Though they conjure images of bright lights and blaring sirens, it has been suggested that paramedics could expand their scope of practice as Australia aims to address its ongoing healthcare staffing shortage.
A new study, The definition of a community paramedic: An international consensus, published by Australian and US researchers in Paramedicine, has highlighted that over the past two decades innovative strategies such as the development of the extended care paramedics, paramedic practitioners, and community paramedic roles, have been pioneered by paramedic service providers internationally.
These roles, collectively known as community paramedicine, aim to reduce the burden on overwhelmed health services, supplement primary health workforce shortages, and to improve the patient experience.
Study co-author, ECU lecturer and PhD candidate, Ms Alecka Miles, has been a paramedic for 18 years, but now when outside the ambulance she uses her skills at a GP clinic in suburban Perth as a community paramedic.
Ms Miles explained that paramedics brought a unique skillset into a primary healthcare setting that went well beyond driving ambulances.
“I think we’ve been overlooked as a health profession resource because people don’t fully understand what we do,” she said.
“We’re seen as the ambulance people, but paramedicine is the profession; an ambulance is just the vehicle that a lot of paramedics work in.”
Her team’s research suggested that as a globally evolving model of care, community paramedicine programs provide a bridge between primary healthcare and emergency healthcare, predominantly in rural, remote, and other under-resourced communities.
While this might include the application of specialised skills, guidelines and protocols beyond base-level paramedic education and training, alternately the community paramedic might engage in an ‘expanded role’ working in non-traditional roles using existing skills.
However, previous research has highlighted that there can be confusion about what community paramedics do in their role and the lack of consistent terminology only contributes to this.
The International Roundtable of Community Paramedicine (IRCP) developed a broad definition of a community paramedic over a decade ago, which acknowledged the potential for practicing within an ‘expanded scope,’ however, this definition did not clearly identify the skill set, attributes, knowledge, or unique descriptors that community paramedics from other roles may have.
The newly updated global definition of a community paramedic, developed by the study, states that they “provide person-centred care in a diverse range of settings that address the needs of the community.”
“Their practice may include provision of primary health care, health promotion, disease management, clinical assessment and needs based interventions; and they should be integrated with interdisciplinary health care teams which aim to improve patient outcomes through education, advocacy, and health system navigation.”
“This [new] community paramedic definition covers a vast area of practice, and the length of the definition reflects this while still providing significant key differences between established and accepted paramedicine definitions,” Ms Miles said.
Ms Miles highlighted that working in emergency care, often in challenging settings, meant paramedics bring a distinct perspective that makes for a more balanced healthcare team that can work together to make sure patients get the best possible care.
“Paramedics work in a lot of uncontrolled environments, whether it’s a car accident or if we’re trying to get people who have had a fall out of their house that has limited room for equipment, so we’re used to thinking creatively to find solutions,” Ms Miles said.
“We are quite flexible and we’re good at communicating, which works well in teams – paramedics are uniquely placed to collaborate with nurses, doctors, physiotherapists, OTs and the like to make sure patients get the best possible care irrespective of why they’ve come to the facility.”
Ms Miles said while it was vital to have enough paramedics available to perform emergency health care services, there needed to be a shift in funding.
“We don’t want to lose all of our paramedics to these roles,” she said.
“But I think if there was more established funding where, say, in general practice and primary healthcare, we have a GP coordinating care within a multidisciplinary team, we can better treat people in the community for unscheduled urgent and primary healthcare situations.”
A paramedic moving into primary healthcare settings requires additional training and Ms Miles coordinates several ECU postgraduate courses which prepare paramedics to work in primary healthcare, urgent care, extended care, and other community paramedic roles.
“The courses help paramedics to apply their knowledge and critical thinking in different contexts outside of emergency care,” Ms Miles said.
She pointed out that there were many benefits to making the switch from emergency into other areas of healthcare, ranging from different shift times, potential for a better work/life balance and spending more time with patients.
“You can go into people’s homes and apply your knowledge to help people navigate their way through whatever their health problem may be,” Ms Miles said.
“Paramedics get pigeonholed as the people who take people to hospital, but in my clinical work we can prevent people from having to go to hospital, or, if they do need to go to hospital or be treated outside of general practice, we can help make sure they see the right health professional for their condition.
“[Our] findings indicate that regardless of education and paramedic scope of practice, the skill set, knowledge and aims of community paramedic roles can be universally adaptable.”