Transcript

Supporting rural paramedics

Peter O'Meara
p.omeara@latrobe.edu.au

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Transcript

Matt Smith:

Being a paramedic is a job of high responsibility, and isn't just driving an ambulance and playing with the siren. You're in charge of the first assessment and treatment of a patient. Quick decisions are required and sometimes in dangerous circumstances. So how does the situation change for a paramedic in a rural setting. Different environment, different population, different job. I'm Matt Smith, and this is a La Trobe University podcast and my guest today is Professor Peter O'Meara, Head of the Department of Paramedical Studies at the La Trobe Rural Health School, and this is a problem he's been addressing.

Peter O'Meara:

What we did over about a five or six year period was look at rural paramedics to see how they were different from other paramedics and how they were evolving in terms of role with the other changes in the health system.

Matt Smith:

So did you expect to find a lot of changes though?

Peter O'Meara:

We expected the paramedics in rural areas would have a different type of practice in that they see the patients for a little longer in many cases, they often treat patients they know, and they see the same patients repeatedly because of the smaller communities. It was somewhat different and the other thing of course is that they work more closely on a one to one basis with other health professionals. It's different when you're dealing with the local GP on a regular basis than if you're dealing with a large emergency department where there's a cavalcade of doctors and nurses there, although you get to know a few – it's not quite the same thing as in a rural area, where it's always the same people.

Matt Smith:

So it sounds like the job for a paramedic in a rural area, you get to know the patients, you get to know what to expect before you get there. Is that sort of thing fair to say?

Peter O'Meara:

Dealing with people you know is sometimes very difficult. The emotional resilience you need is quite substantial and there's been lots of stories of paramedics who've left towns because the emotional toll of dealing with people they know is a bit of a challenge, and GPs and nurses and other health professionals go through this. On the other side, it's very satisfying to help people you know.

Matt Smith:

So what have you been doing in your study then?

Peter O'Meara:

What we did, we wanted to describe what has been increasingly called a community paramedic is, in a rural area, and we found that there were four elements of the role. One was firstly the engagement with the community, whether as health professionals or as members of the community generally. So people get out and they talk to schools and everyone knows who they are and there's this informal contact and you have more influence on local issues. The second element was emergency response, which is fairly straightforward. That's involving generally to keep people out of hospitals a lot more, so that's a big issue as well. You've seen in the media about the overcrowding in hospital departments. Well, the ambulance service and paramedics have got a big role in trying to manage that situation. The third part of the model was what we called situated practice, and what that means is that your practice changes according to where you are, and the type of population you're looking after. So you could be in a ski resort for instance and you have a lot of tourists during the winter and not many people in the summer, so it's different, and it's a bit more isolated – there's no big hospitals. You could have people at the seaside, you could be out in the middle of Australia with an aboriginal community. So how you practice very much depends on where you are and the people you're looking after. And the final part of the model was primary health care, where paramedics get much more involved in primary health care than they do say in a metropolitan area. So it's being at the top of the cliff doing things like health promotion, health education, rather than waiting at the bottom for people to fall over. So that involves a lot more involvement with other health professionals, and again, with the community. So it sort of closes the loop in a sense.

Matt Smith:

So are rural health paramedics still paramedics, or do you consider them health care providers or something else, because it sounds like a lot of that would go outside their basic job description.

Peter O'Meara:

It's sort of extends their job a little bit. We're not talking about them using skills they don't really have. In a lot of country areas, ambulance services don't do a lot of emergencies. They might do one case a day in some of the really small places. And the paramedics sitting there are really not using their skills and knowledge very effectively, while other health professionals may be really busy, in a little place, doing those preventative primary health care activities. So if you can actually use the paramedic to help supplement those services, everyone's better off.

Matt Smith:

Did the paramedics that you surveyed feel that their practices were suitable?

Peter O'Meara:

I think the changes were a little bit confronting for some paramedics. We've been brought up on the idea that we're emergency providers and we just respond to emergencies and we must be available all the time, and in fact there's a lot of time that nothing much is going on, and you could do other things. So it's really changing the mindset to say, hey, we've got all these skills and knowledge – let's use them. Let's share them with other people and complement what other health professionals are up to, rather than just sit at a station and wait for an emergency to happen.

Matt Smith:

Is there sufficient support for those sorts of changes though, because it sounds like something that people would look at and go, no, that's not their job, it's outside their job description. Paramedics in the city can't be expected to do those sort of duties as well.

Peter O'Meara:

That's right. I think you've hit the nail on the head. It's very difficult to change that. The way the ambulance services are set up, they have to actually believe in this type of change, and set in place some processes to make it happen, so that it's effective and doesn't impact negatively on emergency response. And that's what's going on in other countries, where there's big pushes for what they call community paramedics, and they're making it part of their mainstream operations, rather than just an add-on.

Matt Smith:

Do you have an example of a country that's doing this?

Peter O'Meara:

Yes. There's a number of projects in Canada and in the United States. Probably the longest established program is in Nova Scotia, in Canada, where paramedics, nurse practitioners and medical officers all work together to provide care to some remote island communities. And that seems to work really well.

Matt Smith:

Would that sort of model work in Australia? I mean, we don't have so many island communities, but we have some very remote, isolated outback communities that could maybe benefit from it?

Peter O'Meara:

Oh yes, it would definitely work, and there are some examples in Australia, where this type of scheme's been set up. One in Victoria is Mallacoota, where it's isolated, about 1,500 people, and they're very much doing what we'd describe as a community paramedic.

Matt Smith:

How do you go about teaching rural paramedics to be better prepared then?

Peter O'Meara:

I think you do what most university courses are doing now, and we're particularly doing at La Trobe, is to give them a broader education in things like public health and health promotion and understanding what other health professionals do, so that they can work inter-professionally more effectively. I think the core skills that paramedics have are fine. There's really no need to change that greatly. But they do need to understand population health much better and improve their teamwork skills.

Matt Smith:

So under this sort of system, what would the duties of a paramedic be in a rural health setting? It wouldn't just be to go and assess and be the first point of health and then take somebody to the hospital and that's the end of it. There'd be more duties as an extension, wouldn't there?

Peter O'Meara:

That's right. It depends where you go. There's projects where patients are actually discharged to home and rather than the patient having to go back to the hospital all the time to get checkups, the paramedics can go into the home and monitor their condition – they can monitor them for diabetes, they can monitor their blood pressure, they can do some wound management, so the patient can stay at home. And you just fit that in amongst other jobs. There's programs where paramedics facilitated patients to do rehabilitation at home and to join health clubs and things like that, and set up programs in consultation with the hospitals and doctors and the health clubs and so forth, so it's safe for everyone.

Matt Smith:

OK, so is that suitably dealing with the lack of health care professionals in rural areas, or is that just making do with what we've got?

Peter O'Meara:

It is helping, because in many rural areas, there's just not enough people to go round, and you've got a fairly valuable resource sitting there at an ambulance station, already, not being used to their full potential, and if you can do that, you're sort of making something out of nothing, in a sense. But it's very important that we just don't set ourselves up to practise in isolation. We're not nurses, we're not doctors, we're paramedics, and we can supplement what we do and help other people, without doing anything that steps on anyone's toes.

Matt Smith:

Professor Peter O'Meara there, and he's teaching paramedicine out of the Bendigo Campus of La Trobe University. If you have any questions, comments or feedback about this podcast, or any other, then send us an email at podcast@latrobe.edu.au.

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