The aim of this article is to draw attention to the recent emergence of the community paramedic (CP) in Australia and the current absence of a defined role/understanding of what a CP is. In a recent Delphi study by Shannon et al (2023), 49% (n=37) of community paramedicine experts agreed the following is the most preferred definition of a CP:
‘A paramedic who uses an expanded skill set and scope, which addresses the health care needs of people in their homes or community. They are integrated within interdisciplinary healthcare teams with the aim to improve patient care through education, advocacy, and health system navigation.’
In some states in Australia, the first part of this definition overlaps with the definition of the extended care paramedic (ECP). ECPs work for ambulance services and provide an expanded scope of care in fields such as wound care, suturing, catheterisation and, in some cases, medical prescribing. The extended scope of practice aims to ensure the right care is provided to the patient in their own home and ultimately prevent them from needing to go to hospital. These traits are also partially applicable to the CP role, demonstrating an overlap between the two differing types of paramedic. The following autoethnography is useful for providing clarity around the role of the CP in Australia.
Case study
Autoethnography
Paul is an experienced paramedic with many years working in primary healthcare settings, including private ambulance services and community care facilities. His experiences challenge the current thinking as to what the role of a paramedic is. There is a widely held belief that a paramedic works for a jurisdictional ambulance service and is someone who responds to calls for help from the public via the national emergency system. Paul challenges this assumption by never having been employed by a jurisdictional ambulance service, but instead has worked for a wide range of healthcare services. Today, he is working as a CP as part of a multidisciplinary team at a rural health centre. In this position, Paul will use his current knowledge, skills and experiences as a paramedic to assess and manage patients who attend the centre, where patients typically present with acute, chronic and complex health challenges. While he is currently working at a static location, the centre also offers mobile response services for emergency situations.
Daily tasks include triaging patients as they enter the health centre, assessing, managing and diagnosing patients independently in the absence of a GP, and providing a mobile response when necessary.
Working in collaboration with doctors and remote area nurses (RAN) allows Paul to undertake physical examinations, assess vital signs, take bloods, use point-of-care testing such as iSTAT for blood and electrolyte tests, take lab core samples, use and interpret point-of-care ultrasound, and use catheters, among other tasks. In this model, medications (such as antibiotics, beta blockers and vaccinations) are administered to patients on-site as necessary, as there is limited access to GPs across regional localities.
This is a relatively new trial programme that explores the role of paramedics integrating into a system under strain. While Paul works under the auspices of the GPs and the regional nurse scope of practice, his registration with the Paramedic Board of Australia (PBA) ensures he remains accountable for his day-to-day work practices.
The case
The on-call medical team received a distressed telephone call from Mr B, who lives in the local regional community and is complaining of acute abdominal pain following a traumatic event. As it was a weekend, the centre was closed and only available to respond to emergencies. On this occasion, Paul responded by attending the centre as part of the on-call care team.
Mr B was driven to the healthcare centre where he complained of acute abdominal pain in his lower umbilical region and around the bladder. He described his severity of pain level as ‘10/10’ and explained he had fallen onto an upturned chair.
On examination, Mr B presented with a severely distended abdomen and absent bowel sounds on auscultation; however, he had minimal visible evidence of trauma. A brief history revealed that he was ethanolic at the time of the incident, which contributed to the injury. Ultrasound was unavailable on the day; however, if it had it been available, Paul could have used it to confirm the cause of the intra-abdominal bleeding.
Following a thorough physical examination and history as part of the care plan, intravenous (IV) pain relief was administered; however, it had little effect. Mr B was also unable to void, which led Paul to insert an indwelling catheter (IDC), which reduced some of the abdominal swelling. Haematuria was notable in Mr B's urine, which presented as cloudy red urine and large blood clots. This complicated matters further, as it was then blocking the catheter. Paul was able to unblock the catheter using the recommended procedure.
Mr B was escalated following the medical escalation process and, under the guidance of an emergency on-call doctor, was transferred to the Metropolitan trauma unit. En route to the hospital, Paul administered IV antibiotics, IV fluids and ongoing pain relief.
Discussion
Out-of-hospital care is a highly specialised field unlike any other healthcare profession. Paramedics work autonomously, away from a typical healthcare team, with limited resources and make diagnoses based on a thorough history and physical exam, to be able to develop person-centred care plans. These skills and experiences are highly desirable across all healthcare settings and enable paramedics to work in community practice as a valued part of an interdisciplinary healthcare team. This case study evidences the ability of experienced paramedics to transfer their knowledge, skills and experiences of out-of-hospital care to work in diverse, non-traditional ambulance service settings, as part of a multi-disciplinary team to meet the needs of a community.
The role of a CP will vary depending on definition, scope of practice, the geographical location and the healthcare system they work in. The example, outlined by Paul, demonstrates the necessity to change mindsets away from the traditional definitions of what a paramedic is, and shift them towards what a paramedic can be.
The highest professional body for paramedics in Australia, the Australasian College of Paramedicine (2022), accepts the recommendations from the Grattan Report, which acknowledges the potential role of the paramedic in helping to fill gaps in a healthcare system that is currently under strain.
The recommendations will not only see paramedics working in roles that have not previously been explored within Australasia, but will also allow Australian paramedicine career pathways to develop in a similar manner to those in the UK.
Conclusion
This article adds to the literature by detailing the lived experience of a CP as he undertakes his duties in a non-traditional setting. It provides the first-known reflective account of a lived experience from a CP as he undertakes his role within the community.
The knowledge and skills paramedics possess are transferable and can benefit the healthcare system. The Australasian College of Paramedicine is aggressively pursuing the migration of the paramedic workforce. It is in a process of consultation with their paramedic members to allow paramedics to expand its areas of practice into the wider healthcare system.
This expansion challenges the current mindset of the workforce to see the term ‘paramedic’ as depicting that of an autonomous healthcare practitioner (who can work across healthcare settings), as opposed to someone who works solely for a jurisdictional ambulance service. As community paramedicine in Australia is explored and unfolds, this account may be useful to those paramedics considering career progression and for policymakers who will support the emerging role of the CP.