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Bridging the Gap –Primary Health Care Paramedics/Community Paramedicine in Australia

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Introduction

The Australian health care system is a world class scheme that includes private insurance companies, not for profit organizations, allied health, public and private health providers and all three levels of government (federal, state and local). In other words, it is a rather complex network of providers, and like many other westernized countries, Australia’s population is changing. Its population is growing, maturing in age and culturally, we are making poor lifestyle choices. For these reasons the Australian health system is under both functional and financial pressure.

As a result, there is increased demand for health services and a rising incidence of chronic diseases. This means that paramedics are increasingly the first point of contact for acute illness or injury, and to provide primary health care advice and support. Also, worth considering is that Australian (like Canada) is a very large country by land mass and its population is widely spread from metropolitan centre to remote communities.

Enter the community paramedic model.

Background

Paramedicine has recently (2018) become a registered health professional in Australia and there are approximately 18,000 registered paramedics, some are state ambulance based and others are in private services.1 The bachelor’s degree benchmark is now the industry standard for entry into the profession within Australia. The development of post graduate education community paramedicine programs in Australia, as well as state driven programs are aiding the implementation of the community paramedicine model in metropolitan, remote and rural areas. As a developing and highly responsive workforce paramedic are increasingly being called upon to respond to not only emergency incidents but also all manner of primary health care and supportive requests. Whilst models are developing in Australia, there is evidence from similar programs in Canada that suggest appropriately experienced and trained paramedics can deliver safe, community based, interprofessional and collaborative primary health care.

Development

In recognition of this trend several Australian jurisdictions are establishing dispatch and operational systems to specifically address the needs of patients with primary health care related concerns. Several Australian state ambulance services including Queensland Ambulance Service (QAS), Ambulance Service New South Wales (ASNSW), Tasmanian Ambulance and South Australia Ambulance Services (SAAS) have recently introduced programs aimed to identify and better manage the increasing volume of ambulance patients that present with primary health care needs.2

Of the remaining state/territory-based ambulance services several are considering specific programs to impact this space. Ambulance Service Victoria is currently considering a paramedic practitioner model that is largely based off the nurse practitioner and the United Kingdoms (UK) paramedic practitioner model. Skills involved within these models include pathology, prescribing and radiology to support and develop advanced treatment plans.2

Right care at the Right Place

Whilst community paramedicine programs are increasing in Australia, the latent benefits of these models are already wide reaching. The programs objectives focus on providing the right care at the right place and moving the right patient to the right clinician, thus providing patient focused care. This ultimately reduces unnecessary ambulance transport and emergency room (ER) attendance, provides better management of chronic diseases, streamlines the referral processes and provides post hospital follow-ups thereby reducing hospital re-admissions.

Historically the ambulance responded, treated and transported to hospital, and in Australia, as in many other developed countries, the cultural lean towards engaging an ambulance for non-urgent health issues has been negatively impacting the delivery of the service through increased hospital presentations and cost. Although referral processes are still developing in the metropolitan areas, they are becoming available and are reducing unnecessary ER transports. In the remote and rural areas, the health workforce is often inadequate. The ambulance is sometimes the only health service. Remote clinicians working in ambulance are often confronted with a broad range of acute, chronic and sometimes complex challenges in their everyday practice and it is within this context that the innovative community paramedicine model have developed.

Filling the Gaps

The community paramedicine model is a paramount feature in closing health care gaps in rural and remote communities where shortages in primary health care access occurs. Nationally, rural communities have historically reported poorer health statuses and poorer health outcomes when compared to urban statistics.

Assimilating the contemporary paramedic (with primary health care skills) with other health care agencies and health professionals will improve patient access to primary health care, achieve better health outcomes and provide paramedics with career enhancement. By linking the appropriate health care to the appropriate patient in an appropriate amount of time, the community paramedicine model can reduce the peril to high-risk patients through frontline primary health care support, and aid in the management of chronic disease. That said, the sustainability and ongoing development of a community paramedicine model is particularly dependent on building a strong relationship with, and integration with the existing health services.

The Future

Paramedics are regarded as trusted and respected medical professionals and historically they have provided an emergency service. However, more and more responses are the community seeking advice or support regarding primary health care needs.

The evolution of the community paramedicine model can address unmet needs for primary health care services in the community and ultimately provide and facilitate better access for patients. There is growing evidence to suggest that the community paramedicine models trialled and developing in Australia are currently shifting the health care strategy and identifying health care reforms needed to provide best care.

Within Australia there eight State (or Territory) based ambulance services that deliver prehospital emergency medical services and whilst the focus is on responding, the current models for treatment are developing to support primary health needs.

The potential to assimilate the contemporary paramedicine delivery models that exist within the Australian health care system with other health care agencies and health professionals is a key development of the growing primary health support programs.

Throughout this article we have used the term community paramedic, however this was to reduce confusion across the international fields of paramedicine. Where litigation and law define the parameters of paramedicine delivery, language becomes very important. As the defined role that encompasses paramedics working within primary health roles increases, the terms “community paramedic”, “extended care paramedic” or “paramedic practitioner” will vary considerably. Whilst the authors acknowledged that historically primary health care is not a standard remit of paramedic education or understanding, paramedics are well placed within the communities of Australia to positively impact primary health problems. 

References

1. Paramedicine Board of Australia Registrant data. Reporting period: 01 July 2019 to 30 September 2019. https://www.paramedicineboard.gov.au/News/Statistics.aspx

2. O’Meara, P., & Duthie, S. (2018). Paramedicine in Australia and New Zealand: A comparative overview. Australian Journal of Rural Health, 26(5), 363–368. doi:10.1111/ajr.12464

Greg Reaburn

Greg Reaburn is a critical care flight paramedic, physician assistant and part-time academic at Griffith University and vice president of the Australian College of Paramedic Practitioners
Greg currently works as a critical care paramedic is a small rural town in Queensland. During down time Greg supports the single local General Practitioner at is surgery.

Steve Whitfield

Steve Whitfield

Steve Sunny Whitfield is a lecturer at Griffith University School of Medicine (paramedicine) with experience in humanitarian operations, high altitude expeditions, marine expeditions and flight and retrieval medicine. In 2015 Steve founded a platform that became the international collaboration Medics Beyond Borders to support health care in remote communities. Steve is also a keen geographer, surfer and climber. Updated 2021

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