A comparison of the practice of rural and urban paramedics : bridging the gap between education, training and practice

This thesis compares rural and urban paramedic practice within two states in Australia to establish whether rural paramedics have distinct roles necessitating specifically directed education and training. Other Australian health professions specialize in rural practice, with education and training to suit however there have been few studies comparing the roles of rural paramedics with urban paramedics in Australia. The topic is particularly significant given suggestions of a mismatch between paramedic education, training, and practice. This study contributes to the foundations needed to establish relevant education and training for rural paramedics in Australia by providing a comparison of rural and urban paramedic practice. A comparative case study strategy was used, and multiple sources of data were collected. These included semi-structured interviews with intensive care paramedics across two states in Australia; an audit of case dispatch data; review of documentation, including job descriptions, ambulance service and union websites, archival information, local media, and universities; and observation of paramedics within their local environment looking at key processes and events. The use of multiple data sources allowed triangulation of data with consequent reduction of research bias. The major finding of this study was the presence of clear differences between rural and urban paramedic practice. Rural paramedics: 1. practice a community response rather than a case dispatch response, 2. are multidisciplinary team members rather than solely ambulance team members, 3. are educators and managers of volunteers rather than clinical supervisors and, 4. are isolated health workers rather than having access to full resources. Two main similarities were noted, and these were a strong concern for progress in continuing professional development, and dispatch of similar types of cases in both rural and urban areas. The comparison of results suggests that there is a need in Australia for paramedic education and training with specific rural components. Rural clinical placements, along with community based and multidisciplinary components could form an integral part of this education and training process. Future directions for continuing professional development require input from paramedics themselves. Further research concerning the three tiers of undergraduate education, postgraduate education, and continuing professional development will ensure education and training for the rural paramedic in Australia avoids the risk of a mismatch between training, education and practice.