Paramedics in Australia

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A Paramedic in Australia is a health care professional who holds a minimum of a Bachelor's Degree in Paramedicine and is registered with the Paramedicine Board of Australia via the Australian Health Practitioners Regulation Agency (AHPRA) [1] As of December 2021, there are over 22,500 registered paramedics in Australia, of which approximately 70% (15,750) work for a jurisdictional service (each of which covers an entire state or territory), and of which 47% of which are female. [2] [3] Paramedics in Australia may undergo further training and complete a Master's Degree to specialise in either Intensive Care or Primary Care medicine. [4]

Contents

Regulation

From 1 December 2018, Paramedicine in Australia became regulated under the Paramedicine Board of Australia (who are supported in their function by AHPRA, the national body which administers the registration scheme), and the titles "Paramedic" and "Paramedicine" are legally restricted to registered practitioners. [1] Paramedics may use the post nominal letters RP (Registered Paramedic). Initial registration requires holding an approved qualification and being deemed suitable under the standards of criminal history, English language skills, professional indemnity insurance, and recency of practice. Annual re-registration additionally requires completion of 30 hours continual professional development. All registered paramedics are publicly visible and able to be searched on the AHPRA registry of practitioners. [5]

Education and training

Undergraduates

Registration as a Paramedic requires completion of an approved qualification recognised by AHPRA. Currently, 15 universities offer undergraduate Bachelor degrees recognised by AHPRA:

Entry to undergraduate degrees remains competitive, with a mean entry ATAR of 83.2 in 2021. [6] Some paramedic degrees are dual (that is, combined with another discipline, for example Bachelor of Paramedicine/Bachelor of Nursing). [7] In 2021 there were approximately 8,000 Bachelor's Degree paramedicine students in Australia, with a significant surplus of graduates to recruitment within the jurisdictional services, leading to increased recruitment in other health services such as GP clinics and Emergency Departments. [2]

Undergraduate degrees involve three years of full-time study, consisting of three core elements: traditional academic coursework, practical simulations, and placement. Academic coursework involves anatomy, physiology, pathology, pharmacology, resuscitation, traumatology, cardiology, pulmonology, neurology, paediatrics, obstetrics, and mental health, with less detailed study of gastroenterology, toxicology, and endocrinology. Assessment for academic coursework is via essays and closed-book written exams. Practical simulations (commonly called 'pracs') are aligned to match the current academic topics, and provide a setting to practice skills such as laryngoscopy, ventilation, resuscitation, and delivery. Assessment for practical classes is, as with medicine and nursing, via Objective Structured Clinical Examinations (OSCEs), usually with the local state clinical practice guidelines as the marking criteria. Placement is not assessed, and requires simply attending rostered shifts accompanying on-road paramedics. The placement conditions vary by state, but generally involve several hundred hours of unpaid shift work. Due to the nature of paramedicine, students on placement regularly are required to assist with patient treatment under the supervision of qualified paramedics.

Paramedics are generally not able to practice autonomously following completion of an undergraduate degree, with most services requiring completion of a 12-month graduate program with supervision and additional assessment (colloquially referred to as a 'grad year').

Postgraduate qualifications

A Master's Degree is generally mandatory to progress to specialisation as an Intensive Care or Primary Care paramedic, and is usually funded by the employer. Doctoral studies are growing in paramedicine, and are offered at multiple universities.

Employment

As of December 2021, there are over 22,500 registered paramedics in Australia, of which approximately 70% (15,750) work for a state service. [2] [3] With the exception of the Northern Territory and Western Australia, all services are government agencies, and are commonly collectively referred to as the jurisdictional ambulance services (JASs). The services had a collective budget of over $4 billion AUD in 2021. [3] The eight state services are:

  1. Ambulance Tasmania
  2. Ambulance Victoria
  3. Australian Capital Territory Ambulance Service
  4. New South Wales Ambulance
  5. Queensland Ambulance Service
  6. SA Ambulance Service
  7. St John Northern Territory
  8. St John Western Australia

Employment outside the state services is not subject to routine data collection, and there is limited accurate information available to summarise these roles.

Clinical scope of practice

Although paramedics are legally given autonomous authority to practice by their registration, in practice as a public service employee a paramedic's interventions (skills and medications they are allowed to perform) are determined by their employer. Scope of practice varies by jurisdiction, but broadly involves three levels: [4]

  1. Generalist paramedics (Bachelor's Degree)
  2. Intensive and Critical Care Paramedic (Master's Degree)
  3. Additional scopes of practice including extended scope, low Acute, community paramedicine.

Generalist paramedics are Bachelor's Degree trained paramedics who hold AHPRA registration and who have completed a 12-month on-road graduate year. They make up the majority of practicing paramedics, with a scope of care focused on resuscitation, assessment, analgesia, cardiology, and pulmonology. Generalist paramedics can undertake additional postgraduate training to qualify as an Extended Care or Intensive Care paramedic.

Extended Care paramedics (ECPs), also sometimes known as Community paramedics (CPs) or Local Area Assessment and Referral Unit (LARUs) provide additional primary care skills, with the specific goal of avoiding unnecessary transportation for patients to increase efficiency.

Intensive care paramedics (ICPs) also known as Critical Care Paramedics (CCPs) or Mobile intensive care ambulance paramedics (MICAs) provide additional critical care skills, generally on airway management, cardiology, and sedation. ICPs most commonly operate solo out of an SUV and do not transport patients themselves, instead assisting generalist crews as required.

Beyond Critical & Intensive Care paramedics, most services additionally have a third-tier clinical level, usually reserved for Helicopter Emergency Medical Services (HEMS) paramedics, commonly called Flight Paramedics. Additional qualifications for this level vary; in some services a Graduate Diploma is required, while in others a second Master's Degree is undertaken (for a total of 7 years' university, including previous qualifications). Flight Paramedics undertake high level and critical cases by both road and air, and depending on the service have additional aviation training as down-the-wire winch crew. Paramedics have additional critical care training to facilitate stabilisaiton of the patient prior to helicopter transportation. This usually includes administration of blood products, pressors, mechanical ventilation, finger thoracostomy, and ultrasonography. In Western Australia, the Northern Territory, South Australia, and Victoria Flight Paramedics usually work autonomously, while in ACT, NSW, Queensland, and Tasmania they usually work in a team with a critical care doctor. Flight responses generally fall into two categories: a primary rescue (where the helicopter vehicle is required to access the patient - such as for winching - or transport larger distances) or a primary retrieval (where the additional skills or medications of a Flight Paramedic are required for stabilisation of the patient).

An example of the types of skills and medications often authorised by employers to the different paramedic clinical levels is provided in the table below:

Clinical levelGeneralist paramedicExtended Care paramedicIntensive Care paramedicAdditional scopes of practice (commonly Flight Paramedics)
Routine medicationsAdrenaline, aspirin, antivenoms, ceftriaxone, clopidogrel, dexamethasone, droperidol, fentanyl, glucagon, glyceryl trinitrate, heparin, hydrocortisone, hydroxocobalamin, ibuprofen, ipratropium bromide, ketamine, magnesium sulphate, methoxyflurane, midazolam, morphine, naloxone, ondansetron, oxytocin, paracetamol, prochlorperazine, tenecteplase, ticagrelor, tranexamic acidFrusemide, lignocaine, loperamide, loratadine, Amlodipine, Amoxicillin / Azithromycin / Benzacine penicillin / Ceftriaxone / Erythromycin / Flucloxacillin / Gentamicin / Roxithromycin / Chloramphenicol / Doxycycline / Nitrofurantoin, Metronidazole, Bisacodyl / Sennoside B, Codeine / Oxycodone, Hyoscine butylbromide, Kenacomb, Levomepromazine, Levonorgestrel, Loperamide, Metoprolol, Miconazole, Parecoxib, Prednisolone, VaccinesAtracurium, Amiodarone, Atropine, Adenosine, Benztropine, Calcium gluconate, levetiracetam, olazapine, propofol, rocuronium, vercuronium, suxamethonium, sodium bicarbonateBlood products, Enoxaparin, Plasma, Fibrinogen, Isoprenaline, lorazepam, metaraminol, metoprolol, noradrenaline, phenytoin, nifedepine, parecoxib
Routine skillsIntravenous cannulation, medication administration (IV, PO, IM, SC, SL), ausculatation, vital signs survey, airway management (OPA, NPA, LMA, suction), gastric tube insertion, laryngoscopy, magill's forceps, needle thoracostomy, resuscitation (CPR, defibrillation), IPPV, CPAP,Local anaesthesia (digital ring block, dental block, fascia iliaca block, wound exploration / closure), Enema administration – fleet (phosphate) / microlax, Manual decompaction of faeces, Ophthalmoscopy, Otoscopy, Peak expiratory flow rate measurement, PEG management, Rectal prolapse reduction, Urinary catheterisation, Wound closure – glue, staples, suturesRapid sequence induction, delayed sequence induction, ketamine-only breathing intubation, cricothyroidotomy, mintracheostomy, infusions, cardioversion, pacing, intraosseous accessFinger or tube thoracostomy, mechanical ventilation, ultrasonography FAST scans, invasive blood pressure monitoring

Paramedic Practitioners

Unlike in the United Kingdom, the role of a Paramedic Practitioner does not yet exist in Australia. The Australian Institute of Paramedic Practitioners (ACPP), a group that advocates for the creation of a role similar to that found internationally, states that a Paramedic Practioner would have the capability to "assess and treat a broad range of patients". [8] While paramedics are legally allowed to work independently (i.e. open their own clinic), in practice this is not realistic as paramedics do not have prescription rights, medication ordering rights, or access to bill via the national healthcare system.

In June 2023, Monash University announced it had been promised $20 million in funding by the Victorian Government to develop an Australian 'Paramedic Practitioner' role and begin training in 2024 to have 25 Paramedic Practitioners qualified by 2026. [9] [10]

Clinical practice guidelines

All jurisdictional services in Australia utilise clinical practice guidelines (CPGs) to determine a paramedic's scope of practice. Unlike in nursing and medicine, adhering to the CPGs is often regarded as pivotal, and new paramedics may be expected to memorise all their CPGs. Cases are routinely audited, and variations from CPGs usually result in a paramedic being formally asked to explain their reasoning behind the variation, and in some cases disciplinary action. Additionally, universities usually use the local CPG as an assessment tool during OSCEs. All 8 state service CPGs are openly available.

With the exception of a sharing agreement between Ambulance Victoria and Ambulance Tasmania (where Tasmania pay a nominal annual licensing fee to use Ambulance Victoria's CPGs, which are then modified as appropriate for Tasmanian requirements), CPGs are developed largely in isolation by each individual service.

Professional organisations

Colleges

Australia's primary college for paramedics is the Australasian College of Paramedicine (ACP). In 2019, a group of paramedics founded a subset college specialising in low acuity medicine, the Australasian College of Paramedic Practitioners (ACPP). There is no high acuity medicine college. Unlike in medicine, membership of a college is not a prerequisite to specialisation, and colleges do not authorise training programs nor assess candidates for clinical skills. The role of the colleges is a combination of providing continual professional development (of which 30 hours per year is required to maintain registration with AHPRA) opportunities via education and conferences, advocacy, and funding research.

Unions

Paramedics are encouraged to join unions by employers, and union-employer bargaining is the primary determinant of Enterprise Bargaining Agreements that determine pay and work conditions. Industrial representation varies from state to state. Registered paramedic unions in Australia include Ambulance Employees Australia (AEA) and the Health Services Union. Unregistered (non-Union employee support organisations) include Australian Paramedics Associations (APA), Victorian Ambulance Union (VAU) & Australian Paramedic Association QLD (APAQ).

Related Research Articles

<span class="mw-page-title-main">Emergency medical services</span> Services providing acute medical care

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

<span class="mw-page-title-main">Registered nurse</span> Nurse who has graduated from a nursing program

A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.

<span class="mw-page-title-main">Emergency medical technician</span> Health care provider of emergency medical services

An emergency medical technician is a medical professional that provides emergency medical services. EMTs are most commonly found serving on ambulances and in fire departments in the US and Canada, as full-time and some part-time departments require their firefighters to be EMT certified.

<span class="mw-page-title-main">Paramedic</span> Healthcare professional who works in emergency medical situations

A paramedic is a healthcare professional trained in the medical model, whose main role has historically been to respond to emergency calls for medical help outside of a hospital. Paramedics work as part of the emergency medical services (EMS), most often in ambulances. They also have roles in emergency medicine, primary care, transfer medicine and remote/offshore medicine. The scope of practice of a paramedic varies between countries, but generally includes autonomous decision making around the emergency care of patients.

In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US. In Asian countries like India, this term has been replaced mainly by Medical Officers, Registered Medical Practitioner etc.

<span class="mw-page-title-main">Podiatrist</span> Medical professional devoted to the medical treatment of disorders of the foot

A podiatrist is a medical professional devoted to the treatment of disorders of the foot, ankle, and related structures of the leg. The term originated in North America but has now become the accepted term in the English-speaking world for all practitioners of podiatric medicine. The word chiropodist was previously used in the United States, but it is now regarded as antiquated.

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<span class="mw-page-title-main">Paramedics in Canada</span> Overview of paramedics in Canada

A paramedic is a healthcare professional, providing pre-hospital assessment and medical care to people with acute illnesses or injuries. In Canada, the title paramedic generally refers to those who work on land ambulances or air ambulances providing paramedic services. Paramedics are increasingly being utilized in hospitals, emergency rooms, clinics and community health care services by providing care in collaboration with registered nurses, registered/licensed practical nurses and registered respiratory therapists.

Allied health professions (AHPs) are a group of health care professions that provide a range of diagnostic, technical, therapeutic, and support services in connection with health care, and which are distinct from the fields of dentistry, medicine, nursing and pharmacy.

<span class="mw-page-title-main">Medical education in Australia</span> Summary of education and training of medical practitioners (doctors) in Australia.

Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.

<span class="mw-page-title-main">Paramedics in the United States</span> Overview of paramedics in the United States of America

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<span class="mw-page-title-main">New South Wales Ambulance</span>

NSW Ambulance, previously the Ambulance Service of NSW, is an agency of NSW Health and the statutory provider of pre-hospital emergency care and ambulance services in the state of New South Wales, Australia.

<span class="mw-page-title-main">Emergency medical personnel in the United Kingdom</span> People engaged in the provision of emergency medical services

Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.

A flight paramedic is a paramedic who provides care to sick and injured patients in an aeromedical environment. Typically a flight paramedic works with a registered nurse, physician, respiratory therapist, or another paramedic. Flight paramedics must have an advanced medical knowledge along with years of clinical experience. Flight paramedics in the United States usually hold certifications such as the FP-C or the CCP-C, while in countries like the United Kingdom, they are typically required to hold a postgraduate certificate in critical care as a minimum, with many holding a master's degree in advanced practice or aeromedical critical care.

An Emergency Care Practitioner (ECP) generally come from a background in paramedicine and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard paramedic or qualified nurse. It has been recommended by the College of Paramedics that ECPs be trained to PgDip or MSc level, although not all are. Evidence of the best way to target Emergency Care Practitioners is limited with utilisation of traditional Ambulance dispatch codes not always being shown to be most effective and referrals from GPs also potentially failing to deliver management of demand that would be appropriate for this different level of practitioner. Evidence however clearly demonstrates that in discreet groups of patients the use of these extended role staff responding to emergency calls can reduce admissions and thus improve patient outcomes as well as delivering a clear cost saving to the NHS.

<span class="mw-page-title-main">Emergency medical responder</span> Person who provides out-of-hospital care in medical emergencies

Emergency medical responders are people who are specially trained to provide out-of-hospital care in medical emergencies, typically before the arrival of an ambulance. Specifically used, an Emergency Medical Responder is an EMS certification level used to describe a level of EMS provider below that of an emergency medical technician and paramedic. However, the EMR is not intended to replace the roles of such providers and their wide range of specialties.

Emergency medical services in Australia are provided by state ambulance services, which are a division of each state or territorial government, and by St John Ambulance in both Western Australia and the Northern Territory.

Emergency medical services in New Zealand are provided by the Order of St John, except in the Greater Wellington region where Wellington Free Ambulance provides these services. Both have a history of long service to their communities, St John since 1885 and Free beginning in 1927, traditionally having a volunteer base, however the vast majority of response work is undertaken by paid career Paramedics. Strategic leadership of the sector is provided by NASO which is a unit within the Ministry of Health responsible for coordinating the purchasing and funding of services on behalf of the Ministry and the Accident Compensation Corporation.

<span class="mw-page-title-main">PHECC</span>

The Pre-Hospital Emergency Care Council (PHECC) is an independent statutory organisation responsible for implementing, monitoring and further developing the standards of care provided by all statutory, private and voluntary ambulance services in Ireland. It is also responsible for conducting examinations at six levels of pre-hospital care, the control of ambulance practitioner registration and the publication of clinical practice guidelines.

The West Midlands Central Accident, Resuscitation & Emergency (CARE) team is a charitable organisation who respond to serious medical incidents within the West Midlands, UK. Working in teams alongside West Midlands Ambulance Service, volunteer doctors, nurses and other healthcare professionals deliver enhanced critical care to seriously injured and unwell patients.

References

  1. 1 2 "Registration". Paramedicine Board of Australia. Australian Health Practitioner Regulation Agency. Retrieved 5 February 2021.
  2. 1 2 3 "Registrant data". Statistics - Paramedicine Board of Australia. Paramedicine Board of Australia. 31 December 2021. Retrieved 5 February 2021.
  3. 1 2 3 "Report on Government Services 2022, Part E, Section 11, Table A.8". Australian Government Productivity Commission. 1 February 2022.
  4. 1 2 Wilkinson-Stokes, Matt (2021-01-03). "A taxonomy of Australian and New Zealand paramedic clinical roles". Australasian Journal of Paramedicine. 18: 1–20. doi: 10.33151/ajp.18.880 . ISSN   2202-7270.
  5. ↑ "Registry of practitioners". AHPRA.
  6. ↑ "ATAR Requirements". The Paramedic Observer. Retrieved 2022-02-05.
  7. ↑ http://www.acu.edu.au/courses/640253 [ dead link ]
  8. ↑ https://www.acpp.net.au/what-is-a-paramedic-practitioner-
  9. ↑ https://www.monash.edu/medicine/news/latest/2023-articles/monash-university-to-train-australias-first-paramedic-practitioners
  10. ↑ https://www.premier.vic.gov.au/delivering-australian-first-paramedic-practitioners
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