Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature
Tegwyn McManamny A F , Paul A. Jennings B , Leanne Boyd C , Jade Sheen D and Judy A. Lowthian A EA School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.
B Department of Community Emergency Health and Paramedic Practice, Monash University, Moorooduc Hwy, Frankston, Vic. 3199, Australia. Email: paul.jennings@monash.edu
C Cabrini Health, 154 Wattletree Road, Malvern, Vic. 3144, Australia. Email: lboyd@cabrini.com.au
D School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia. Email: jade.sheen@deakin.edu.au
E Bolton Clarke Research Institute, Suite 1.01, 973 Nepean Highway, Bentleigh, Vic. 3204, Australia. Email: jlowthian@boltonclarke.com.au
F Corresponding author. Email: tegwyn.mcmanamny@monash.edu
Australian Health Review 44(1) 114-120 https://doi.org/10.1071/AH17228
Submitted: 28 September 2017 Accepted: 21 September 2018 Published: 15 November 2018
Abstract
Objective A growing body of research indicates that paramedics may have a greater role to play in health care service provision, beyond the traditional models of emergency health care. The aim of this study was to identify and synthesise the literature pertaining to the role of paramedic-initiated health education within Australia, with specific consideration of metropolitan, rural and remote contexts.
Methods A literature review was undertaken using the Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and Scopus databases. The search time frame was limited from January 2007 to November 2017. The search was performed using key paramedic search terms in combination with keywords such as health education, rural, metropolitan, remote and Australia. Reference lists from relevant papers were also reviewed.
Results Fourteen articles met the inclusion criteria for synthesis. Health education in the Australian paramedic context relates largely to expanded-scope paramedics, health promotion and the role of paramedics as key members of local communities. There were no studies specifically related to the paramedic role in health education, although many papers referred to health education as one of many roles paramedics engage in today.
Conclusion This review highlights a broadening of paramedicine’s traditional scope of practice, and an indication of how vital paramedics could be to local communities, particularly in rural and remote areas. An expanded role may help address health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers.
What is known about the topic? A broadening of paramedicine’s traditional scope of practice has been linked to improvements in health workforce sustainability problems in areas where health care provision is challenged by geographical constraints and low workforce numbers, such as rural and remote Australia. Health education, as well as health promotion, primary health care and chronic disease management, have been proposed as potential activities that paramedics could be well placed to participate in, contributing to the health and well-being of local communities.
What does this paper add? This paper identifies and synthesises literature focusing on paramedic-initiated health education in the Australian context, assessing the current health education role of paramedics in metropolitan, rural and remote areas. It provides an understanding of different geographical areas that may benefit from expanded-scope prehospital practice, indicating that the involvement of paramedics in health education in Australia is significantly determined by their geographical place of work, reflecting the influence of the availability of healthcare resources on individual communities.
What are the implications for practitioners? Today’s paramedics fill broader roles than those encompassed within traditional models of prehospital care. Rural and remote communities facing increasing difficulty in obtaining health service provision appear to benefit strongly from the presence of expanded-scope paramedics trained in health promotion, primary injury prevention, chronic disease management and health education: this should be a consideration for medical and allied health practitioners in these areas. Australian paramedics are uniquely placed to ‘fill the gaps’ left by shortages of healthcare professionals in rural and remote areas of the country.
References
[1] Paramedics Australia. Paramedic. 2017. Available at: https://www.paramedics.org/paramedicine-role-descriptors/paramedic/ [verified 3 November 2017].[2] Stirling CM, O’Meara P, Pedler D, Tourle V, Walker J. Engaging rural communities in health care through a paramedic expanded scope of practice. Rural Remote Health 2007; 7 839
[3] Raven S, Tippett V, Ferguson JG. An exploration of expanded paramedic healthcare roles for Queensland. Brisbane: Queensland Department of Emergency Services; 2006.
[4] Hocke I, O’Brien A. Strengthening the capacity of remote Indigenous communities through emergency management. AUJIEmMgmt 2003; 18 62–70.
[5] Reeve C, Pashen D, Mumme H, De la Rue S, Cheffins T. Expanding the role of paramedics in northern Queensland: an evaluation of population health training. Aust J Rural Health 2008; 16 370–5.
| Expanding the role of paramedics in northern Queensland: an evaluation of population health training.Crossref | GoogleScholarGoogle Scholar |
[6] Evans R, McGovern R, Birch J, Newbury-Birch D. Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature. Emerg Med J 2014; 31 594–603.
| Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[7] Mason S, O’Keeffe C, Coleman P, Edlin R, Nicholl J. Effectiveness of emergency care practitioners working within existing emergency service models of care. Emerg Med J 2007; 24 239–43.
| Effectiveness of emergency care practitioners working within existing emergency service models of care.Crossref | GoogleScholarGoogle Scholar |
[8] Mason S, Knowles E, Freeman J, Snooks H. Safety of paramedics with extended skills. Acad Emerg Med 2008; 15 607–12.
| Safety of paramedics with extended skills.Crossref | GoogleScholarGoogle Scholar |
[9] White R, Wingrove G. National Rural Health Association policy brief. Principles for community paramedicine programs. 2012. Available at: https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/PrinciplesforCommunityParamedicineSept-2012.pdf.aspx?lang=en-US [verified 15 October 2018].
[10] Garza M. Beyond EMS. Community paramedics make house calls. JEMS 2007; 32 62–8.
[11] Ambulance Service of New South Wales. Ambulance year in review 2010/11. 2011. Available at: http://www.ambulance.nsw.gov.au/Media/docs/120328%20Year%20in%20Review%202010-11-d7c20512-b849- 4b3c-8288-addd21baaac5-0.pdf [verified 4 April 2013].
[12] Australian Institute of Health and Welfare (AIHW). Rural, regional and remote health: a guide to remoteness classifications. Catalogue no. PHE 53. Canberra: AIHW; 2004.
[13] Agarwal G, Angeles RN, McDonough B, McLeod B, Marzanek F, Pirrie M, Dolovich L. Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS). BMC Res Notes 2015; 8 113
| Development of a community health and wellness pilot in a subsidised seniors’ apartment building in Hamilton, Ontario: Community Health Awareness Program delivered by Emergency Medical Services (CHAP-EMS).Crossref | GoogleScholarGoogle Scholar |
[14] Jaslow D, Ufberg J, Marsh R. Primary injury prevention in an urban EMS system. J Emerg Med 2003; 25 167–70.
| Primary injury prevention in an urban EMS system.Crossref | GoogleScholarGoogle Scholar |
[15] Krimston J, Griffiths K. EMS champions of injury prevention. Highlights from some of the best injury-prevention programs in the United States. JEMS 2004; 29 80–4, 86, 88 passim.
[16] Lerner EB, Fernandez AR, Shah MN. Do EMS professionals think they should participate in disease prevention? Prehosp Emerg Care 2009; 13 64–70.
| Do EMS professionals think they should participate in disease prevention?Crossref | GoogleScholarGoogle Scholar |
[17] MacDonald GS, Steiner SR. Emergency medical service providers’ role in the early heart attack care program: prevention and stratification strategies. Md Med J 1997; 1985 67–79.
[18] Mann NC, Hedges JR. The role of prehospital care providers in the advancement of public health. Prehosp Emerg Care 2002; 6 S63–7.
| The role of prehospital care providers in the advancement of public health.Crossref | GoogleScholarGoogle Scholar |
[19] Tadros A, Crocco T, Davis SM, Newman J, Mullen J, Best R, Teets A, Maxwell C, Slaughter B, Teter S. Emergency medical services-based community stroke education: pilot results from a novel approach. Stroke 2009; 40 2134–42.
| Emergency medical services-based community stroke education: pilot results from a novel approach.Crossref | GoogleScholarGoogle Scholar |
[20] Olaussen A, Semple W, Oteir A, Todd P, Williams B. Paramedic literature search filters: optimised for clinicians and academics. BMC Med Inform Decis Mak 2017; 17 146
| Paramedic literature search filters: optimised for clinicians and academics.Crossref | GoogleScholarGoogle Scholar |
[21] Lynagh M, Sanson-Fisher R, Shakeshaft A. Alcohol-related harm: perceptions of ambulance officers and health promotion actions they do and would do. Health Promot J Austr 2010; 21 19–25.
| Alcohol-related harm: perceptions of ambulance officers and health promotion actions they do and would do.Crossref | GoogleScholarGoogle Scholar |
[22] Mulholland P, O’Meara P, Walker J, Stirling C, Tourle V. Multidisciplinary practice in action: the rural paramedic – it’s not only lights and sirens. J Emerg Prim Health Care [now Australasian Journal of Paramedicine] 2009; 7: 990312. Available at: https://ajp.paramedics.org/index.php/ajp/article/view/166 [verified 23 October 2018].
[23] Mulholland P. A comparison of the practice of rural and urban paramedics: bridging the gap between education, training and practice. MMedSci Thesis, University of Tasmania, Hobart; 2010.
[24] Mulholland P, Stirling C, Walker J. Roles of the rural paramedic much more than clinical expertise. In Gregory G, editor. 10th National Rural Health Conference, 17–20 May 2009; Cairns Qld. Canberra: National Rural Health Alliance; 2009.
[25] O’Meara PF, Tourle V, Stirling C, Walker J, Pedler D. Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural Remote Health 2012; 12 1978
[26] Bisits Bullen P. Medics as a channel for worksite health promotion in remote global locations. Am J Health Promot 2012; 26 352–5.
| Medics as a channel for worksite health promotion in remote global locations.Crossref | GoogleScholarGoogle Scholar |
[27] Oprescu F, Barr N, Lord W. What are the potential roles of the Paramedic Professionals in Health Promotion? An inter-professional perspective. 22nd National Australian Health Promotion Association Conference & 18th Chronic Diseases Network Conference, 4–5 September 2014; Alice Springs, Australia. Adelaide: AHPA; 2014. p. 1–2.
[28] Raven S, Tippett V, Murdoch J, Stephens J, O’Brien A. Expanded paramedic healthcare roles in rural and remote communities. In: 9th National Rural Health Conference; 7–10 March 2007; Albury, NSW. Canberra: National Rural Health Alliance; 2007.
[29] Reed B. Paramedic health promotion: connecting ambulance services to communities. Abstracts of the 2012 Paramedics Australasia Conference, 2–3 November 2012, Hobart, Tasmania, Australia. Melbourne: Paramedics Australasia; 2012. p. 12.
[30] Acker JJ, Johnston TM, Lazarsfeld-Jensen A. Industrial paramedics, out on site but not out of mind. Rural Remote Health 2014; 14 2856
[31] Blacker N, Pearson L, Walker T. Redesigning paramedic models of care to meet rural and remote community needs. In Gregory G, editor. 10th National Rural Health Conference, 17–20 May 2009; Cairns Qld. Canberra: National Rural Health Alliance; 2009.
[32] The Council of Ambulance Authorities. The factors affecting the supply of health services and medical professionals in rural areas: submission to the Senate Standing Committee on Community Affairs. Melbourne: The Council of Ambulance Authorities; 2011.
[33] Toloo S, FitzGerald G, Aitken P, Ting J, Tippett V, Chu K. Emergency health services: demand and service delivery models. Monograph 1: literature review and activity trends. Brisbane: Queensland University of Technology; 2011.
[34] Lowthian JA, Jolley DJ, Curtis AJ, Currell A, Cameron PA, Stoelwinder JU, McNeil JJ. The challenges of population ageing: accelerating demand for emergency ambulance services by older patients, 1995–2015. Med J Aust 2011; 194 574–8.
[35] O’Meara P, Ruest M, Stirling C. Community paramedicine: Higher education as an enabling factor. Australasian Journal of Paramedicine 2014; 11
[36] O’Meara PF, Furness S, Gleeson R. Educating paramedics for the future: a holistic approach. J Health Hum Serv Adm 2017; 40 219–51.
[37] O’Meara P, Walker J, Stirling C, Pedler D, Tourle V, Davis K, Jennings P, Mulholland P, Wray D. The rural and regional ambulance paramedic: moving beyond emergency response – report to the Council of Ambulance Authorities Inc. Bathurst: Charles Sturt University, School of Public Health; 2006.
[38] Thompson C, Williams K, Morris D, Lago L, Kobel C, Quinsey K, Eckermann S, Andersen P, Masso M. HWA Expanded Scopes of Practice Program evaluation: extending the role of paramedics sub-project final report. Wollongong: Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong; 2014.
[39] Deakin CD, King P, Thompson F. Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills? Emerg Med J 2009; 26 888–91.
| Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?Crossref | GoogleScholarGoogle Scholar |
[40] Moscati R. Protection of human subjects in prehospital research. Prehosp Emerg Care 2002; 6 S18–23.
| Protection of human subjects in prehospital research.Crossref | GoogleScholarGoogle Scholar |
[41] Cooke MW, Wilson S. Obstacles to research in pre-hospital care. Pre-hospital Immediate Care 1999; 3 149–51.
[42] FitzGerald G. Guest editorial - research in prehospital care. J Emerg Prim Health Care [now Australasian Journal of Paramedicine] 2003; 1
[43] Tippett V, Woods S, Fitzgerald G, Clark M. Towards a national research agenda for the ambulance and pre-hospital sector in Australia. J Emerg Prim Health Care [now Australasian Journal of Paramedicine] 2003; 1(1–2). Available at: https://ajp.paramedics.org/index.php/ajp/article/view/73 [verified 23 October 2018]
[44] Jacobs I. Pre-hospital care: a plea for more research. Emerg Med Australas 2000; 12 175–6.
| Pre-hospital care: a plea for more research.Crossref | GoogleScholarGoogle Scholar |
[45] Erich J. Ending the opinion age: seeking evidence behind EMS. Emerg Med Serv 2002; 31 45–8.
