramedic, through asking a set of questions. These questions include, how the differences in paramedic roles give insights into the roles of rural paramedics and how these differences enrich the training and the education of paramedics. Methodology A comparative case study model and a qualitative approach were employed during this study of the differences between urban and rural paramedic roles. Different data sets were gathered, using different tools. The first tool was semi-structured interviews with the paramedics working in intensive care settings, across two Australian states. The second tool was the review of available literature on ambulance services, job descriptions, union websites, universities and local media; archival information and case dispatch information. Other tools for the study included the observation of the practitioners within the areas of study and key events and processes. The collection of data took place between Jan 2012 and Feb 2013. The design of the case study was administered according to the model suggested by Yin, where the different cases are developed based on analysis units – in the current study, these included the localities of paramedics, which were compared and contrasted for the two areas (Yin, 2003). For instance, one given rural case featured two analysis units, where the two were independent rural centers. The analysis of the different localities took account of the different data sources, and the formation of the case involved comparing the different units of analysis, noting differences and similarities. The total number of localities, two urban and five rural, contributed towards one urban and two rural cases, from two states: Victoria and Tasmania. In the case of the urban side, the guidelines of comparison were that the paramedic centers had to show some comparison, in the area of the accessibility to populations, medical facilities, and paramedic crewing. Two cities of relatively similar sizes from Victoria and Tasmania were chosen. Using remoteness / accessibility levels in Australia, the two cities had an index of highly accessible, from a wide range of social interactions and services (Huang et al., 2001). The guidelines used for the two rural centers were that they fitted either of the two models identified for rural paramedics in Australia. The two cases include 1) the model, where ambulance locations were determined before, in response to political and community pressure (O’Meara, 2002) and 2) the recently determined model for rural emergency care, community engagement, primary health care and the scope of practice extension (O’Meara et al., 2006). Three of the rural centers were identified as moderately accessible, which means that there was limited access to social interactions, opportunities and goods and services. Two rural centers were grouped as remote, meaning that they were considerably restricted from access to social interactions, opportunities and goods and services. Two locations were grouped under model (1) and three were classified under the model (2). Through the creation of two rural cases, the differences in the practice in the rural areas, among the two models will be determined. So as to sustain consistency, interviews were administered to the practitioners at the performance level of ICU paramedics. The interview questions were aimed at determining the types of work executed by the paramedics, their interactions with other health practitioners and that with the members of the community as well as their thoughts on their training and education. The intensive care paramedics communicated with the researcher directly, in expression of their interest to participate in the study (Andersson, Lennox & Petersen, 2003). Ten paramedics showed interest initially – the ten included three from group 2, four from the volunteer group and three from the urban paramedics groups. One urban and one rural paramedic pulled out of the study, prior to the interviews. The interview conversations were taped and later transcribed by the researcher. The documents gathered for the study include job descriptions, dispatch data, ambulance and union service memoranda, and the local media reports aligned to the different analysis units. Ambulance facility educational curricula and university educational models showed the types of subjects administered to the practitioners. The interviews were conducted in the local areas, which allowed for the observation of the workplace of the paramedics, in terms of service delivery and the local environment. Two interviews were administered over the phone, and in the two cases, the paramedics described their work environments (Huang et al., 2001). The cross referencing of different data forms enhanced the process of triangulation, which helped in eliminating any biases made during the individual interview sessions. The analysis of data was done inductive, using the NVivi 7 statistical package; the analysis fostered comparison between the different urban and rural cases, and enhanced the identification of consistent themes. Ethics approval was acquired from the HRECN (Human Research Ethics Committee Network) of the University of Tasmania. Results The study did a comparative study of the rural and the urban practice. Despite the fact that some similarities were evident, there were four main differences between urban and rural paramedic practice from the data. The differences included that 1) the rural paramedic employs a community-wide approach during practice, rather than a case dispatch outlook 2) the rural paramedic is a multi-disciplinary player, rather than an ambulance team member 3) the rural paramedic plays extra roles as a manager and teacher for volunteer staffs 4) the rural paramedic is a highly respected and visible community member (Yin, 2003). Similarities were apparent, between the cases dispatched to urban and rural paramedics. The paramedics from the different regions were often required to attend to cases like cardiac problems, breathing problems, abdominal conditions, falls, fainting or unconscious patients and the victims of road accidents. The main difference evident from the dispatch data, except that on the number of cases, depicted a large proportion of transfers from rural to urban areas, following the need to transfer patients to better equipped medical facilities. Rather than positioning themselves as a response team for the management of emergency cases only, the rural paramedic works like an active member of the community. The works they do – differently from urban paramedics – include school visits, public education, and general first aid education. Their approach towards their roles is innovative, which is evident from their use of public media like newsprint and radio to pass messages related to the health of the community to groups (Andersson, Lennox & Petersen, 2003). The primary health care duty broadens to cover community health centers, rural health care groups and drug rehabilitation classes to other emergency services groups like the state emergency and the fire service centers. This case was evident from the involvement of one paramedic, who has taken a central role in the development of a community health center, in a locality that did not have allied health support services like occupational therapy, physiotherapy and drug and alcohol education (Huang et al., 2001). The role of the rural paramedic, within the community, is highly proactive, and that was evident from the formulation of plans for future health needs, among the practitioners. One example from one rural paramedic was the proposal for the development of a casualty treatment center, at a locality that did not have emergency department outlets and public hospitals. Many of the paramedics were members of the hospital committees of local hospitals. Although urban, like rural paramedics, extend their duties beyond pre-hospital care, to work with emergency staff and hospital accident staffs when there is a need for the rural paramedics to depict a more multidisciplinary practice. In all the cases checked, rural practitioners are engaged, as members of other community organizations related to health, apart from the ambulance services (McAllister et al., 1998). Others are members of community health councils, together with occupational therapists, psychotherapists and district nursing staffs, apart from participating in educational initiatives and community health promotion. The programs where rural paramedics are participants include those to do with drug and alcohol awareness and prenatal classes. Due to the multidisciplinary outlook, rural paramedics improve the overall health well being of individuals, and will advise other organizations and agencies, on the specific needs of the given community (Huang et al., 2001). One such case was the instances, where the members of the community seek psychological or counseling support, and not issues to do with their medical well being. At the hospital environment, rural paramedics report that they often work together will ally health staffs, nursing staffs and doctors, towards the continual provision of care from the pre-hospital to the hospital stage. Their multidisciplinary practice also extends to the areas, where the paramedic personnel aid in the care of critically ill patients, in delivering services like drug therapy and intubation (Yin, 2003). The last aspect of their multidisciplinary service delivery is evident through the education of other groups in the rural areas. For example, some of the paramedics reported that they engaged in basic first aid training and offering specialized training/ education on advanced clinical practices of other professionals. As managers of volunteers, rural paramedics help in the training and the management of local volunteers, and many paramedics regard the training of volunteer units an important area of priority (Tasmanian Ambulance Service, 2007). Through developing a capable and well-trained volunteer team, the rural paramedics ensure that the volunteer staffs offer the best pre-hospital care at the rural area. The interrelation between the paramedics and the volunteer groups are wider than those of trainers and trainees. The relations will often fit the scope of a volunteer manager, where they facilitate volunteer recruitment, offer peers support, determine shift rosters and aid in occupational health and safety checking (Andersson, Lennox & Petersen, 2003). Implications From the comparative study of urban and rural paramedics, four main similarities were evident from their practice. These similarities include that 1) rural paramedics, unlike those from the urban areas adopt a whole community outlook, beyond specializing on the case dispatch outlook. 2) The rural paramedic is a multidisciplinary team player – rather than one operating within their scope in ambulance teams. 3) the rural practitioner takes extra responsibility as a manager and a teacher to the volunteer staffs they work with 4) the rural paramedic is highly vibrant and visible to the members of the community. The results collected from the study demonstrate a high level of consistency with the data available from previous studies, which show that the Australian rural paramedic is engaged in the rural emergency care, practice extension, community engagement, involved with ambulance volunteers and a participant in primary health care service delivery (Huang et al., 2001). The consistency of the results from the diverse studies shows that the duty of the rural paramedic practitioner is more widespread than that of other professionals. The differences established through this study depict that the rural paramedic is an independent practitioner, offering support for the development of emerging courses for paramedical practice. The differences show a relationship to a range of paramedic roles. From a whole community outlook, the role of the paramedic is that of cultivating community involvement, where they engaged in project management or the utilization of local media for the well-being of the community (Yin, 2003). The multidisciplinary outlook shows that the paramedic needs a multidisciplinary education and exposure, so that they can interact fruitfully, with other team players, and so that they can bridge pre-hospital and hospital care. Conclusions and future research Although the site of an ambulance attending to emergency cases may be familiar, there is a wider coverage in the role of the paramedic. Particularly, the current study has shown that there are major differences between the practice of the rural and the urban paramedic. The differences have helped demonstrate the need for the widening of the scope of the paramedic’s duties, because those from the rural areas acknowledge doing work, which is beyond that of attending to acutely injured or ill patients. The role of a rural paramedic is different from that of one working in the urban area, noting that the rural paramedic is a highly visible and engaged community member, who works closely with other professionals working at different areas throughout the health sector. Noting the differences between rural and urban paramedics, different roles are evidenced as contributory to community development and those likely to increase accountability and professionalism. Multidisciplinary and community-based aspects are evident from the scope of the expanded paramedic’s role in the US and the UK. In Australia, ambulance agencies and educational centers are merging the knowledge gained from the emerging models of service delivery, with local research centers, leading to more advanced postgraduate paramedic education. Their contribution, so far, shows that paramedics play a major role in determining the future scope of the paramedic, and the knowledge they will need before engaging in community service. The valuable contribution demonstrates that more research is required, which will help explore the multidisciplinary approaches and the changing outlook of service delivery staffs, in anticipation for the changing needs of the society. References Andersson, E. S., Lennox, A. I. & Petersen, S. A. (2003). Learning from lives: a model for health and social care education in the wider community context. Medical Education, 37, p. 59- 68. Brown, L. H., Copeland, T. W., Gough, J. E., Garrison, H. G. & Dunn, K. A. (1996). EMS knowledge and skills in rural North Carolina: a comparison with the National EMS Education and Practice Blueprint. Prehospital Disaster MED, 11 (4), p. 254-260. Burton, J. H. (2003). Endotracheal intubation in a rural EMS state: procedure utilization and impact of skills maintenance guidelines. Prehosp Emerg Care, 7 (3), p. 352. Huang, C. H., Chen, W. J., Ma, M., Lai, C. L., Lin, F.Y., & Lee, Y.T. (2001). Ambulance utilization in metropolitan and rural areas in Taiwan. Journal of the Formosan Medical Association, 100, p. 581-586. Jemmett, M. E., Kendal, K. M., Fourre, M. D. & Burton, M. D. (2003). Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency services testing. Academic Emergency Medicine, 10 (9), p. 961-965. McAllister, L., McEwan, E., Williams, V. &Frost, N. (1998). Rural attachments for students in the health professions: are they worthwhile? Aust J Rural Health, 6(4), p. 194-201. O’Meara, P. F. (2002). Models of ambulance service delivery for rural Victoria [Doctorate]: The University of New South Wales. O’Meara, P., Walker. J., Stirling, C., Pedler, D., Tourle, V., & Davis, K., et al. (2006). The rural and regional ambulance paramedic: Moving beyond emergency response: Report to The Council of Ambulance Authorities Inc. Stevens, S. L. & Alexander, J. L. (2005). The impact of training and experience of EMS providers’ feelings toward pediatric emergencies in a rural state. Pediatric Emergency Care, 21 (1), p. 12-17. Tasmanian Ambulance Service. (2007). Statement of duties: Branch station officer (advanced life support). Yin, R. K. (2003). Case study research: design and methods, 3 Ed. Thousand Oaks: Sage Publications. Appendix Figure 1: Dispatch types for the rural paramedic in Tasmania (2012) (N=1588) Source(Tasmanian computer Aided Dispatch system) Figure 2: Dispatch types for the urban paramedic in Tasmania 2006 (N=31174) Source(Tasmanian computer Aided Dispatch system) Figure 3: Dispatch types for the Urban paramedic (Victoria) 1st Jan 2012 – 31st Dec 2012 Source: Victorian Ambulance service Additional Reading Ambulance Service of New South Wales. (2008). Performance review, Ambulance Service of NSW: New South Wales Government, Department of Premier and Cabinet. Ambulance Service of New South Wales. (2006). Ambulance rural plan, consultation paper: Ambulance Service of New South Wales. Gregory, P. (2006). Training for emergency care practitioners: BSc Degree. Journal of Emergency Primary Health Care, 4(1), Online Accessed 26 Sep 2013, http://www.jephc.com/ Hallikainen, J., Vaisanen, O., Rosenberg, P. H., Silfvast, T. & Niemi-Murola, L. (2007). Interprofessional education of medical students and paramedics in emergency medicine. Acta Anaesthesiologica Scandinavica, 51(3), p. 372-377. NSW Ambulance Service. (2008). The management and operations of the ambulance service NSW. Online Accessed 26 Sep 2013 http;//www.parliament.nsw.gov.au/prod/parlment/committee.nst/0/B719A16DF5B974EB CA2574E7007F68D4. Woolard, M. (2006). The role of the paramedic practitioner in the UK. Journal of Emergency Primary Health Care, 4(1): Online Accessed 26 Sep 2013, http://www.jephc.com/ Read More