Making it about the professional

I am just back from the Paramedics Australasia conference in Hobart and the Rural Health and Research Congress in Wagga. At both conferences, one for paramedics and one for rural health professionals, community paramedicine featured high on the agenda for the first time. Community paramedicine is a new and evolving subset of practice, really having not existed before the mid-2000s. Given “Paramedicine” itself is thought to only be less than 16 years old as an academic body of knowledge, there’s a lot of room for growth.

One of the key issues being discussed is how does a paramedic working in the community paramedicine model is whether the profession is centred around the paramedic or the ambulance. In rural practice where there is increasing emphasis on multi-disciplinary and situated practice, the ambulance is less aand less a part of the paramedic’s professional identity. Having said that it will always be a key component of the rural paramedic’s arsenal of tools and the continued role of rural paramedics role in emergency response.

A number of papers have been done which outline the unique position of rural paramedics and the diversity of their role. These papers all discuss the unique community-based nature of rural paramedicine and discuss the context of practice. (Mullholland, Stirling, &Walker 2010, Blacker, Pearson & Walker 2010, O’Meara, et al 2006)

A model I have developed to help conceptualise a paramedic-centric view of the profession is shown below:

Emergency response will always remain at the core of paramedic practice. However, as paramedics in rural communities are not always engaged in emergency response taskings this creates capacity to expand the role to incorporate other health activities with the unused capacity. Primary health care is one of the logical extensions of paramedic practice given the impact of primary health care on acute heath emergencies. Health promotion is an equally related area which assists in building community engagement as well as improving health outcomes and equity.

Some services, especially in Canada are reconceptualising themsleves as “paramedic services” (for example Country of Renfrew or Frontenac, or Ottawa Paramedic Services). This concept potentially moves the focus from the vehicle to the professional.

Having said that, ambulances will always have role in paramedic practice and the movement of discourse away from the vehicle by no means reduce the importance of ambulances or transport to hospital from emergenc response to health emergencies. While a large focus of paramedicine is moving highly trained professionals to patients, the value of rapidly moving patients to appropriate facilities is equally as important.