Facilitators of expanded and extended scope of paramedic practice: What makes them work? Jakki Germann, David Lim, Leo McNamara, Vivienne Tippett School of Clinical Sciences, Queensland University of Technology Email: [email protected] Objective Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper examines models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice. Methods An exploratory multi-case study analysis of Australia (Queensland), New Zealand, Canada (Alberta) and the United Kingdom (London) expanded and extended paramedic practices were analyzed. Results © Queensland Ambulance Service. Used with permission. Successful models of expanded and extended practice harness the full capacity of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guidelines and policy frameworks (boundary); access to physical infrastructure; clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of practice is however influenced by individual employers’ capacity, perceived community needs and preference/ priorities. The potential for paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and function for building on paramedic practice. Recognition of such paramedic practice provides a structure for professional growth, process for career progression, support workforce retention, improves healthcare and equity of access. Micro Recruitment Autonomy Meso Location Education Stakeholder engagement Macro Additional scope of practice Internal Governance Isolated Practice Area Paramedic (IPAP) (2006) Expression of interest Advanced Care Paramedic (or equivalent) Selection process Somewhat; in accordance with protocols Queensland 1 year Health approved GradCert (AQF Level 8) most rural and Combined the Rural and Isolated isolated Practice Endorsed Nursing program communities developed by the Queensland only Health and Australian College of Rural and Remote Medicine chronic disease strategy, using the Primary Clinical Care Manual New Zealand: Unknown Somewhat Urban 1 month equivalent of classroom and • Involvement of Council of 1 month practicum shadowing an Ambulance Authorities ECP and Minister of Health in GradCert and Master (equivalent to policy formulation AQF 8 and 9) Wound care Suturing Blood sample Usual quality and safety governance Direct contact with oncall Emergency Physicians Selection process (interview) Limited 2 major urban cities 6 weeks classroom and 4 weeks practicum shadowing Nurse Practitioners in care facility Advanced diploma (equivalent to AQF Level 6) Usual quality and safety Professional governance registration Direct contact with Medical Director (Medical Control) and patients’ family doctors Unknown High degree Urban Honour and Master (equivalent to AQF Via NHS 8 and 9) Extra prescribing and dispensing rights Wound care Suturing Ability to directly refer to community and prehospital support program/ homecare Extra prescribing and dispensing rights Specific direct referral Australia – Queensland: Extended Care Paramedic, Community Care Paramedic Canada – Alberta: Community Care Paramedic UK – London: Paramedic Practitioner, Community Care Paramedic At practitioner level • Authorised to Supervision of project Involvement of the practice under IPAP delivery through Council of Ambulance • Health assessment Queensland Ambulance Authority in policy of patient in Service formulation accordance with Direct contact with on Partnership between Health Management call Emergency Queensland Health, Protocol Physicians (Medical Queensland Ambulance Director) Service, and James Cook University Legislation Post-hospital discharge organised by discharging physician Community initiated via Alberta Health Services and municipality, in partnership with Alberta College of Paramedics Usual quality and safety governance Direct contact with control centre for medical direction Amendment of Health (Drugs and Poisons) Regulation 1996 (QLD) to allow expanded paramedic practice Health Care Professions Counsel registration Conclusions The achievement of enhanced knowledge and skills has positioned the paramedic profession as a valuable part of the healthcare team. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting expanded and extended paramedic practice.