The nature of paramedic practice in rural and remote locations: A scoping review.


allied health personnel
emergency medical technicians
health resources
emergency medical services
rural population
scope of practice

How to Cite

Spencer-Goodsir H, Anderson J, Sutton C. The nature of paramedic practice in rural and remote locations: A scoping review. Australasian Journal of Paramedicine [Internet]. 2022Jul.4 [cited 2023Mar.26];19. Available from:


Introduction: Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients.

Methods: Arksey and O’Malley’s six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles.

Results: The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies.

Conclusion: Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.


Australian Institute of Health and Welfare. Australia’s health 2020. Canberra: AIHW; 2020.

Australian Institute of Health and Welfare. Rural and remote health. Canberra: AIHW; 2019.

Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019;19(1):974. doi: 10.1186/s12913-019-4815-5.

Vaughan L, Edwards N. The problems of smaller, rural and remote hospitals: separating facts from fiction. Future Healthc J 2020;7(1):38–45.

Peura C, Kilch JA, Clark DE. Evaluating adverse rural crash outcomes using the NHTSA State Data System. Accid Anal Prev 2015;82:257–62.

MacGregor-Fors I, Vázquez L-B. Revisiting ‘rural’. Sci Total Environ 2020;741:132789. doi: 10.1016/j.scitotenv.2019.06.135.

Australian Government, Department of Health. The Modified Monash Model [Internet]. 2020 [updated 2021 February 10; cited 2021 February 2]. Available from:

Alanazy ARM, Wark S, Fraser J, Nagle A. A comparison of pre-hospital emergency medical services’ response and duration times in urban versus rural areas of Saudi Arabia. Australas J Paramedicine 2020;17. doi: 10.33151/ajp.17.805.

Muula A. How do we define ‘rurality’ in the teaching on medical demography? Rural Remote Health 2007;7(1):653. PMID: 17328654.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169(7):467–73.

Spencer-Goodsir H, Anderson J, Sutton C. The nature of paramedic practice in rural and remote locations: a scoping review. 2022 [cited 2022 January 12]. Available from:

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8(1):19–32.

Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci 2010;5(1):69. doi: 10.1186/1748-5908-5-69.

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(1):146. doi: 10.1186/s12911-017-0544-z.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.

Alanazy ARM, Fraser J, Wark S. Organisational factors affecting emergency medical services’ performance in rural and urban areas of Saudi Arabia. BMC Health Serv Res 2021;21(1):562. doi: 10.1186/s12913-021-06565-3.

Al-Thani H, Mekkodathil A, Hertelendy AJ, Howland I, Frazier T, El-Menyar A. Emergency medical services (EMS) transportation of trauma patients by geographic locations and in-hospital outcomes: experience from Qatar. Int J Environ Res Public Health 2021;18(8):4016. doi: 10.3390/ijerph18084016.

Martin LK, Lewis VJ, Clark D, Murphy MC, Edvardsson D, Stub D, et al. Frontline barriers to effective paramedic and emergency nursing STEMI management: clinician perspectives. Australas Emerg Care 2020;23(2):126–36.

Adams ME, Lazarsfeld-Jensen A, Francis K. The implications of isolation for remote industrial health workers. Rural Remote Health 2019;19(2):5001. doi: 10.22605/RRH5001.

Martin AC, O’Meara P. Perspectives from the frontline of two North American community paramedicine programs: an observational, ethnographic study. Rural Remote Health 2019;19(1):4888. doi: 10.22605/RRH4888.

McManamny T, Jennings PA, Boyd L, Sheen J, Lowthian JA. Paramedic involvement in health education within metropolitan, rural and remote Australia: a narrative review of the literature. Aust Health Rev 2018;44(1):114–20.

O’Meara P, Wingrove G, Nolan M. Frontier and remote paramedicine practitioner models. Rural Remote Health 2018;18(3):4550. doi: 10.22605/RRH4550.

Phung V-H, Trueman I, Togher F, Ørner R, Siriwardena AN. Perceptions and experiences of community first responders on their role and relationships: qualitative interview study. Scand J Trauma Resusc Emerg Med 2018;26(1):13. doi: 10.1186/s13049-018-0482-5.

DeSoucy E, Shackelford S, Dubose J, Zweben S, Rush S, Kotwal R, et al. Review of 54 cases of prolonged field care. AFRICOM 2017;20:37–40.

Patterson DG, Coulthard C, Garberson LA, Wingrove G, Larson EH. What is the potential of community paramedicine to fill rural health care gaps? J Health Care Poor Underserved 2016;27(4):144–58.

Pennel CL, Tamayo L, Wells R, Sunbury T. Emergency medical service-based care coordination for three rural communities. J Health Care Poor Underserved 2016;27(4):159–80.

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(2):1978. PMID: 22497586.

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. Australas J Paramedicine 2009;7(2). doi: 10.33151/ajp.7.2.166.

Ross LJ, Eade A, Shannon B, Williams B. Out-of-hospital or pre-hospital: is it time to reconsider the language used to describe and define paramedicine? Australas Emerg Care. Forthcoming 2022.

Paramedicine Board of Australia. Registrant data table – December 2021. Paramedicine Board of Australia; 2021.

National Rural Health Alliance. The paramedic workforce in rural, regional & remote Australia. Deakin, ACT: NRHA; 2019.

Steering Committee for the Review of Government Service Provision. Report on government services 2021. Canberra: Productivity Commission; 2021.

Martin AC, O’Meara P. Community paramedicine through multiple stakeholder lenses using a modified soft systems methodology. Australas J Paramedicine 2020;17. doi: 10.33151/ajp.17.793.

Bennett KJ, Yuen MW, Merrell MA. Community paramedicine applied in a rural community. J Rural Health 2018;34:s39–s47.

Pearson KB, Shaler G. Community paramedicine pilot programs: lessons from Maine. J Health Hum Serv Adm 2017:141–85.