Introduction Existing rural pre-hospital models have been criticised for being isolated from the health care system, and for following inflexible clinical protocols. Greater reliance on clinical judgement and informed decision-making in the pre-hospital setting offer the potential to improve patient care.

Methods Soft Systems Methodology was used to develop and critically appraise the Pre-Hospital Practitioner Model as an alternative to existing models. This approach started from the philosophical viewpoint that pre-hospital services should be patient-centred. Soft Systems Methodology was used to structure the elements of pre-hospital systems and the relationships between them into metaphors and pictures that could be analysed.

Results My analysis shows that the most powerful reason for advocating the pre-hospital practitioner model is that it places pre-hospital systems within a symbiotic relationship with the health care system. Unlike the existing emergency service models or the 'chain of survival' model, it is an integrated system that provides a range of services at multiple points during the patient-care cycle. Thus, the pre-hospital practitioner would have roles in the prevention of injury and illness, responding to emergencies, facilitating recovery, and planning future strategies for a healthy community.

Conclusions Implementing this new model would see the pre-hospital system using its available capacity more effectively to fulfil broader public health and primary care outreach roles than is currently the case. Patients would be referred or transported to the most appropriate and cost-effective facility as part of a seamless system that provides patients with well-organised and high quality care.

*The full text version of this paper has been published by Emerg. Med. Jnl., March 2003; 20: 199-203.

Author Biography


Dr Peter O'Meara is Professor of Paramedic Practice and Leadership at Charles Sturt University (CSU) in Australia, and is the first Australian paramedic to be appointed as a professor anywhere in the world.

At CSU, Peter co-ordinates postgraduate paramedic programs; including the new Graduate Diploma in Clinical Practice (Paramedic) and the Graduate Certificate in EMS Leadership and Management. He also teaches social science subjects in both the prehospital and health services management programs.

In additon to his professorial role at CSU, Peter is a Visiting Professor in Pre-hospital Care at Coventry University in the United Kingdom, and will soon commence a Teaching Fellowship with the Education for Practice Institute at CSU in 2010.

He is a Fellow, and Board Member of the New South Wales Branch of the Australian College of Ambulance Professionals, and a member of a number of national and international professional bodies.

Peter recently had the honour of presenting the David Shugg Lecture at the 2nd Annual Journal of Emergency Primary Health Care Symposium, which was held at the Alfred hospital, Melbourne in March 2010.


The prehospital community-volunteer model has a place in rural Australia.

Ambulance Satisfaction Surveys: Their Utility in Policy Development, System Change and Professional Practice "Would a Pre-hospital Practitioner model improve patient care in rural Australia?"

Using a community development approach to develop an innovative paramedic role.

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