Over the past decade paramedics have seen changes in their level of clinical practice, education and training, and increased their participation in research. This has increasingly placed them alongside other health professionals and helped develop their own sense of professional identity.
There has been a transition of paramedic care from a simple response, deliver first aid and transport model to a more integrated role within the health system including stronger links to the primary care system.1 This transition from strict protocol driven practice to procedures requiring the paramedic to use knowledge and experience to problem solve and provide solutions is creating a more complex practice for paramedics.2 Supporting these changes and providing a firm foundation for the future development of the profession has been the progressive move from a vocationally based training system to university based undergraduate education, with Bachelor degrees as the entry-level qualification.
The debate now taking place in regard to the future registration and regulation of paramedics in Australia is a healthy sign of a growing professional identity amongst paramedics.3-6 The catalyst for this debate has been the Federal Government moves to set-up a unified national registration scheme for health professionals.7 In order to be considered for entry into this regulatory framework, paramedics need to be recognised and acknowledged as an emerging profession. Other health professionals, government and the community will largely determine where paramedics are located on the professional continuum of health professions and whether registration and new forms of regulation will be introduced. Irrespective of these outcomes, it is our responsibility to lead the discussion and debate on professional issues that will determine our future as a profession.
Over a number of years a number of Australian writers have made positive contributions toward discussion of paramedic professionalism.8-17 These contributions have ranged from the view that professional status has been achieved, with others arguing that further action is required if professional recognition is to be realised. Fitzgerald17 encouraged the development of a body of knowledge through research as a crucial step along the path toward professional status. Considerable progress has been made in this regard. Mahony14 and McIntyre18 advocated a more political approach using the successful tactics of the established professions to establish a place for paramedics amongst health professionals. Reynolds12 has explored the cultural issues associated with professionalism and has since extended her work through completion of doctoral research.19
More recently, Fitzgerald and Bange3 have pressed the case for a strong regulatory framework through the registration of individual paramedics. In their JEPHC article, they sought detailed input from ACAP members to a range of options for registration and regulation using a set of principles developed in the United Kingdom where the registration of paramedics is further advanced. As a result of member input to this invitation, ACAP have developed a policy position on registration and regulation that has been the basis of their submissions to a number of reviews and inquiries such as the National Health and Hospitals Reform Committee.20 Sometimes these views are at odds with other interested parties such as the Council of Ambulance Authorities Inc.5
A number of writers, such as Grantham16,21, Reynolds12 and Wyatt9 have argued that we are at or near the end of this journey toward professional recognition. However, these optimistic assumptions need to be tested through an examination of what constitutes a profession in the modern world and the nature of paramedic practice. There is a world of difference between presenting ourselves as health professionals and being formally recognised as such. Unlike medicine, nursing and allied health, paramedics are rarely consulted or even considered as a profession when health policy is discussed at a national level.
While professional registration and regulation are components of this fabric of influence, finding a respected place at the table with government and other health professionals requires approaches that embrace the broader concepts of professionalism. Sheather2 offers a framework for this dialogue and discussion of paramedic professionalism and identifies where the debate may lie in the future. For instance, he illustrates how language and symbolism are important when we refer to ourselves as paramedics and professionals rather than some of the older terms that some of us have memories of, such as drivers, bearers and officers. Reynolds19,22 has also explored these cultural and symbolic markers that mark the progress of our journey toward professional status. At a policy level, Sheather2 argues that we need to address both the development of an economic and social model of our profession and the issues associated with the professionalisation of behaviours. A number of issues have the potential for future exploration, discussion and debate. These inter-related issues include social and technological changes such as the increasing complexity of practice, the development of professional knowledge, and the community acceptance of paramedics in extended roles. Sheather uses the example of how paramedic practice has changed from " a relatively simple response based, non invasive series of activities that ended at the hospital door to a much more complex practice based upon judgement and problem solving."2, p. 63 Within this context of changing roles and emerging professionalism, questions of how paramedics are educated, deployed and regulated need to be discussed amongst policy makers, employers and the profession.
The evolving professionalism of paramedics needs to be confirmed through professional behaviours that incorporate adherence to professional codes of conduct, reflective practice and commitment to continuing professional development. Many of the continuing professional development activities of ACAP already seek to encourage these outcomes amongst members. As these behaviours are integrated within a professional model of practice, paramedics may be able to join other health professionals in making a positive contribution to health and well being of our communities.
JEPHC has decided to encourage further dialogue and debate on these questions of professional identity, behaviour and recognition through the establishment of a new section in the journal where the issues of professionalism can be canvassed through scholarly enquiry and reflection. This will provide paramedics with the opportunity to contribute to and shape the future of the profession through examination of the evidence, critical reflection and creativity.
The introduction of the section also coincides with the Inaugural Annual JEPHC Symposium, on 16th April 2009. The theme for the symposium, Embedding Professionalism in Paramedic Education and Practice in the setting of Emergency Primary Health Care will provide a national forum to promote interaction and discussion between local and national managers, researchers, educators, practitioners and students, from ambulance services, universities and kindred emergency primary health care organisations.
PhD, MPP, BHA, FACAP, AFACHSM
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.JEPHC PUBLICATIONS
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.
'The Thesis Journey: Tales of personal triumph'. (Book Review) Professor Tricia Vilkins (Editor) Pearson Education: NSW, 2005. ISBN ISBN: 0-7339-7278-0 A generic performance framework for ambulance services: an Australian health services perspective. Rural and Frontier Emergency Medical Services: Agenda for the Future. National Rural Health Association, 2004. An Australian Perspective.Future. National Rural Health Association, 2004. An Australian Perspective.Searching for paramedic academics: vital for our future, but nowhere to be seen!
"Paramedics marching towards professionalism,"
Journal of Emergency Primary Health Care:
1, Article 1.
Available at: http://ro.ecu.edu.au/jephc/vol7/iss1/1