Paramedicine's evolution – Embracing the new era

This study is a small part of a larger PhD program of research. There is a need for evidence-based pre-employment physical fitness assessment standards in paramedic organisations. This program of research has assessed the feasibility of implementing an existing, international, standardised pre-employment paramedic physical capacity test, the Ottawa Paramedic Physical Abilities Test (OPPAT™), in the Australian context. This abstract focusses on paramedicine students’ perceptions of physical preparation activities in an undergraduate paramedicine degree program. Paramedicine is an increasingly popular profession, with the main pathway into the role through the completion of a two to five-year bachelor’s degree program. This tertiary pathway presents some challenges for the physical preparation of students for the paramedic role. Student paramedic physical fitness is a safety concern for the student, patients and existing staff.

Consensus-based studies appear to be increasingly common in paramedicine research. Recent analyses in other disciplines describe great diversity in methods characterised by frequent modifications. Despite its methodological amenability, rigour must be maintained to ensure meaningful robust outputs. This research involved a bibliographic analysis of published research reporting the use of a consensus methodology in the pre-hospital context. The findings of this research suggest that there may be a need for stronger methodological guidance within the paramedicine research space to ensure quality, and stronger engagement with reporting guidelines to ensure completeness and transparency.

This literature review found there is a critical need for a structured capability framework for advanced practice paramedics (APPs) in Australia, where a national standard is currently absent. By analyzing 17 documents from the UK, Canada, and Australia, the review identified four essential capability domains for APPs: Clinical Practice, Education, Research, and Leadership and Management. Despite commonalities found across the literature, variations in specific capabilities and differences in general registration requirements and capabilities highlight the necessity for a framework tailored to Australia’s paramedicine context. The review explores challenges and opportunities in standardising APP roles and advocates for further research and consultation to distinguish advanced practice from general practice, guiding APP education, regulation, and standardisation in Australia.

Emergency clinicians, including paramedics, are often the sole point of contact with the healthcare system for people who use drugs. The toxic drug crisis has seen the rapid expansion of emergency buprenorphine initiation for people with opioid use disorder interested in opioid agonist therapies. This systematic review summarised the available evidence relating to this topic, highlighting the crucial role emergency clinicians play in the continuum of care for people who use drugs.

Quantitative mask fit testing (QnFT) was widely implemented as a safety control measure during the COVID-19 pandemic. The aim of this study was to evaluate whether education + qualitative fit check (QFC) is no worse (non-inferior) than education + QnFT in terms of mask fit performance measured both immediately and two weeks later. A randomised controlled non-inferiority trial was conducted comparing QnFT with guided mask selection by the QnFT administrator compared to a self-selection procedure with self-performed QFC. This study confirmed that quantitative mask fit testing remains the gold standard, despite the resources used, to meet required safety control standards.

This study assessed the research activity of 170 Australasian paramedicine academics using the Scopus H Index (Sc-H). Findings reveal that 61% had a Sc-H of zero, and 90% had a Sc-H below five. Among 17 professoriate paramedicine academics, five had a Sc-H of 10 or more, and three were above 15. These results suggest most academics are either inactive researchers or their work is not being cited or is published in non-Scopus journals. These insights are valuable for discussions about the effectiveness of using a single-metric system to evaluate paramedicine research activity.

This study explores the clinical leadership practices of Extended Care Paramedics (ECPs) in Australia and Aotearoa New Zealand. Despite ECPs being a decade-old specialist role, little is known about their clinical leadership practices. Using qualitative content analysis and semi-structured interviews with five ECPs, the study identified key themes such as conflict resolution, clinical education, patient advocacy, and leadership styles. The research reveals that ECPs see themselves as senior clinicians focused on enhancing patient care, despite facing barriers like limited leadership training and cultural perceptions. This study provides valuable insights into ECPs' clinical leadership roles in healthcare.

This study describes the scope and context of pain management therapies applied by paramedics. Evidence was obtained through database searches. A total of 194 articles were included in the review. Evidence for the application of 20 analgesic medicines and 4 non-pharmacological therapies was found. Extensive contextual gaps were identified and evidence for pain therapy in specific groups was lacking.

Work-integrated learning (WIL) and its assessment are prominent features within the curriculum of Australasian paramedicine tertiary education programs. However, research on the diversity and assessment of WIL in the context of paramedicine tertiary education is scarce. It remains unclear what WIL activities paramedicine students undertake and what assessment tools are used to evaluate outcomes. This study aimed to provide a comprehensive overview of WIL practices in Australasian tertiary paramedicine programs.

Paramedicine education lacks a nationally standardised assessment tool for evaluating students during work-integrated learning (WIL). The absence of a national harmonised assessment sets paramedicine apart from other health disciplines, risking patient safety and workforce competence.  In 2023, with support from the Australasian Council of Paramedicine Deans (ACPD), the Australian Paramedicine Professional Capabilities Tool (APPCAT) has been developed to meet program accreditation standards.  The APPCAT aims to develop a reliable method for assessing paramedicine students under direct observation during placement.   This multi-phase project has completed its first phase with a modified Delphi process to identify the behavioural cues descriptors.

The landscape of paramedic practice in Australia and Aotearoa New Zealand is rapidly evolving, with increasing numbers of paramedics working in primary health care roles. Despite this, paramedics are still seen as synonymous with ambulances and associated with responding to emergency calls. This presentation highlights the characteristics, patient presentations, clinical assessments, and procedural skills practiced by paramedics operating within primary care in Australia and Aotearoa New Zealand.

The study aimed to assess the accuracy of point-of-care (POC) lactate measurements compared to laboratory lactate levels in trauma patients with suspected critical bleeding. In an emergency department setting, 70 patients had venous or arterial blood samples collected. The POC lactate measurements were conducted using a StatStrip Xpress® lactate meter. The results showed a mean difference of -0.19 mmol/L between POC and laboratory lactate levels, with most measurements (94.3%) within the limits of agreement. A POC lactate level >3.3 mmol/L was highly specific (>90%) for indicating the need for transfusion, while a level <1.4 mmol/L had high sensitivity (90%) for ruling out transfusion. The study concludes that POC lactate measurement is accurate and feasible for developing prehospital transfusion decision rules.

Simulation-based education, rooted in aviation, is now integral in health professions education, enhancing clinical competence and patient safety. Interpreting 12-Lead ECGs is essential for paramedics, yet specific educational strategies to master complex rhythms are lacking. This study assessed the impact of weekly simulation sessions on improving paramedicine students' ECG interpretation skills. A retrospective analysis of data from 2019-2024, involving 304 students and 1,251 scenarios, showed significant performance improvements in most years. Findings suggest that frequent simulation practice may enhance ECG interpretation skills in paramedicine students.

Traditionally, there's limited out-of-hospital data to inform evidence-based practices, often relying on expert opinions or hospital data. In Aotearoa New Zealand, Māori and Pacific peoples face poorer health outcomes. Research enabled by the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) aims to to ensure equitable, evidence-based prehospital care. ANZPaCC collects data from emergency services and links it with national health datasets. This facilitates research on the diverse range of conditions encountered by Paramedics to improve paramedic care quality, equity, and effectiveness.

In partnership with McMaster University, La Trobe University and Sunraysia Community Health Services implemented CP@clinic, an evidenced-based community paramedicine program in rural Australia. Weekly drop-in clinics delivered chronic disease screening, referrals, and health education,  which recorded data and client care in a purpose-built database. A mixed-methods evaluation assessed program feasibility and fit, finding high client acceptability, significant healthcare needs, and improved community engagement. Expansion to additional sites is underway, despite identified barriers to paramedic integration in primary care. Future evaluations will explore health outcomes and cost-effectiveness across rural settings.

Back pain leads people to seek healthcare from paramedics, yet the management approaches by providers of ambulance services remain unclear. This study aimed to investigate paramedic management of back pain in NSW, Australia. We performed a retrospective analysis of computer-aided dispatch and electronic medical records of adults who sought care for a complaint of back pain, triaged as non-traumatic back pain and received treatment by paramedics. Back pain makes up 1.4% of the total ambulance service caseload in NSW. Common management strategies include transport to hospital and pharmacology. There is limited reporting of non-pharmacological care and alternate referral pathways.

This session forms part of a series looking at the broader topic of Whole of Health Approaches. The other sessions in the series are Closing the Gap, Palliative Care, Chronic Disease Management. 

(Full session overview coming soon)

Kallie’s nutrition presentation delves into the crucial role of nutrition for paramedics, highlighting how their health often suffers due to long hours, shift work, and disrupted sleep patterns. The session will address the unique challenges paramedics face, emphasise the importance of balanced nutrition, and provide practical strategies for implementing effective nutritional practices within the paramedicine field.

This retrospective cohort study sought to describe the epidemiology of adult syncope presentations within an emergency medical service and the associated transport outcomes of these presentations. From almost 2.5million patients over 4 years, syncope accounted for almost 2% of all presentations. Despite more than half of all presentations being over the age of 55, less than 33% received a 12-lead ECG. Almost 80% of all presentations were transported to hospital, with an overall re-presentation rate of 0.5%. An improved understanding of patients presenting with syncope could help paramedics to better risk-stratify patient provide them with more efficient alternative care pathways.

Paramedics often feel uncomfortable and lack confidence in caring for paediatric patients due to limited exposure and experience. This review aims to understand paramedics' comfort and confidence levels in managing critically ill paediatric patients, including final-year students. A systematic search of electronic databases identified 20 relevant studies, revealing that paediatric cases cause significant anxiety and stress among paramedics. The review highlights the need for improved training, especially simulation-based training, to enhance paramedics' comfort, confidence, and overall care quality for critically ill paediatric patients. These findings can guide policy and practice improvements in paediatric trauma care.

Medical Yarn-Ups decolonise the Western way of health care delivery. GPs are invited into the safe space of a yarning circle to openly discuss certain topic’s whilst delivering medical consultations. Waminda has been developing models to integrate Medical Yarn Ups into primary health care for years. Decolonising health care allows for Aboriginal ways of knowing being and doing into the primary health care space. We have found them to empower clients,  building knowledge and confidence to create self-determining outcomes.

Tara will present a fresh perspective on resilience by focusing on the five core pillars of communal psycho-social health. She will advocate for a shift away from the current emphasis on individual resilience programs, emphasizing the need for a more holistic, multi-dimensional approach. By driving change from the bottom up, top down, outside in, and inside out, Tara will demonstrate how this comprehensive strategy is essential for effectively building both individual and organisational resilience within the paramedic community.

This observational cohort study investigated demographic, clinical, and health utilisation factors associated with increasing levels of Emergency Department (ED) attendance at Frankston Hospital from 11/01/2017 to 10/31/2018, using multivariable negative binomial regression and logistic regression. Among 45,126 participants with 69,027 ED presentations, patients who frequently present accounted for 5.2% of the population and 9.6% of all ED attendances. Higher rates of ED presentation were associated with non-private residency and mental health concerns, with predictors of extreme presentation found to be enrolment into a hospital outreach program, and comorbidities such as cardiac arrhythmias and unhealthy alcohol use.

Māori frequently encounter culturally unsafe experiences throughout the health system, however, research exploring experiences of Māori in the pre-hospital context is lacking. Thus, utilising a qualitative descriptive and Kaupapa Māori Research (KMR) approach, this study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care. In-depth semi-structured interviews allowed for the emergence of three key themes that highlighted Māori experiences of culturally unsafe pre-hospital care, whereby, despite fewer reports of interpersonal discrimination reported than in previous research, systemic and structural barriers were still found to be harmful. Thus, improving workforce representation, addressing resource disparities and improving cultural safety education (focussing on communication, partnership and connection) are necessary to improve experiences and outcomes for Māori.

A brief overview of the evolution of paramedic practice in the End of Life and Palliative Care space in NSW. The transition from a protocol-based service up to current and future scope with increasing autonomy, and how it supports end of life patients and complements existing palliative care services in the community. The evolution of palliative care in NSW reflects the changes in the paramedic profession from a transport service to the modern day out-of-hospital healthcare providers.

Drawing on our recent research in recruit paramedics, this presentation will describe how sleep changes with the start of shift and emergency work, and the impact poor sleep has on the later development of mental health symptoms in paramedics. The presentation will then outline evidence-based strategies that paramedics can use to promote healthy sleep when working shift work.

The evolving role of paramedics now encompasses the ability to prescribe medication. This scoping review aims to explore paramedic experiences and perceptions of medication prescribing, identifying challenges and facilitators to inform future policy and practice. This review highlights the critical need for structured support, clear role definitions, and robust legal frameworks to empower paramedic prescribers. Addressing technological and systemic barriers will be essential for the successful integration of prescribing roles within paramedic practice.

Delivering care to people living with dementia in the out-of-hospital setting comes with unique challenges. With the integration of paramedicine into multidisciplinary teams, clarity surrounding the paramedic role in dementia care needs to be established. The international panel of 25 experts from this sequential, electronic Delphi study included clinicians, carers and persons with lived experience. Response rates varied from 92% (Round 1) to 76% (Round 3). The top priority for paramedic management was communication skills, with 78.9% consensus, while distinguishing delirium from dementia emerged as the top priority for paramedic education with 73.7% consensus.

This session forms part of a series looking at the broader topic of Whole of Health Approaches. The other sessions in the series are Closing the Gap, Palliative Care, Inquiry into Womens Pain.

(Full session overview coming soon)

This session will look at the evolution of culture within ambulance services. It will examine the importance of a safe, inclusive and supportive culture and the critical role that culture plays in preventing psychological injury following trauma.   Once occurring somewhat naturally, we now need to be more intentional about creating the culture that we feel comfortable with.

The study aimed to compare the effectiveness of traditional cotton and foil blankets with a novel self-warming blanket in maintaining normothermia in trauma patients. In a simulated trauma scenario, participants were cooled and then warmed using either combination of blankets. Core and total body temperatures were measured throughout the process. Results indicated no significant difference between the two methods in maintaining normothermia, as both showed similar temperature changes. The study concludes that the novel self-warming blanket is not more effective than the traditional method, suggesting further research into other warming methods.

This study examines the prehospital paediatric emergency care burden in the Western Cape, South Africa. The study found 87,457 cases were managed between January 2022 and December 2023, with most cases coming from rural areas. The most common presenting complaints were respiratory emergencies, non-cardiac pain, and trauma. Most cases were prioritised as priority 2, with these being children between one and five years old. Low acuity cases accounted for 67.3% of the sample, with the highest mortality occurring between 29 days and 12 months.

Despite the documented effects of shift work on health and performance, few studies have examined its impact on the paramedic population. My work explores the acute impact of shift work on paramedics and their practice through analysis of decision making, work performance, communication, and individual physiology. In pairs, participants complete a simulated shift rotation, during which they engage in high fidelity paramedic scenarios and decision-making tasks. Biological measures are collected throughout the rotation to assess underlying physiological conditions.

Trauma impacts over 4.4 million people globally each year, with approximately 950,000 being paediatric cases. However, paediatric trauma is rare in paramedic practice, challenging their confidence and preparedness. This study evaluates the attitudes, self-reported confidence, competence, and comfort levels (CCL) of student paramedics (SP) and practitioners regarding paediatric trauma patients. Using literature reviews and surveys, the research identifies significant anxiety among paramedics in paediatric care. So far, it has been identified that there is a recommendation for simulation-based training and improved education to address gaps, ultimately enhancing paramedic skills and patient outcomes in paediatric trauma care.

This session is the first in a series of presentations on Assessment of Special Populations and aims to shine the light on the considerations and different approaches to assessment when engaging with paediatric populations. This will include communication, biases, and clinical challenges. 

This session will include 3 other presenters who will speak about bariatrics, neurodivergent and geriatrics.

The field of private paramedics presents vast opportunities, driven by an increasing demand for personalized healthcare services and rapid response capabilities. Private paramedics can work in diverse settings, including energy, mining and infrastructure, event medical services, corporate healthcare, private transport, and community health programs. This sector allows for a broader scope of practice beyond traditional emergency response, including preventative care, health education, and chronic disease management. Additionally, private paramedics can engage in telehealth, remote patient monitoring, and mobile health units, enhancing access to care in underserved areas. This flexibility fosters professional growth and innovation in delivering high-quality, patient-centered healthcare services.

This session will begin the TeleHealth series and Jackson will discuss what secondary triage is, how it is used and the role that video calls play in the secondary triage environment.

An introduction to the Vortex Approach of airway management model.  A review of the Vortex approach and application of the airway vortex in the pre-hospital context.  

Currently 68% of the Australian population are overweight or are people living with obesity. All health care practitioners need to improve there understanding and knowledge to improve our nations health. Assumptions and outdate theories/ beliefs have lead to reduced access to care, adding to our countries chronic disease burden. This presentation will cover some for the key areas of considerations in bariatric healthcare, weight stigma, assessment, treatments and potential presentations. 

The field of private paramedics presents vast opportunities, driven by an increasing demand for personalized healthcare services and rapid response capabilities. Private paramedics can work in diverse settings, including energy, mining and infrastructure, event medical services, corporate healthcare, private transport, and community health programs. This sector allows for a broader scope of practice beyond traditional emergency response, including preventative care, health education, and chronic disease management. Additionally, private paramedics can engage in telehealth, remote patient monitoring, and mobile health units, enhancing access to care in underserved areas. This flexibility fosters professional growth and innovation in delivering high-quality, patient-centred healthcare services.

This session forms part of a panel series looking at the broader topic of telehealth. This session will discuss the legal and ethical aspects of the use of telehealth options while ambulance crews are ramped at hospitals with patients (both in ambulances and internally).

This presentation will delve into the critical importance of targeted ventilation strategies, highlighting the significant benefits of using mechanical ventilators in prehospital settings. 

This session is the third in a series of presentations on Assessment of Special Populations and aims to shine the light on the considerations and different approaches to assessment when engaging with neurodivergent populations - including communication, biases, and clinical challenges.

This presentation aims to outline how to optimise opportunities in Paramedicine outside of jurisdictional Ambulance Services. Practical tips and real life examples of how this can be achieved will be discussed, along with realistic timelines and pathways to ensure maximum job satisfaction.

This session forms part of a panel series looking at the broader topic of telehealth. The other sessions in the panel are secondary triage, telehealth on the ramp (complications, legalities, considerations, and controversies) and maximizing the use of telehealth. This will be third in the series and would be discussing the benefits and challenges of remote patient monitoring.

(Full session overview coming soon)

A shallow dive into current blood products, adjunctive therapies and pressors used to treat haemorrhage in the prehospital setting with the aim to assist decision making in determining the appropriate circulatory support strategies.

This session will focus on essential elements of assessing the older person including:

• Recognising delirium, and dementia.

• Communicating with the unwell older adult

• Identifying changes from the patient’s baseline.

• Avoiding bias

• Clinical challenges in the evaluation of older adults including the reduced reliability of classic clinical presentations in identifying disease- and how to overcome this.

This session is the last in a series of presentations on Thriving in Private Paramedicine and aims to provide guidance on how to choose your employer. It should include things to look for, considerations and alternatives to direct employment.  

(Full session overview coming soon)

Dr. Nirvana Luckraj’s session will explore how telehealth can maximize patient health outcomes from both clinician and consumer perspectives. She will discuss effective strategies, share success stories, and address challenges in telehealth implementation. After her presentation, Dr. Luckraj will join a facilitated discussion with other panellists to delve deeper into the themes covered

Throughout the 80s, 90s, and early 2000s, prehospital trauma care and advanced trauma systems evolved rapidly in Australia. This was paralleled by very effective public safety campaigns reducing the incidence of drink-driving and speeding, increased vehicle safety and the use of seatbelts and airbags. Today, trauma mortality is comparably low, but we still have more work to do. In this presentation, Ben will discuss where we can achieve maximal gains in trauma care, and this starts with paramedicine.

Panel discussion surrounding the topic of Assessment of Special Populations

Panel discussion surrounding the topic of work in the private sector

Panel discussion surrounding the topic of Telehealth

Panel discussion surrounding the topic of Critical and Intensive Care

The International Perspective - Vanuatu

This session will cover the development of the program in Vanuatu, the complexities and celebrations, the current prehospital environment and the future of paramedicine in Vanuatu.

The International Perspective - Ambulance Care in Papua New Guinea: From Basic Life Support to Critical Care in Trauma, Childbirth, Snakebite, and Sepsis Management

This presentation highlights how the National St John Ambulance in Papua New Guinea manages a clinical case load involving relatively unique rates of trauma, snakebite, sepsis, and childbirth.

The International Perspective - Evolution and Current State of EMS in South Africa: A Journey from Fragmentation to Modernisation

The presentation traces the evolution of South Africa's Emergency Medical Services (EMS) from its fragmented pre-1994 state to today's modern, professionalised system. Key milestones include the post-apartheid reforms that unified the system and standardised training, followed by a period of expansion and challenges. The presentation also highlights the current state of EMS, including its structure, service delivery, workforce, and the role of technology. It concludes by looking towards the future of EMS in South Africa, emphasising the potential for further advancements and improvements.

Workforce Futures

Paramedicine roles are expanding beyond emergency response to include preventative care and chronic disease management, in urgent and primary care settings. The rising demand for paramedics, especially in rural and under-serviced areas, underscores the need for strategic workforce planning and support to leverage paramedic capabilities. There is an intersection where regulation, healthcare settings and frameworks meet, and this session will look at these aspects. 

Paramedicine is evolving – Specialist Practice Paramedic Endorsement

Paramedicine is evolving. In this session, we will explore Te Kaunihera Manapou | Paramedic Council’s regulatory journey and how regulation is supporting the endorsement of specialist paramedic practice. In the first part of the session, Jacq Manley will share insights into Te Kaunihera’s journey. The second part will feature an interactive and engaging Q&A session with our Manukura | Chairs, Bronwyn Tunnage and Carlton Irving; audience participation will be encouraged. 

Paramedicine Board of Australia: Advanced practice endorsement

Stephen will be speaking on the topic of the Paramedicine Board of Australia’s work toward reviewing the establishment of an ‘Advanced Practice’ endorsement in paramedicine for consideration by Australian Health Ministers.

The Role of Frameworks in Leading Change

Frameworks play an important role in informing healthcare strategy, understanding workforce capability, and shaping healthcare delivery. In this presentation John Bruning, CEO, Australasian College of Paramedicine will highlight how frameworks lead change. 

This series is called Climate Change, Public Health and Paramedicine and aims to stimulate conversation and consideration of the practical impacts of climate change for paramedics

Implications for Service Planning and Practice

Climate-related extreme events such as heatwaves, bushfires and floods can have devastating impacts on local emergency responders and health services, both during and in the aftermath of these events. In a warming world, how can paramedic services best plan for extreme events, and what does the evidence say is needed in the future? How can you, as a paramedic, make a difference?

Infection prevention and control in ambulance services

Where we were, how the pandemic changed us, and where we are headed.

Infection prevention and control (IPC) programs continue to evolve in ambulance services and are vital to keep our patients, colleagues, and communities safe. The recent pandemic presented many opportunities, challenges, and areas of growth. This included the progression of IPC professionals, the way ambulance services can assist in community outbreak management, environmental sustainability, preparation for future public health emergencies, and expanding scope of practice.

Hot and Bothered - Climate change, extreme heat and health for older Australians

The environmental impacts of climate change are diverse and translate to multiple direct and indirect population health impacts- often hidden and exacerbators of existing health conditions.  The past three years of northern hemisphere summers and the 2023-2024 summer in Australia provide a window into the breadth and impacts of one such climate threat –extreme heat. This presentation provides an overview of the warming of the planet and how this is translating to rising heat and health impacts. It will focus on what this means for one particular at-risk population – older adults.  It will include an overview of the Ethos (Extreme Heat and Older Persons) project - an individualised heat-health early warning system for older persons and present some of our survey research findings, communication outputs and learnings from our phase 1 trials.

Thermophysiological Impacts of Climate Change on Paramedics

Attendees will leave with a sense of responsibility to the community, feeling enabled to start practicing sustainable healthcare practice, and beginning to consider how these factors of climate change will impact their clinical practice in the future.

Mobile ECMO

This session will cover the development of mobile ECMO, including an explanation of what ECMO is, how it varies from standard ECMO, its successes and failures and why it has become mobile in some jurisdictions and not others.

Pre-hospital Critical Care in the remote and resource limited environment of Vanuatu: Challenges, differences and lessons learnt 

Using Clinical Case reviews and lived experience from practicing Pre-hospital Critical care in the remote and resource-limited environment of Vanuatu. This presentation will introduce some of the challenges, the differences  and considerations in this environment and seek to answer the question: how does resources shape clinical practice and scope of practice for critical care paramedics and what does pre-hospital critical care look like in resource-limited environments.