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Paramedics in Australia

A paramedic in Australia is a health care professional who responds to and treats all types of medical and trauma emergencies outside of a hospital setting before and during transportation to an appropriate medical facility. Paramedics also work in the inter-facility transport environment where a paramedic will continue or upgrade medical care to a higher level while transporting a patient from one healthcare facility to another. Paramedics usually transport patients to a hospital based emergency department, but paramedics can treat patients out of the hospital setting and then not transport the patient to the hospital (e.g. a paramedic gives a diabetic patient 50% dextrose in water).

In Australia use of the term "paramedic" is not restricted, registered or licensed. Prior to the 1990s most paramedics were known as "ambulance officers".

Definition of a Paramedic (Australian Council of Paramedicine)

"A Paramedic is a specialist health care professional who responds to requests for assistance and attends people suffering acute health crises of any nature. Paramedics provide health assessment, initial diagnosis, design a treatment plan and manage the patient’s crisis. The Paramedic may provide adequate treatment that may resolve the crisis and may or may not refer the patient onto another health professional. The Paramedic may continue treatment and provide patient transfer to an appropriate health care facility for ongoing referral and patient care." (Australasian Council of Paramedicine, 2008)^[1]

Clinical Scope of Practice & Qualifications

Please note that these terms and qualifications vary slightly between states. These are the minimum qualifications, but some states require more advanced training to hold these positions. For example, in Victoria, "Ambulance Transport Attendants" (ATA) (who primarily work for non-emergency private companies) are now required to hold a Diploma, and the term "Ambulance Paramedic" (Victoria) can also be referred to as "Advanced Care Paramedic" (Queensland).

First Responder

In some locations, volunteer first responders, Community Emergency Response Teams (CERT) are used by ambulance services to begin basic treatment before a paramedic arrives. Their training is a high standard of advanced first aid.

In some states volunteer "Ambulance Officers" have similar training to First Responders.

Recently a new national certificate, Certificate II in Emergency Medical Response has been endorsed.

The term is non-specific and is used by private first aid companies, volunteer organisations and workplaces to describe many levels of advanced first aid training.

Patient Transport Officer

Patient Transport Officers (PTOs), or Ambulance Transport Officers, provide non-emergency patient transport. PTOs provide a pre-booked, non-urgent service that includes home to hospital and hospital to hospital transfers. In some states PTOs may occasionally be required to act as first responders to emergencies. This is usually limited to situations where it would take significantly longer for Paramedics to arrive at the scene than a nearby patient transport crew, or patients that are assessed to be low-risk and require a low level of care in transit.

Patient Transport Officers complete a course of training that will earn them a nationally recognised Certificate III in Non-Emergency Patient Transport.

Ambulance Officer / Ambulance Transport Attendant

This is the basic level of pre-hospital emergency care. These Paramedics hold a Certificate IV in Basic Emergency Care, or equivalent, and are trained in basic life support skills. Meanwhile, in Queensland, Ambulance Officers hold only Certificates I-IV in Basic Emergency Care. When entering the Ambulance service, workers can enter at Certificate I Level and can work towards a new Cert every year or, with the completion of a Bachelor degree in paramedics, can enter as a level V Paramedic.

Paramedic

Paramedics in Australia are all educated to Advanced Life Support Level. The base qualification for a paramedic is a Bachelor degree (in Health Science, Paramedic Science, Emergency Health or Paramedicine) or a post Graduate Diploma (pre-Masters - for health professionals converting to paramedicine). Some paramedic degrees are dual, that is with another discipline, for example Bachelor of Paramedicine/Bachelor of Nursing.

In some States paramedics can still undergo an in-service (post employment) Diploma or Advanced Diploma level of education. Post employment is slowly being phased out in most states of Australia except New South Wales, Australian Capital Territory and the Northern Territory. Victoria has completely ceased all in-service education and entry into Practice requires graduation from a University.

Paramedics practice includes all components of the Basic Life Support level and the further enhancement of IV canulation, drug therapy (oral, intramuscular injection (IM), intravenously (IV), narcotic pain relief, anti emetics, cardiac arrest, respiratory drugs, etc), fluid resuscitation, advanced airway management (usually a laryngeal mask airway [LMA], or Endotracheal Intubation and Cricothyroidotomy in Western Australia) and the maintenance of infusions.

Paramedics perform extensive physical assessment, blood examinations (eg Random glucose test), interpret electrocardiograms (ECG), SpO2, temperature, and provide care for a range of patients from the new born to the elderly.

Intensive Care or Mobile Intensive Care Ambulance (MICA) Paramedic

Intensive Care (IC) Paramedics, or Mobile Intensive Care Ambulance (MICA) Paramedics, have completed post-graduate education that allows then to have a primary role of supporting paramedics by providing in-field stabilisation and mobile intensive care.

IC or MICA Paramedics are able to practice Intensive Care procedures such as Endotracheal Intubation, surgical airways, rapid sequence intubation (RSI), nasogastric intubation, chest tube insertion, and drug infusions (eg Adrenaline, Salbutamol, Sedation, Thrombolytics etc).

IC or MICA Paramedics practice under clinical practice guidelines independently of medical control.

Graduands have completed a University level Post Graduate Diploma in Intensive Care Paramedical Practice, Emergency Health (MICA Paramedic) or equivalent in addition to their base qualification and graduate (intern) program.

Rescue Paramedic

Some ambulance services employ paramedics specially trained in rescue techniques. Officers are trained in areas such as road crash rescue, vertical rescue, confined space and trench rescue. They learn navigation skills, four wheel driving, urban search and rescue, and chemical biological and radiological procedures.

Flight Paramedic

Flight Paramedics work on fixed wing and helicopter aircraft in many states, performing both emergency and routine transport operations. They are generally considered to be extremely highly trained in emergency medical care, but also aviation medicine, rescue and aviation emergencies. In some states this role is performed by doctors (usually emergency or intensive care specialists).

Training

Employment

Paramedics are employed by various public and private service providers. The state run ambulance services are activated by the 000 (similar to 911 in the USA or 112 in Europe or for mobile phones). Paramedics may respond to medical incidents in a conventional ambulance, sedan, SUV, rescue vehicle, helicopter, fixed-wing aircraft, motorcycle or even bicycle or foot at large public gatherings.

There are also private transport ambulances which are crewed by Patient Transport Officers (or sometimes Ambulance Attendants and/or nurses). They generally transport non-emergency patients between hospitals and other health settings such as nursing homes.

In Australia paramedic salaries can range anywhere from unpaid volunteer positions to over $100,000 a year, depending on location, experience, supervisory responsibilities and overtime.

Professional Organisations

The Australian College of Ambulance Professionals (ACAP) is the professional college for paramedics and ambulance personnel.

The Australasian Council of Paramedicine (ACP) is a new organisation that commenced operation in 2008. The primary aim of this peak professional organisation is to be a political lobby group and to make submissions to Government on behalf of the paramedic profession. ACP is not a union and does not compete with ACAP.

Industrial representation varies from State to State, although the largest Paramedic Union in Australia is the Ambulance Employees of Australia (AEA) which represents paramedics from Queensland, Victoria and Western Australia.