Industrial paramedics, out on site but not out of mind.

INTRODUCTION: Australian natural resource exploration and production companies are employing paramedics to provide emergency medical response, primary health care, injury prevention, and health promotion services in remote locations nationally and internationally. Although Australian paramedic practice has steadily evolved to include increasingly complex medical interventions in the prehospital setting, paramedics are not yet registered health professionals, and in many states and territories their title is not protected. Similarly, tertiary-level education is becoming the entry to practice standard for traditional ambulance paramedics; however, certificate- and diploma-level paramedic courses remain an acceptable pathway to private and industrial paramedic jobs. To ensure acceptable patient safety standards are maintained and to protect all related stakeholders, the role, skills, training, and professional capacity of industrial paramedics must be defined. METHODS: The study objective was to explore the published literature for a definition for the discipline of industrial paramedicine. A comprehensive systematic analysis was conducted using the EBSCOhost (health), MEDLINE, SCOPUS, and CINAHL electronic databases. The primary search terms "remote", "offshore", "mining", and "oil" were combined with the secondary search terms "paramedic" and "emergency medical services". RESULTS: An initial search using the combined two-term sets identified 870 citations. After application of the inclusion and exclusion criteria to a title and abstract review, 69 citations met the criteria including those discovered by searching the reference lists. Of these, nine citations were excluded because full-text papers could not be found and eight citations were excluded based on review of the full article. The result was 40 articles that discuss the role of paramedics in the remote or offshore environment (ROP) and 12 articles that discuss the provision of emergency medical services in the mining or oil and gas sectors (MOEMS). There is no single definition or comprehensive role description for industrial paramedic practice within the literature. CONCLUSIONS: Worldwide, there is little high-quality published evidence to adequately reflect all aspects of industrial paramedic practice. However, based on the literature available, this definition is offered: 'An industrial paramedic is an advanced clinical practitioner in paramedicine with an expanded scope of practice. The industrial paramedic provides emergency response, primary health care, chronic disease management, injury prevention, health promotion, medical referral, and repatriation coordination at remote mining sites, offshore installations, and other isolated industry settings. The industrial paramedic is resourceful, adaptable, and comfortable working independently. Industrial paramedics practice on site with limited resources, remotely located from tertiary care, and use telemedicine to consult with other health professionals as required. Industrial paramedics are experts at rapidly assessing, prioritising, and establishing control in their unpredictable workspace to reduce risks and create an environment conducive to quality patient care. The industrial paramedic preferably holds a specialised tertiary qualification and is committed to maintaining their clinical competency through continuing professional development.' Further research is required to validate, refute, or expand this proposed definition.

Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization.

BACKGROUND: Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. OBJECTIVE: To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. METHODS: This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. RESULTS: A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. CONCLUSION: This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.

No Two Systems Are the Same: Paramedic Perceptions of Contemporary System Performance Using Prehospital Quality Indicators.

Introduction In recent years, researchers have identified two new models of paramedicine within the Anglo-American paramedic system known as the Directive and Professionally Autonomous paramedic systems. The research team now seek to compare paramedic perception of system performance between the two systems using prehospital quality indicators. Methods Paramedics employed within Anglo-American paramedic systems undertook a survey evaluating their experience and perception of system performance against a set of modified prehospital quality indicators. Data were collected using a survey combining single-choice questions with matrix multiple-choice questions. Key results were cross-tabulated with demographic (informant) and system factors to compare performance between the two new paramedic systems. Results The survey indicated a substantial difference in perceived clinical and operational performance between the Professionally Autonomous and Directive paramedic systems, with the Professionally Autonomous paramedic system performing consistently better in all 11 prehospital quality indicator domains. Conclusion The results of this survey are a vital step in helping paramedics, health leaders, and academics understand the complex relationship between paramedic system design and system performance, and, for the first time, provides empirical evidence upon which to make a conscious decision to adopt one system or the other.

From stretcher bearer to practitioner: A brief narrative review of the history of the Anglo-American paramedic system.

BACKGROUND: This narrative review presents a brief chronological history of the Anglo-American paramedic system, combining decades of stories from across ambulance services in western, English-speaking developed countries METHODS: Databases, including Embase, MEDLINE, Web of Science, CINAHL and Google Scholar were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forwards and backwards searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Included studies were summarised using narrative synthesis structured around the exploration of the history of the Anglo-American paramedic system. RESULTS: The research team structured the narrative in chronological order and used metaphorical models based on philosophical underpinnings to describe in detail each era of paramedicine. The narrative explores several key milestones including, industrial orientation, scope of practice, innovation, education and training, regulation as well as significant clinical and technological advancements in the delivery of traditional and non-traditional paramedic care to patients. CONCLUSIONS: Paramedicine, like other allied health professions, has successfully navigated the pathway toward professionalisation in a considerably short period of time. From its noble beginnings as stretcher bearers in times of war, the profession has looked outwards to emulate the success of our healthcare colleagues in establishing its own unique body of knowledge supported by strong clinical governance, national registration, professional regulatory boards, self-regulation, and a move towards higher education supported by the development of entry-to-practice degrees. Whilst the profession has achieved many great milestones, their application across multiple jurisdictions within the Anglo-American paramedic system remains inconsistent, and more research is needed to explore why this is.

Defining two novel sub models of the Anglo-American paramedic system: A Delphi study.

INTRODUCTION: While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a lack of research that explores and identifies new sub-models of paramedicine within the Anglo-American paramedic system. METHODS: A Delphi method was used to gain consensus among international paramedic experts regarding two new models of paramedicine known as the Directive and Professionally Autonomous paramedic systems. Following the development of a preliminary definition, a set of questions were established for experts aimed at defining the new sub-models; the responses were reviewed and amended based on feedback before being re-distributed to an expanded group of participants for further rounds of questions. Rounds continued until consensus was achieved. RESULTS: Consensus was achieved for both statements regarding the Professionally Autonomous paramedic system definition in round 2, 85.7% (n = 18). Following analysis and revision of the definition, the additional two statements regarding the Directive paramedic system achieved consensus in round 3, 100% (n = 19). CONCLUSION: This Delphi study was the first study to explore a standardised definition for two newly identified sub-models of the Anglo-American paramedic system with the overall results used to help inform high performing system design for modern Anglo-American paramedic systems into the future.

Reassessment of the tri-modal mortality distribution in the presence of a regional trauma system.

BACKGROUND: The temporal distribution of trauma-related deaths has been described as tri-modal with immediate, early, and late peaks. With the development of trauma centers and systems, it has been suggested that this distribution might be altered. METHODS: Information regarding all trauma-related deaths occurring from 1990 through 2003 in Jefferson County, AL, was obtained and the elapsed time from injury to death was calculated and categorized as <1 hour, 1 to 6 hours, 7 to 24 hours, 1 to 3 days, 4 to 7 days, and >1 week. The distribution of the time from injury to death was compared before and after the implementation (November 1, 1996) of a regional trauma system. RESULTS: Of the 5,240 deaths included in the analysis, 2,830 occurred between January 1, 1990 and October 31, 1996, before trauma system implementation, and 2,410 occurred afterward (i.e. November 1, 1996 to December 31, 2003). The temporal distribution of trauma death was significantly different (p < 0.0001) after trauma system development with a higher percentage of immediate deaths (56.3% compared with 51.4%) and a lower percentage that occurred 1 week after injury (4.8% compared with 8.1%). CONCLUSION: The development of a regional trauma system had a significant impact on the temporal distribution of trauma deaths. An increase in the proportion of immediate deaths and a decrease in the proportion of deaths that occurred >1 week after injury was observed, suggesting a shift toward a bimodal distribution.

Information infrastructure for emergency medical services.

The pre-hospital emergency medical and public safety information environment is nearing a threshold of significant change. The change is driven in part by several emerging technologies such as secure, high-speed wireless communication in the local and wide area networks (wLAN, 3G), Geographic Information Systems (GIS), Global Positioning Systems (GPS), and powerful handheld computing and communication services, that are of sufficient utility to be more widely adopted. We propose a conceptual model to enable improved clinical decision making in the pre-hospital environment using these change agents.