Andrew McDonell


The practice of caring for people outside the medical and hospital environments has changed considerably over the last 120 years. In the majority of western countries (and many Middle Eastern and eastern) formalization of ambulance services or emergency medical systems have evolved into an organized health system that care for members of the community who are in an acute health crisis.

Within the Australian context caring for people outside the medical and hospital environments has changed rapidly particularly over the last ten years. The move of "ambulance" (paramedic) education into Universities has seen the development of the professional paramedic with an appropriate qualification. In some cases the ambulance service has become only one place of employment, with paramedics being employed in areas such as educational institutions, research, patient transport, industry and private practices (e.g. "movie set paramedic").

It has been well documented that Australia has a shortage of health professionals, particularly general medical practitioners (GPs) and registered nurses. This has become particularly evident in remote and rural regions. Traditionally registered nurses have worked in areas that have lacked a doctor. More recently the nursing profession has pushed for the creation of nurse-practitioners to further service these areas of Australia without a doctor. Paramedic practice has changed considerably with paramedics already performing and caring for patients that were traditionally the practice of the GP. In the United Kingdom (UK) it has been recognized that paramedics can perform advanced clinical practice which is not only advantageous to the patient, but to the entire health system and have developed the paramedic practitioner. So in Australia have paramedics been overlooked for providing primary health care in the community? Or do paramedics themselves fail to recognize their ability, education and potential scope of practice?

Despite the changes in clinical practice and the potential for the development of an independent practitioner, the profession remains in a state of flux and confusion. Unfortunately our profession cannot even agree upon the name of the practitioner, are we paramedics or ambulance officers? What do we practice, "ambulance", "pre-hospital care", "emergency care" or "paramedicine"? Should paramedics be registered or should they be under the control of ambulance services or health departments?

Without these questions being asked and answered, paramedics will never be able take control of their own unique discipline and/or move onto full independent practice.