IntroductionThis study reports on a subset of findings from a recent doctoral study by the first author, which explored the lived experience of being a paramedic preceptor to novice paramedics in their first year of on-road practice.MethodsA qualitative methodology underpinned by Gadamerian hermeneutics was chosen for this study. Semi-structured interviews were undertaken with a purposive sample of 11 paramedic preceptors from an Australian government-funded ambulance service. Interviews were audio-recorded and data analysis proceeded from the interview transcripts.ResultsAnalysis revealed the paramedic preceptor to be a complex, multidimensional role that is operationalised within four key domains: coach, role model, socialiser and protector. Expectedly, a core function of being a paramedic preceptor is that of coach, supporting and scaffolding novices as they learn to apply theoretical knowledge in practice. Preceptors also appear to play an integral role in the professional socialisation of new employees, and are an important role model of professional behaviours and an empathetic healthcare provider. The paramedic preceptors in this study also viewed their role as a critical advocate for patient safety in the clinical practice environment. Advocacy and protection by the preceptor extended to the novice too, safeguarding their physical and emotional wellbeing during the learning process.ConclusionTo our knowledge, this is the first study to specifically explore paramedic preceptorship from the perspective of preceptors in an Australian context. Therefore it provides an important contribution to understanding how paramedic preceptors operationalise this educative role in the clinical practice environment.

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Introduction: Recent literature has explored the health and social implications of industrial workers who are involved in a variety of long-distance commute (LDC) work arrangements including fly-in, fly-out; bus-in, bus-out; and drive-in, drive-out. However, the role of an industrial health worker in caring for this special population of workers is poorly understood and documented in current literature. In Australia, the health role has existed primarily to meet minimum standards of safety legislation and carry out compliance activities. The combination of low social risk tolerance, increasingly remote locations and changing health and safety legislation are driving changes to accountability for the health as well as the safety of remote industrial workers. Health staff are recruited from the ranks of registered nurses, paramedics and diploma-qualified medics. Often, they work in autonomous transdisciplinary roles with little connection to other health workers. The lack of a clear professional identity contributes to increased tension between the regulatory requirements of the role and organisations who don't always value input from a specialist health role. The aim of this study was to understand the experience of isolation for health workers in industrial settings to better inform industry and education providers. Methods: A phenomenological methodology was chosen for this study owing to the paucity of qualitative literature that explored this role. This study utilised face-to-face or telephone interviews with nurses and paramedics working in remote offshore and onshore industrial health roles seeking to understand their experience of working in this context of health practice.Results: Three thematically significant experiences of the role related to role dissonance, isolation, and gaining and maintaining skills. The second theme, isolation, will be presented to provide context for nurses' and paramedics' experiences of geographical, personal and professional isolation. Conclusions: Nurses and paramedics working in remote industrial roles are not prepared for the broad scope of practice of the role, and the physical and profession isolation presents barriers to obtaining skills and confidence necessary to meet the needs of the role. Limited resources in rural and remote areas combined with the isolation of many industrial sites pose challenges for industrial staff in accessing primary healthcare services, yet industrial organisations are resisting attempts to make them responsible for the health as well as the safety of their onsite workers, particularly in off-duty hours. Health workers in remote locations have to cope with their own experience of isolation but also have to treat and counsel other industrial workers experiencing chronic illness complications, separation from family and other consequences of the fly-in, fly-out 'workstyle'. In addition to the tyranny presented by distance and the emotional isolation common to all remote industrial workers, health workers are isolated from professional networks,...

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 © JJ Acker, TJ Johnston, A Lazarsfeld-Jensen, 2014. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 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 loca...

Australian universities, the majority of paramedic undergraduates tend to come straight from school and many programs are unable to offer early or lengthy on-road placements. This was cited as a cause of the immaturity and poor interpersonal skills raised repeatedly in focus group discussions in a year-long study of paramedic education in Australian universities. Focus groups struggled to label the missing factor in university educated paramedics. A deficit of soft skills was widely suggested, but the phrase was not adequate for the range of problems described. Soft skills is used interchangeably with employability, key skills, generic skills and graduate attributes (HEFCE, 2003; Cranmer, 2006; Treleaven and Voola, 2008), but for paramedics it boils down to road readiness. The suggestion that a new generation of paramedics has fewer relational skills than the last generation could be regarded as hollow, except for the fact that it was graduates who raised the problem in focus groups. Using sociological tools to analyse the cultural context of work, it is possible to suggest that deficits interpersonally may be influenced by an increasingly isolated and de personalised youth culture. This culture particularly affects young people who are moving into a uniquely interpersonal workplace, such as paramedic practice (Metz, 1982; Wright Mills, 2000 [1959]). Some social commentators describe the problem of youth culture as the ‘shrinking home habitat’ (Cunningham and Morpurgo, 2006), whereby changes in family structure, social isolation and parental protection, create a smaller social world for Western youth. At the same time, dependence on communication technologies has created ‘disembodied’ communities (Willson, 1997), lacking in real time contact with strangers. While young people may be ‘digital natives' (Bennett et al, 2008; Prensky, 2001) in their use of technologies and social networking, these skills do not translate into road readiness. Graduates also enter a workplace experiencing previously unknown levels of complexity, escalating diversity including ethnic and aging populations, the needs of marginalized people living in the post-institutional, post-welfare era, and high social sensitivity to issues of inclusion and risk. While social change has been incremental for existing professionals, graduates are immersed into the complexity of a social milieu they may not recognize, from the moment of recruitment.