Roles of the rural paramedic—much more than clinical expertise

Background Paramedic education and training has a focus on the type of work performed. Some recent findings regarding the work of the rural paramedic indicate an expanded scope of practice with a strong community focus and involvement in primary health care. Because of this, proposals now appear for specific rural education and training. Whilst a picture is developing of the work of the rural paramedic, there is little knowledge about the differences between rural and urban paramedic practice. Revealing these differences will offer insight into specific roles for the rural paramedic and enhance any rurally oriented education and training for paramedics. Objectives To determine differences between rural and urban paramedic practice and the roles of the intensive care paramedic working in rural Australia. Methods A case study approach uses multiple sources of data including semi-structured interviews with intensive care paramedics across two states in Australia, review of relevant documentation and literature, case dispatch data, and observation. Interviews focus on specific work carried out, current education and training, and pathways for the future. Findings Rural paramedic practice is different from urban paramedic practice in that the rural paramedic: 1) adopts a whole of community approach rather than a case dispatch approach; 2) is a multidisciplinary team member rather than operating mainly within ambulance teams; 3) has extra responsibility as a teacher and manager for volunteers; and 4) is a highly visible and respected member of the community rather than relatively anonymous. With these differences, the rural paramedic displays various roles. For a whole of community approach, we see the role of community involvement, with the paramedic involved in project management or use of local media. A multidisciplinary approach means that the paramedic requires a multidisciplinary awareness in order to work well with other team members. Similarly, volunteer management requires an awareness of volunteers, of how to manage and teach volunteer groups. Finally, being a highly visible and respected community member means roles must display professionalism and accountability. Implications for the future Initial implications will be that those interested in undertaking rural placements in pre-hospital care will have a greater understanding of the demands of a rural environment. With longer-term development, knowledge of rural paramedic roles will enhance specific rural education and training for paramedics. Initiatives such as rural clinical placement for paramedic undergraduates, or courses with a