The Nature of Paramedic Practice in Rural and Remote Locations: A Scoping Review

Abstract

Introduction: Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods: Arksey and O’Malley’s six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results: The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion: Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.

Paramedic Workforce Disparities Marked by Geographical Positioning

“…This increased driving time is not unusual in literature related to emergency services and has been related to distance from services in literature related specifically to paramedic transport in rural areas (Adeyemi, Paul, & Arif, 2022;Miller, James, Holmes, & Van Houtven, 2020;Smith, English, Whitman, Lewis, & Gregg, 2022). Discussion about adverse terrain indicates that such driving conditions can be dangerous, particularly in rural and remote areas with poor road conditions, lighting, and adverse weather conditions, however urban areas also have issues related the possibility of additional vehicles being involved or traffic congestion (Liu, 2022;Spencer-Goodsir et al, 2022;Wubben, Denning, & Jennissen, 2019). Similar issues have also been identified in literature related to firefighting, where response times are also considered to be important (Wan Jusoh et al, 2023).…”

“…One of the most obvious differences between rural and urban paramedic work was the increased distance and therefore time taken to reach and transport patients (Spencer-Goodsir, Anderson, & Sutton, 2022). This disparity was frequently discussed in the literature located in this scoping review, particularly in relation to response times and transport times being extended (Alanazy Ahmed Ramdan et al, 2021;Ashburn Nicklaus et al, 2022;Ashburn et al, 2020;Cui Eric et al, 2021;Lu & Davidson, 2017;Newgard Craig et al, 2017;Stopyra et al, 2022).…”