A large workforce is employed in remote environments in the Australian mining and fuel sectors. Whereas paramedics are increasingly assuming roles as healthcare providers in these locations, little is known about industrial paramedic practice. The aim of this exploratory study was to better understand the demographics, education, clinical practice and work environment of the Australian paramedic workforce in remote and industrial settings to inform future research and education for the emerging specialty.
Web-based respondent driven network sampling was used to recruit remote and industrial paramedics in this cross-sectional descriptive study. A self-administered questionnaire elicited responses (n=111) about participant demographics, work environment, initial and continuing education, and clinical scope of practice.
Paramedic participants working in remote and industrial settings are predominately male (86.5%) with the majority aged 35 to 44 years (38.7%). Their job titles range widely and include paramedic, intensive care paramedic, industrial, mine and offshore paramedics. Participants report an average of 15.4 years of total healthcare experience and working in the remote or industrial health sector for a mean of 7.1 years, primarily in Western Australia (34.2%). These paramedics often engage in continuing education, with 45% studying at a vocational or tertiary institution at the time of the survey. Most respondents (63.9%) describe their employment as directly or indirectly related to the natural resource sector and 75.7% have experience in remote settings such as camps, mining sites, offshore platforms, vessels or small communities. Most practitioners (59.5%) work in a full-time capacity and can perform core paramedic skills including intravenous cannulation, 12-lead electrocardiogram interpretation, chest needle decompression and restricted drug administration. Additionally, more than 40% of those actively working in the sector report having endotracheal intubation and intraosseous access in their scope of practice. They also administer immunisations, antibiotics and other prescription medications, manage chronic diseases, and perform low acuity skills typically included in a community paramedic role.
This workforce survey is the first of its kind designed to gain a broader understanding of the paramedic practitioners who work in remote and industrial settings and the characteristics of their work environment. Key areas highlighted by this study serve to inform professional regulators, educators and employers with respect to the skills that remote and industrial paramedics perform and the education that is required to support the evolving specialised practice.
Norman JN, Ballantine BN, Brebner JA, et al. Medical evacuations from offshore structures. Br J Ind Med 1988;45:619-23.
Commonwealth of Australia. Why Australia: Benchmark Report 2020. Australian Trade and Investment Commission (AUSTRADE); 2020 August 2020. Report No.: 2205-9415.
Bisits Bullen PA. Medics as a channel for worksite health promotion in remote global locations. Am J Health Promot 2012;26:352-5.
Parker S, Fruhen L, Burton C, et al. Impact of FIFO work arrangements on the mental health and wellbeing of FIFO workers. West Australia: Centre for Transformative Work Design; 2018. Available at: https://www.mhc.wa.gov.au/media/2547/impact-of-fifo-work-arrangement-on-the-mental-health-and-wellbeing-of-fifo-workers-full-report.pdf
Jones R, Cattani M, Cross M, et al. Serious injuries in the mining industry: preparing the emergency response. Australasian Journal of Paramedicine 2019;16.
Taylor DH, Casta R, Walker V, Collier F, Fromm RE, Jr. Air medical transport of patients from offshore oil and gas facilities. Historical accident data and initial experience. Air Med J 1993;1:21-8.
Phillips JC. Medical support by a team of doctors to offshore paramedics. J R Coll Gen Pract 1987;37:168-9.
Duffy B. Dental problems in the offshore oil and gas industry: a review. Occup Med 1996;46:79-83.
Aalund LR. Remote paramedics have high level of training. The Oil and Gas Journal 1996;94:42.
Proctor JC. Distant oceanic paramedical practice: an example of environmental health nursing in remote hazardous locations. Life Support Biosph Sci 1998;5:437-42.
Harries MG. Medical aspects of the North Sea oil industry. J R Soc Med 1983;76:793-5.
Vearrier D, Greenberg MI. Occupational health of miners at altitude: adverse health effects, toxic exposures, pre-placement screening, acclimatization, and worker surveillance. Clin Toxicol 2011;49:629-40.
Rhodes A. Oil companies focus on health care for remote operations. The Oil and Gas Journal 1996;94:76-80.
Torkington AM, Larkins S, Gupta TS. The psychosocial impacts of fly-in fly-out and drive-in drive-out mining on mining employees: a qualitative study. Aust J Rural Health 2011;19:135-41.
Levett-Jones T, Bourgeois S. Occupational health nursing. 2011. In: The clinical placement: an essential guide for nursing students [Internet]. Chatswood, NSW: Churchill Livingstone.
Cox RAF. Medical services to offshore drilling. Injury 1970;1:217-25.
Joyce C, Wainer J, Piterman L, Wyatt A, Archer F. Trends in the paramedic workforce: a profession in transition. Aust Health Rev 2009;33:533-40.
Witham H. Remote and rural nursing: an endangered profession? Aust Nurs J 2000;7:18-21.
Council of Ambulance Authorities. Regulation of Paramedics 2012. Available at: www.caa.net.au/attachments/article/127/2012_Regulation_of_Paramedics_CAA_Submission_Final.pdf
National Rural Health Alliance Ltd. The paramedic workforce in rural, regional and remote Australia. 2019. Available at: www.ruralhealth.org.au/sites/default/files/publications/paramedic-fact-sheet.pdf
Campeau AG. The space-control theory of paramedic scene-management. Symb Interact 2008;31:285-302.
Seel D, Turner M. Industrial paramedic: an emerging speciality? Journal of Paramedic Practice 2016;8:350-5.
Bigham BL, Buick JE, Brooks SC, et al. Patient safety in emergency medical services: a systematic review of the literature. Prehosp Emerg Care 2012;16:20-35.
Jensen J, Croskerry P, Travers A. Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study. BMC Emerg Med 2009;9:17-20.
O'Meara P, Wingrove G, Nolan M. Frontier and remote paramedicine practitioner models. Rural Remote Health 2018;18(3).
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.
Australasian College of Paramedicine. Membership 2021. Available at: https://paramedics.org/membership
Acker J, Johnston T, Lazarsfeld-Jensen A. Industrial paramedics, out on site but not out of mind. Rural Remote Health 2014;14.
Bowles RR, van Beek C, Anderson GS. Four dimensions of paramedic practice in Canada: defining and describing the profession. Australasian Journal of Paramedicine 2017;14.
Keane S, Smith T, Lincoln M, Wagner S, Lowe S. The Rural Allied Health Workforce Study (RAHWS): background, rationale and questionnaire development. Rural Remote Health 2008;8:1132.
Worley P, Strasser R, Prideaux D. Can medical students learn specialist disciplines based in rural practice: lessons from students’ self reported experience and competence. ibid. 2004;4:338.
Wejnert C, Heckathorn DD. Web-based network sampling: efficiency and efficacy of respondent-driven sampling for online research. Sociol Methods Res 2008;37:105-34.
Bauermeister JA, Zimmerman MA, Johns MM, et al. Innovative recruitment using online networks: lessons learned from an online study of alcohol and other drug use utilizing a web-based, respondent-driven sampling (webRDS) strategy. J Stud Alcohol Drugs 2012;73:834-8.
Gibson Smith K, Paudyal V, Klein S, Stewart D. Health, self-care and the offshore workforce - opportunities for behaviour change interventions, an epidemiological survey. Rural Remote Health 2018;18.
Australian Health Practitioner Regulation Agency. Paramedicine Board of Australia 2019/20 Annual Report. 2020. Available at: https://www.ahpra.gov.au/Publications/Annual-reports/Annual-Report-2020.aspx
Carte NS, Williams C. Role strain among male RNs in the critical care setting: perceptions of an unfriendly workplace. Intensive Crit Care Nurs 2017;43:81-6.
Cudé G, Winfrey K. The hidden barrier: gender bias: Fact or fiction? Nurs Womens Health 2007;11:254-65.
Lewis J, Miles M, Watson TA, Lankford E. Effect of intern and preceptor gender on internship experiences for paramedic training. Australasian Journal of Paramedicine 2019;16.
Mason P. Identifying the barriers to female leadership in paramedicine. Irish Journal of Paramedicine 2017;2.
Wilkinson-Stokes M. A taxonomy of Australian and New Zealand paramedic clinical roles. Australasian Journal of Paramedicine 2021;18.
Adams ME, Lazarsfeld-Jensen A, Francis K. The implications of isolation for remote industrial health workers. Rural Remote Health 2019;19:5001.
Peate I. Scope of practice: considering how the role of the paramedic continues to change. Journal of Paramedic Practice 2015;7:330-1.
Saxon R, Gray M, Oprescu F. Extended roles for allied health professionals: an updated systematic review of the evidence. J Multidiscip Healthc 2014;7:479-88.
McManamny T, Jennings P, Boyd L, Sheen J, Lowthian J. Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature. Aust Health Rev 2018;44.
FitzGerald GJ. Paramedics and scope of practice. Med J Aust 2015;203:240-1.
Bigham BL, Kennedy SM, Drennan I, Morrison LJ. Expanding paramedic scope of practice in the community: a systematic review of the literature. Prehosp Emerg Care 2013;17:361-72.
O'Meara P TV, Stirling C, Walker J, Pedler D. Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural Remote Health 2012;12.
Boehronger B, O'Meara P, Wingrove G, Nudell NG. An emergency amendment to the national scope of practice for paramedics in the setting of a global pandemic. J Rural Health 2021;37:191-3.
The College of Paramedics. College of Paramedics’ position statement on the designation of paramedics: undertaking extended scope of practice. Journal of Paramedic Practice 2011;3:59-61.
Thompson J. Exploring paramedic patient assessment. ibid. 2013;5:342-7.
O'Meara P, Ruest M, Stirling C. Community paramedicine: hHigher education as an enabling factor. Australasian Journal of Paramedicine 2014;11.
Hou X, Rego J, Service M. Paramedic education opportunities and challenges in Australia. Emerg Med Australas 2013;25:114-9.
Aslop P. Provision of the training of offshore medics. Journal of Paramedic Practice 2011;3:48-9.
University of Tasmania. Graduate Certificate in Healthcare in Remote and Extreme Environments 2020. Available at: www.utas.edu.au/courses/chm/courses/m5a-graduate-certificate-in-healthcare-in-remote-and-extreme-environments
Charles Sturt University. Master of Paramedicine (with specialisations) 2020. Available at: https://study.csu.edu.au/courses/allied-health-pharmacy/master-paramedicine
James Cook University. Graduate Diploma of Rural Generalist Practice 2020. Available at: www.jcu.edu.au/courses/graduate-diploma-of-rural-generalist-practice