The Australian Health Care System

Published Date: 02 Nov 2017

Explore the statement - A paramedic is a health care professional operating autonomously and independently within the Australian health care system.

Name: Dorine Pantacchini

Student ID: 1069561

Tutor: Jules Foster

Date due: Friday, 19th April

Word count:

Within the Australian healthcare system, paramedics are healthcare professionals that operate both autonomously and independently. They are crucial resources to Australian communities as they deliver appropriate treatment and care to patients in order to optimise their condition (patient outcome). Nowadays, paramedics make accurate clinical judgements and decisions based on evidence-based practice, employ clinical leadership and adhere to relevant ethical standards. Paramedics incorporate their knowledge and clinical expertise with the outcomes of evidence-based practice in order to make appropriate judgements and decisions for patients. Additionally, they exercise clinical leadership through innovation and improvement to deliver the best patient care. Finally, paramedics are aware of and act accordingly to ethical boundaries. Thus, the paramedic profession is a crucial component of Australia’s healthcare system, achieving the best patient outcome whilst operating both autonomously and independently.

The Paramedic Profession

‘A paramedic is a health professional who provides rapid response, emergency medical assessment, treatment and care in the out of hospital environment’ (Paramedics Australasia 2013). Paramedics are healthcare professionals that form an integral part of the Australian healthcare system made up of nurses, doctors, the Royal Flying Doctor Service (etc.) (Willis, Reynolds & Keleher 2012). Paramedics operate in a wide range of different settings within the public spectrum including ‘community, industrial, resource sector, education, defence or event/public gathering’ (Paramedics Australasia 2009). There are various types of paramedics such as intensive care and rescue paramedics who attend different scenes based on their roles and qualifications (Willis, Reynolds & Keleher 2012).

The Development of the Paramedic Profession in Australia

Over the past 30 years, the paramedic profession has immensely evolved. The role of paramedics went from being solely an emergency transport service to now delivering a vast variety of pre-hospital treatments to patients (Lowthian et al. 2011). Its development is clearly illustrated by an industrial action which took place in 1989 which saw Australian paramedics going from majority community volunteers to full-time trained professionals. Additionally, the education required for the profession advanced ‘from ad hoc in-service training to formalised programs that are accredited with the Vocational Education and Training (VET) and with the university sectors’ (Willis, Reynolds & Keleher 2012).

The significant development of the profession is demonstrated by Joyce, et al. (2009, p.1) who claims that the utilisation of ambulance services has considerably increased over recent years as:

Responses by ambulance services nationally increased from 13 per 100 000 persons in 2002 to 15 in 2007, representing 15% growth. The number of patients treated rose from 10 per 100 000 persons to 13 (30% growth) in the same period.

Autonomous and Independent Practice

Paramedics are healthcare professionals that operate autonomously and independently within the Australian healthcare system. According to Skar (2010, p.1) ‘autonomy means having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base’ whilst respecting the decisions of patients (ethics). On a daily basis, paramedics operate autonomously by making their own decisions within set guidelines. They have to make appropriate decisions and judgments that will improve patient outcome and additionally, that are consistent with ethical codes and standards (Holden 1991) (Joyce et al. 2009). Furthermore, paramedics operate independently as there are different guidelines associated with the different states and territory of Australia due to different governing bodies (Cartwright et al. 2013). Thus, they must adhere to their specific guidelines which may be completely different in another part of Australia. Moreover, paramedics are independent as they do not work alongside other healthcare professionals in the pre-hospital setting such as nurses and doctors. Therefore, it can be seen that they cannot rely on the expertise of other medical professionals and consequently they must make their own judgements and decisions regarding patients, as they have limited contact with them (Nordby & Nohr 2012).

Clinical Judgement and Decisions based on Evidence-Based Practice

Clinical judgement and decisions are fundamentals of the paramedic profession and form part of the everyday routine. Paramedics have to promptly make appropriate clinical judgment and decisions regarding factors such as triage, management and the referral of patients (Joyce et al. 2009). They must make operational decisions such as ‘should I go in – is it safe, what equipment should I take’ as well as clinical decisions regarding the patient. Additionally, they also must have the ability to gather, analyse and synthesise clinical information to effectively treat patients (O’meara & Grbich 2009, p.96).

In order to make appropriate clinical judgements and decisions, paramedics must use the best information available alongside their best judgment (O’meara & Grbich 2009). Paramedics do this by integrating their knowledge and clinical expertise with external evidence, more commonly known as evidence-based practice. Evidence-based practice is the ‘provision of clinical actions and interventions based on research findings which have been shown to result in improved outcomes for patients/consumers’ (Curtis & Ramsden 2011). Evidence-based practice undoubtedly changes the previous clinical decisions paramedics made (Curtis & Ramsden 2011). As a result of evidence-based practice, paramedics no longer make decisions ‘based on routine’ or what they were previously taught. They now make appropriate clinical decisions and judgements based on evidence found by well-conducted research. However, evidence-based practice is definitely not meant to override a paramedic’s clinical experience but rather, its outcomes are meant to be integrated with the ‘clinical experience and professional expertise’ of paramedics in order to improve patient outcomes (O’meara & Grbich 2009, p.96).

Clinical Leadership

Clinical leadership is an underlying aspect of the paramedic profession. It involves the advancement of ‘the quality and safety of [patient] care through innovation and improvement’ (Clinical Excellence Commission 2013, p.1) alongside the use of leadership qualities which are ‘required to lead an [effective] team’ (Dr Kos & Kavanagh 2010, p.4). Leaders are crucial in the paramedic profession as they motivate colleagues to work as a united team in order to achieve goals. Additionally, they are important as they allow services to be managed correctly in order to provide care for and meet patient needs (Curtis & Ramsden 2011, p.87).

In order for paramedics to achieve the best patient outcome, leaders must apply clinical leadership characteristics such as ‘clinical competence, being supportive, acting role models, directing and helping people, having effective communication skills and behaving with integrity’(Stanley 2012, p.1). Furthermore, according to Curtis & Ramsden (2011, p.83), leaders in the paramedic profession are individuals that ‘have a vision for the future of clinical practice, can lead chance, build and motivate teams and implement systems to support evidence-based, patient-centred care’. An important aspect of clinical leadership is for leaders to utilize the research of evidence-based practice when making clinical decisions. They must have the ability direct and influence colleagues by integrating evidence-based practice into their clinical practice. Additionally, they must have a creative and innovative approach to their work to allow for change to be implemented (Curtis & Ramsden 2011). Moreover, clinical leadership can be taken on by everyone (no matter the experience), not only those appointed. These people can demonstrate clinical leadership by ‘developing and improving practice to meet the needs of patients’ (Curtis & Ramsden 2011, p.85). Paramedics that exercise clinical leadership in their daily routine not only are more likely to improve patient outcome, but they also form strong, cohesive relationships between colleagues which are undoubtedly crucial in the profession, especially when faced with difficult and confronting scenes.

Ethical Issues

Ethical issues are present in everyday life, challenging one’s morals, values and beliefs. They shape people into unique individuals having developed over time from experiences including one’s upbringing, schooling career and cultural background (Curtis & Ramsden 2011). In the paramedic profession, ethical issues often present themselves and paramedics must make quick professional decisions in difficult circumstances. Thus, it is necessary for paramedics to have a comprehensive knowledge of the rights of patients to refuse treatments when it comes to ethical decision making (O’meara & Grbich 2009).

Every day, paramedics are faced with extremely ‘complex and multi-faceted’ end-of-life decisions which require split second decisions to be made (O’meara & Grbich 2009, p.135). ‘Ethical decisions involve interplay between the clinical and social problems, together with the individual paramedic’s morals, values and beliefs’ (O’meara & Grbich 2009, p.145). In order to assist paramedics make these decisions, the Australian College of Ambulance Professionals developed a non-legally binding Code of Conduct consisting of eight codes. Furthermore, Tom Beauchamp and James Childress established four principles namely ‘respect for autonomy, beneficence, non-maleficence and justice’ to guide ethical decision making (Curtis & Ramsden 2011, p. 36).

In order to treat a patient, paramedics must be given autonomy and informed consent. The patient or patient’s representative (if a minor, unconscious or not in the state to make a decision) must understand ‘the health intervention that is being proposed, what alternatives are available’ and the associated risks in order to consent (Curtis & Ramsden 2011, p.37). In Australia, patients age 18 years of age or older have the right to refuse treatment as they have full legal capacity (unless proven otherwise) (O’meara & Grbich 2009). If younger than 18 years of age, a parent (or legal guardian) ‘is entitled to consent to the child’s medical treatment’ (Curtis & Ramsden 2011, p.37). Thus, if a patient or parent/guardian refuses treatment, even lifesaving treatment, paramedics must respect the decision even if personally they don’t believe it is the correct one.

This type of ethical situation is common in cardiac arrest cases. An example of this is a 60 year old male patient who has terminal cancer and is in cardiac arrest. If an advance directive or DNR (do not resuscitate) is not evident and a representative of the patient (wife, daughter etc.) says that the patient informed them that in such a case, they do not want to be resuscitated, paramedics must respect this decision (O’meara & Grbich 2009). Furthermore, another example of an ethical case involves a Jehovah’s Witness who refuses to have a blood transfusion due to her religious beliefs even though she is warned that without it she will die. In such cases, paramedics must abide by and respect the patient’s decision (one of the four principles established by Tom Beauchamp and James Childress - respect for autonomy).

Within the Australian healthcare system, paramedics are healthcare professionals that operate both autonomously and independently. On a daily basis, they must make accurate clinical judgements and decisions based on evidence-based practice, use of clinical leadership and have a comprehensive understanding of ethical issues. Paramedics make appropriate clinical judgements and decisions for patients by combining their clinical expertise with evidence-based practice research. Furthermore, they optimise patient care and outcome through the use of clinical leadership. Moreover, they expansively understand the ethical issues that arise with patients and act professionally and appropriately. Therefore, clinical judgements and decisions based on evidence-based practice, the use of clinical leadership and a comprehensive understanding of ethical issues are three vital components of the paramedic profession which help optimise patient care and outcome.