Would a prehospital practitioner model improve patient care in rural Australia?

Abstract

Background: Existing rural prehospital models have been criticised for being isolated from the healthcare system, and for following inflexible clinical protocols. Greater reliance on clinical judgement and informed decision making in the prehospital setting offer the potential to improve patient care. Methods: Soft systems methodology was used to develop and critically appraise the prehospital practitioner model as an alternative to existing models. This approach started from the philosophical viewpoint that prehospital services should be patient centred. Soft systems methodology was used to structure the elements of prehospital systems and the relations between them into metaphors and pictures that could be analysed.Results: This analysis showed that the most powerful reason for advocating the prehospital practitioner model is that it places prehospital systems within a symbiotic relationship with the healthcare system. Unlike the existing emergency service models or the "chain of survival" model, it is an integrated system that provides a range of services at multiple points during the patient care cycle. Thus, the prehospital practitioner would have roles in the prevention of injury and illness, responding to emergencies, facilitating recovery, and planning future strategies for a healthy community. Conclusions: Implementing this new model would see the prehospital system using its available capacity more effectively to fulfill broader public health and primary care outreach roles than is currently the case. Patients would be referred or transported to the most appropriate and cost effective facility as part of a seamless system that provides patients with well organised and high quality care.

New and emerging roles in out of hospital emergency care: A review of the international literature

“…Positive impacts have been described in the form of inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data from the London Ambulance Service in 2003/2004(Department of Health, 2004a suggested a saving of £37 (USD 65) per case, with treatment of patients on scene equating to a reduced ED admission rate of 358 patients per ECP with a cost saving of £31,700 (USD 56,046) per ECP. Mason et al (2006) indicated that the mean cost of an ECP patient contact was £24 (USD 42) compared with an ED contact of £55 (USD 97), producing a saving of £31 (USD 55).…”

“…For example, Cooper et al (2007a) identified cultural issues such as blue collar 'crew room' perspectives versus white collar professionalism; restricted ambulance codes of communication compared to the elaborate communication codes in medicine; varying educational levels; and poor collaborative links between, for example, health and social services. O'Meara (2003) also recognised the barriers to the development of such roles including education, attitude change, and relaxation of professional boundaries, issues which Cooper et al (2007a) suggest may be resolved in part, by appointment of clinical leads, degree level training, clinical supervision, and focussed task allocation/ dispatch. …”

Effectiveness of emergency care practitioners working within existing emergency service models of care

“…This has previously been shown in relation to the management of wounds 10 and hypoglycaemia, 11 or a range of health problems arising in specific populations. 12 We provide evidence that ECPs are fulfilling a broader public health and primary care outreach role in the local community 13 in both rural and urban locations.…”

Models of International Emergency Medical Service (EMS) Systems

“…38 Many countries around the world such as Australia and New Zealand are contemplating about adopting this system into their existing pre-hospital care system especially in rural areas where the gap between primary health care and pre-hospital care is obvious and bridging the gap is a public demand. 39,40 Current international EMS systems have varied features and practices but they all resemble the main models of EMS systems in one way or another. The aim of international EMS systems is to adapt a model that meets the local needs and targets with diverse cultural, political and financial factors of each individual community.…”