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Community Paramedicine: Higher Education As an Enabling Factor Peter O'meara La Trobe University, [email protected]

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Community Paramedicine: Higher Education As an Enabling Factor Peter O'meara La Trobe University, P.Omeara@Latrobe.Edu.Au Australasian Journal of Paramedicine Volume 11 | Issue 2 Article 5 2014 Community paramedicine: higher education as an enabling factor Peter O'Meara La Trobe University, [email protected] Michel Ruest Renfrew County Paramedic Service Christine Stirling University of Tasmania Recommended Citation O'Meara, P., Ruest, M., & Stirling, C. (2014). Community paramedicine: higher education as an enabling factor. Australasian Journal of Paramedicine, 11(2). Retrieved from http://ro.ecu.edu.au/jephc/vol11/iss2/5 This Journal Article is posted at Research Online. http://ro.ecu.edu.au/jephc/vol11/iss2/5 O'Meara et al.: Educating community paramedics Australasian Journal of Paramedicine: 2014:11(2) Original Research Community paramedicine: Higher education as an enabling factor 1Peter O’Meara PhD, 2Michel Ruest, 3Christine Stirling PhD Affiliations: 1 LaTrobe University, Victoria, Australia. 2 Renfrew County Paramedic Service, 3 University of Tasmania, Tasmania, Australia SUMMARY 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. Keywords Paramedic, emergency medical technicians, rural health, education Corresponding Author: Peter O’Meara, [email protected] INTRODUCTION discipline of acute primary health care in Paramedics are increasingly becoming first line unstructured community settings (2). primary health care providers in small rural communities and as a result they are developing The emergence of more complex professional additional professional responsibilities throughout paramedic roles raises questions related to the cycle of care (1-3). Throughout the world, community and professional expectations and the Emergency Medical Services (EMS) are identification of enabling factors associated with increasingly required to provide a wider range of the sustainability of emerging models, such as clinically-focused services than in the past and to community paramedicine roles. These factors also be more accountable than ever before. In may include the degree to which paramedicine is parallel with these pressures, paramedics are integrated within the health system, effectiveness developing new professional roles and identities of clinical governance systems, educational that are broader and more sophisticated than that foundations for paramedics, and the development of the traditional emergency response model (4- of appropriate clinical pathways for patients and 6). Rural paramedics, in particular, are clients (7). This paper addresses paramedicine increasingly working as the ‘expert’ in the education as one of these enabling factors. The Official Journal of Paramedics Australasia © 2014 Published by Research Online, 2014 1 Australasian Journal of Paramedicine, Vol. 11 [2014], Iss. 2, Art. 5 O’Meara et al New and expanded paramedicine roles are METHODS emerging in response to an increasingly ageing population with more complex morbidities, higher Setting community expectations and the contraction of some other health services (8). For instance, This case study was undertaken in the County of many smaller, rural hospitals have limited or no Renfrew, Ontario, Canada where a community emergency department or maternity services, paramedic role has emerged in response to while many family physicians are unwilling or demographic changes and broader health system unable to provide house calls to isolated patients reform. The County was formed in 1861 and is for a variety of reasons, including the threat of made up of a number of small to medium sized violence (9,10). As an example, reports indicate towns, including Arnprior, Eganville, Pembroke, that in Australia less than half of the country’s Renfrew, Barry Bay, Petawawa and Deep River, family physicians regularly conduct home visits along with many other small villages and (11). Emergency Medical Services and settlements. It sits along the boundary between paramedics throughout the world are the provinces of Ontario and Quebec and is consequently stepping into these gaps and facing largely defined by the Ottawa River. the twin challenges of changing levels of clinical practice and greater demands for accountability. The County of Renfrew Paramedic Service was formed in January 2005 as part of a Province- As a result, EMS and paramedics are increasingly wide re-organization of paramedic services that facing higher levels of organizational and locates service delivery at a municipal level and professional scrutiny through mechanisms such regulation at a provincial level. The Paramedic as clinical governance systems and occupational Service is part of the County’s Emergency registration requirements (12-14). In their patient Services Department. It is financially and focused interactions with other health structurally separate to the provincial health professionals they need to balance specialized system. The service’s current model is an expertise with their inherent role and education advanced life support system provided by limitations. This working environment of Advanced Care Paramedics and Primary Care paramedics is unique in the health system. Paramedics, as defined under the Canadian Occupational Competency Profile (16), staffing In 2005, the 1st International Roundtable on seven vehicles 24 hours a day, seven days a Community Paramedicine was held in Nova week deployed from seven leased Ambulance Scotia, Canada. This loosely-bound group has Base Stations (17). At the time of the study, there since developed a definition of community were another three 12 hour-day shift crews paramedicine that is gaining currency around the deployed across the County. world. To reduce the potential for confusion their Research Approach definition was adopted for this study. Building on previous research in Australia (2), a Community Paramedicine is a model of care range of qualitative methods were used to validate whereby paramedics apply their training and skills the professional boundaries of community in “non-traditional” community-based paramedics and identify enabling factors environments, often outside the usual emergency associated with successful community response and transportation model. The paramedicine programs. The La Trobe University community paramedic practices within an Human Research Ethics Committee approved the “expanded scope”, which includes the application research (FHEC12/8). of specialized skills and protocols beyond the base paramedic training. The community Descriptions of the emerging paramedic roles paramedic engages in an “expanded role” working were sought from managers, with the other data in non-traditional roles using existing skills.(15) collected through a combination of direct observation of practice, informal discussions, The aim of this case study was to describe a interviews and focus groups. This qualitative Canadian community paramedic model and to approach from Stake (18) allowed the capture of identify enablers related to successful data encompassing the richness and diversity of implementation. This paper focuses on education the community paramedicine role within a natural as an enabler, with the others to be reported in setting that allowed issues to be studied in depth. detail elsewhere. It also placed practice within the wider community context (19). Participants in the case study were recruited through purposive sampling and included: • Community members, including patients, family and carers The Official Journal of Paramedics Australasia © 2014 http://ro.ecu.edu.au/jephc/vol11/iss2/5 2 O'Meara et al.: Educating community paramedics Australasian Journal of Paramedicine: 2014:11(2) • Paramedics and EMS managers from the an important component of this observational County of Renfrew and Greater Ottawa area phase of the data collection process and helped • Paramedic educators in the Province of establish the general perception pattern of the Ontario community paramedicine program (19). The • Physicians, nurse practitioners and other advantage of using this approach was that it health care providers who interact with shone a light on any discrepancies between community paramedics rhetoric and reality. For this reason observational • Expert informants, such as health economists methods were well suited to this case study of a and health service managers community paramedicine program. This source of data facilitated a richer understanding of the Three focus groups of
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