The aim of this case study was to describe one rural community paramedic model and identify enablers related to the implementation of the model. It was undertaken in the County of Renfrew, Ontario, Canada where a community paramedicine role has emerged in response to demographic changes and broader health system reform. Qualitative data was collected through direct observation of practice, informal discussions, interviews and focus groups.
The crucial role of education in the effective and sustainable implementation of the community paramedicine model was identified as one of four enablers. Traditional paramedicine education programs are narrowly focused on emergency response, with limited education in health promotion, aged care and chronic disease management. Educational programs hoping to include a wider range of topics face the twin challenges of an already crowded curriculum and predominately young students who fail to see the relevance of community primary care content.
A closer match between the paramedicine curriculum and the emerging roles of paramedics, whether they are community paramedics, extended care paramedics, or as yet unformed roles is needed if paramedics are to become valued members of the health care team.
O’Meara P, Walker J, Stirling C, Pedler D. The rural and regional ambulance paramedic: moving beyond emergency response. Paper presented at: National Rural Health Conference Proceedings2007; Canberra.
O’Meara P, Tourle V, Stirling C, Walker J, Pedler D. Extending the Paramedic role in rural Australia: a story of flexibility and innovation. Rural and Remote Health. 2012;12(1978).
Council of Ambulance Authorities. When something goes seriously wrong. Melbourne, Australia: Council of Ambulance Authorities;2012.
Williams B, Onsman A, Brown T. From stretcher-bearer to paramedic: the Australian paramedics' move toward professionalism. Journal of Emergency Primary Health Care. 2009;7(4):Article No 990346.
O'Meara P. The maturation of the paramedic profession through international scholarship. International Journal of Paramedic Practice. 2011a;1(2):2-3.
Cooper S, Grant J. New and emerging roles in out of hospital emergency care: A review of the international literature. International Emergency Nursing. 2009;17:90-98.
O’Meara P. Community Paramedics: Building a sustainable model of service delivery. NSW Rural Health & Research Congress. Wagga Wagga. 2012.
Bradley P. Taking Healthcare to the patient 2: A review of 6 years' progress. London: Association of Ambulance Chief Executives;2011.
Magin P, Adams J, Sibbritt D, Joy E, Ireland M. Experiences of occupational violence in Australian urban general practice: A cross-sectional study of GPs. Medical Journal of Australia. 2005;183(7):352-356.
Ross J. The Patient Journey Through Emergency Care in Nova Scotia: A Prescription for New Medicine. In: Department of Health, ed: Nova Scotia Government; 2010.
Sheppeard A. Money no carrot for home visits. Medical Observer. 13th March, 2008. ed. On-line.
Eburn M, Bendall JC. The provision of Ambulance Services in Australia: a legal argument for the national registration of paramedics. Journal of Emergency Primary Health Care. 2010;8(4):Article 99014.
Woollard M. Professionalism in UK paramedic practice. Journal of Emergency Primary Health Care. 2009;7(4):Article No. 990391.
Townsend R, Luck M. Protective jurisdiction, patient autonomy and paramedics: the challenges of applying the NSW Mental Health Act. Journal of Emergency Primary Health Care. 2009;7(4):Article No 990375.
Emergency Medical Services Chiefs of Canada. Submission to the Standing Committee on Health, December 2011: EMSCC; 2011.
Paramedic Association of Canada. National Occupational Competency Profile. 2011; http://paramedic.ca/nocp/.
Ruest M, Stitchman A, Day C. Evaluating the impact of 911 calls by an in-home programme with a multidisciplinary team. International Paramedic Practice. 2012;1(4):125-132.
Boblin SL, Ireland S, Kirkpatrick H, Robertson K. Using Stake’s Qualitative Case Study Approach to Explore Implementation of Evidence-Based Practice. Qualitative Health Research. September 1, 2013 2013;23(9):1267-1275.
Morgan PI, Ogbonna E. Subcultural dynamics in transformation: A multi-perspective study of healthcare professionals. Human Relations. 2008;6(1):39-65.
Strauss A, Corbin J. Basics of qualitative research: Ground theory procedures and techniques. 2nd ed. Thousand Oaks, CA: Sage; 1998.
Natalier K. The Research Question: the heart of the research design. In: Walter M, ed. Social Research Methods. Melbourne: Oxford University Press; 2013:40-41.
Mays N, Pope C. Qualitative Research: Observational methods in health care settings. British Medical Journal. 1995;311:182.
White R, Wingrove G. Principles for Community Paramedicine Programs: National Rural Health Association;2012.
Thompson J, Drummond C. Exploring paramedic patient assessment. Journal of Paramedic Practice. 2013;5(6):342-347.
Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding Paramedic Scope of Practice in the Community: A Systematic Review of the Literature. Prehospital Emergency Care. 2013;17(3):361-372.
Ontario Paramedic Association. Application for Regulation of Paramedics under the Regulated Health Professions Act, 19912013.
D'Angelo C. Community Paramedicine: Without the Lights and Sirens. Canadian Paramedicine. 2012;35(2):28-29.
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 Journal of Emergency Primary Health Care 2009;7(2):Article 990312.
Joyce CM, Wainer J, Piterman L, Wyatt A, Archer F. Trends in the paramedic workforce: a profession in transition. Australian Health Review. 2009;33(4):533-540.
Lord B. The Development of a Degree Qualification for Paramedics at Charles Sturt University. Journal of Emergency Primary Healthcare. 2003;1(1-2):Article No. 990001.
Willis E, Williams B, Brightwell R, O’Meara P, Pointon T. Road-ready paramedics and the supporting sciences curriculum. Focus on Health Professional Education. 2010;11(2):1-13.
Pointon T. Development of professional paramedic education at Flinders University, Adelaide, South Australia. Journal of Emergency Primary Health Care. 2004;2:1-2.
Hou X-Y, Rego J, Service M. Review article: Paramedic education opportunities and challenges in Australia. Emergency Medicine Australasia. 2013;25(2):114-119.
North Central EMS Institute. Community Paramedic Curriculum 3.0. St Cloud, Minnesota: NCEMSI; 2012:241.
Keyes C, Page D, Corry M. How Freedom House has been reborn. Journal of Emergency Medical Services. 2013;March 25, 2013:Article 27365.
Walker J. Educating paramedics. In: O'Meara P, Grbich C, eds. Paramedics in Australia: Contemporary challenges of practice. First ed. Sydney: Pearson Education Australia; 2009:152-164.
Bowles R, R. From learning activities to the meaning of life: Fostering professionalism in Canadian paramedic education. Journal of Emergency Primary Health Care. 2009;7(4):Article No 990392.
Council of Ambulance Authorities. Guidelines for the Assessment and Accreditation of Entry-level Paramedic Education Programs. Adelaide: Council of Ambulance Authorities Inc.;2010.
Michau R, Roberts G, Williams B, Boyle M. An investigation of theory-practice gap in undergraduate paramedic education. BMC Medical Education. 2009;9(1):Article No. 23.
Ambulance Service Association. The future role and education of paramedic ambulance service personnel (emerging concepts)2000.
Cooper S. Contemporary UK paramedical training and education. How do we Train? How should we educate? Emerg Med J. 2005;22:375-379.
Leggio WJ. Is the Bar for Entry into the Practice of EMS Too Low? A Reflection from the Inside and Outside. DOMAIN3. 2013;Spring/Summer:18-24.
Hallikainen J, Väisänen O, Rosenberg PH, Silfvast T, Niemi-Murola L. Interprofessional education of medical students and paramedics in emergency medicine. Acta Anaesthesiologica Scandinavica. 2007;51:372-377.
Margolis G. The Role of Bachelor's Degree Emergency Medical Services Programs in the Professionalization of Paramedicine: University of Pittsburgh; 2005.
King JA. NHTSA Notes Commentary: EMS Education Agenda for the Future: Flexner Revisited. Annals of Emergency Medicine. 2000;35(6):624-625.
National Association of EMS Educators. Position Statement: EMS education agenda for the future: a systems approach. Prehospital Emergency Care. October/December 2000;4(4):365-366.
Patterson DG, Skillman SM. A National Agenda for Community Paramedicine Research. Seattle, WA: WWAMI Rural Health Research Centre, University of Washington;2012.
O'Meara P. So how can we frame our identity? Journal of Paramedic Practice. 2011b;3(2):5.