Pre hospital medical services and paramedic engagement in Australian health care – Improving the pathways of care through collaborative action
Paramedics Australasia (PA) is the national body representing paramedics engaged in delivery of pre hospital emergency health care. PA is thus uniquely positioned to provide insights into the role of pre hospital medicine in the continuum of care. Every day in Australia, patients are placed at risk of harm within the health-care system. These risks are particularly notable in pre hospital care where paramedics must often tend for patients under adverse operating conditions and performinterventions that carry significant risks. Paramedics must make clinical judgements that may profoundly affect patient outcomes – often with no access to patient history. Pre hospital medicine has changed dramatically in recent years. Paramedic practice has evolved as a unique discipline combining medicine, public health and public safety. Contemporary pre hospital medical care is now provided by professionally qualified practitioners. These developments have been built on a strong evidence base demonstrating the capacity to enhance patient outcomes through appropriate clinical interventions. Paramedics and pre hospital service providers alike have had to overcome many challenges in this journey, not the least being the education, recruitment and retention of a professional workforce and the difficulties in funding the infrastructure upon which to build a comprehensive emergency response capability. The PA vision for pre hospital medicine is based on the premise that it is an essential part of primary health care and that its seamless integration into health care will better meet patient needs that might otherwise remain unfulfilled. Paramedics can provide a variety of community health services that are crucial in the provision of more comprehensive care, especially in rural and remote communities. PA has endorsed the philosophical approach to health care outlined in the 15 National Health and Hospitals Reform Commission Health Care Principles, and recommends the translation of those principles into the pre hospital medicine environment. Given those principles it is inexplicable how paramedics have remained unrecognised as health professionals and pre hospital medicine has been ignored as part of the health care reform process. Embracing the National Health and Hospitals Reform Commission principles should see pre hospital medicine forming not only part of the local health care system but also meshed into the fabric of the community. There should be community engagement in the assessment and evaluation of pre hospital medicine care and the regulation of practitioners under a national system of professional registration. These processes will better enable the benefits of holistic care to be realised. Despite the excellence and dedication of the paramedic workforce, PA recognises that formidable challenges remain in health care delivery. These include issues of equality and access, demographic coverage, safety and quality, as well as other workforce and resource issues that affect patient outcomes. Paramedics can assist in identifying and resolving many of these issues. Australia’s health system should provide suitably rapid pre hospital medical responses with levels of care appropriate to the circumstances of each patient. Paramedics moreover hold competencies that can provide prevention, evaluation, care, triage, referral and health advisory services that can be mobilised to enhance community healthcare resources. Access to professional paramedic services should thus form an integral part of the care regime available to the community. This should be an inter-professional model of healthcare practice founded on contributions from a dynamic mixture of professional expertise at all stages of the patient journey. In PA’s view, the virtual absence of references to the role and funding of paramedic services as a key component of the health care system at a national level is a grave oversight. A nationally driven policy perspective is needed that integrates pre hospital medicine into the health system. Fulfilling the PA vision of health care requires significant change in the way paramedic services are funded and administered. It will need advice from the best available minds and committed leadership within government and the health professions to bring the already demonstrated benefits of paramedic practice to the community. Many issues need to be addressed including: (a) Sustainable funding models under national access and equity principles; (b) Education, clinical training, staff recruitment and retention; (c) Safety and quality standards and the minimisation of patient risk; (d) Extended community care models in remote and low-volume settings; (e) Clinical governance, service accreditation and practitioner registration; (f) Adequacy of evidentiary data collection to assess patient outcomes, support service evaluation and underpin research; and (g) Infrastructure integration including communication networks and dynamic referral to manage external events and cope with capacity constraints. PA strongly believes that these issues cannot be considered in isolation. Pre hospital medicine practitioners must be involved in contributing their expertise in conjunction with other health professionals so as to create a seamless system of best practice care beginning at the point of need – the patient. To fulfil that promise PA has outlined a vision for the delivery of pre hospital medicine as part of an integrated health care system. Only by incorporating the input of paramedic clinicians into that national policy and operational arena can the best patient outcomes be achieved.