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 paramedics 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 paramedics 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 necessarilya 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 personnelwith 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 thereview 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 betweenJan 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 datasources and the formation of the caseinvolved 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 levelsin 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 (OMeara 2002) and 2) the recently determined model for rural emergency care community engagement primary health care andthe scope of practice extension (OMeara 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.