Sunday, March 31, 2013

The difference between a rural and city based paramedic

The University of Tasmania conducted research on what differences are found between a city based paramedic and a paramedic practicing in rural and remote locations. They also wanted to find out what additional skills are needed for the remote medic.

Background
Paramedic education and training has a focus on the type of work performed. Some recent findings regarding the work of the rural paramedic indicate an expanded scope of practice with a strong community focus and involvement in primary health care. Because of this, proposals now appear for specific rural education and training. Whilst a picture is developing of the work of the rural paramedic, there is little knowledge about the differences between rural and urban paramedic practice. Revealing these differences will offer insight into specific roles for the rural paramedic and enhance any rurally oriented education and training for paramedics. 


Methods
A case study approach uses multiple sources of data including semi-structured interviews with intensive care paramedics across two states in Australia, review of relevant documentation and literature, case dispatch data, and observation. Interviews focus on specific work carried out, current education and training, and pathways for the future.

Findings
Rural paramedic practice is different from urban paramedic practice in that the rural paramedic: 

1) adopts a whole of community approach rather than a case dispatch approach; 

2) is a multidisciplinary team member rather than operating mainly within ambulance teams; 

3) has extra responsibility as a teacher and manager for volunteers; 

4) is a highly visible and respected member of the community rather than relatively anonymous. 

With these differences, the rural paramedic displays various roles. For a whole of community approach, we see the role of community involvement, with the paramedic involved in project management or use of local media. A multidisciplinary approach means that the paramedic requires a multidisciplinary awareness in order to work well with other team members. Similarly, volunteer management requires an awareness of volunteers, of how to manage and teach volunteer groups. Finally, being a highly visible and respected community member means roles must display professionalism and accountability. 




Conclusion
Whilst the image of an ambulance rushing to attend an emergency case with lights and sirens is familiar, there is more to the role of the paramedic. In particular, this study reveals differences between the rural and urban paramedic that help explain why we need an expanded role for paramedics that acknowledges practice beyond that of attending the acutely ill or injured person.
Rural paramedic practice is different from urban paramedic practice in that the rural paramedic is a highly involved and visible member of the community, working closely with other health professionals, and ambulance volunteers. 

With these differences, the rural paramedic displays various roles relating to community involvement, multidisciplinary awareness, an awareness of volunteers, and incorporating professionalism and accountability.

Community based and multidisciplinary components are present in models of expanded paramedic practice in the United Kingdom and United States of America. Australian ambulance organisations and educational institutions are combining knowledge gained from these models of practice with locally based research, and in one particular example, roles of multidisciplinary awareness and community involvement are part of a specific rural postgraduate paramedic qualification and have seen promotion of collaborative strategies for health care in rural communities. Continued focus on advanced roles of the rural paramedic will see acknowledgement of these rural roles and the development of further training. Initiatives such as rural clinical placement for paramedic undergraduates, or courses with a multidisciplinary focus, will benefit not only the paramedics but also the health needs of rural communities in which they practice. 




Peter Mulholland, Christine Stirling, Judith Walker University of Tasmania 



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