Perth/Boorloo, Whadjuk Nyoongar Country

'The paramedics in this team have an extended scope because RFDS sees value in that.'

For close to a century, Western Australia’s Royal Flying Doctor Service (RFDS) has been serving communities in regional and remote areas of the state, providing life-saving healthcare for rural and remote communities and industrial operations across the world’s largest health jurisdiction.

Synonymous with the delivery of world-class medical services to geographically challenging areas, the RFDS has throughout the years employed a range of health professionals to address the needs of those living and working in some of the country’s most isolated locations.

In early 2023, paramedicine became entrenched into the organisation with the creation of a Paramedic Team Lead position as part of the organisation’s strategic operational shift that is helping to foster greater inter-professional collaboration and breaking down the traditional siloing of medical disciplines.

For former QAS paramedic Andy Bell and NSWA paramedic Matt Pepper, the profession’s integration marks a significant area of growth for both paramedicine and the RFDS that is opening new career pathways and opportunities for the profession outside of jurisdictional ambulance services.

Andy was initially employed by RFDS as Paramedicine Lead before changing designations to Industrial Health Lead as the team evolved to include paramedics, nurses, doctors and emergency services officers.

“I've been here almost a year to the day,” he said. “When the RFDS made the decision that this was going to be something that they were looking at long-term within the organisation, it made sense to have someone to lead that team as opposed to having the team sitting as an adjunct to the medical team.

“Nurses have a nursing lead, and doctors have a lead, so it makes sense to have a paramedicine lead as well, particularly as they see this as a significant area of growth for the organisation moving forward. There's been a large move in the strategic direction of RFDS; it's happening as we speak, and certainly paramedics are playing and will continue to play a fairly significant role in that evolution.”

RFDS Paramedic Educator Matt works both with the industrial health team and the clinical education team.

“While my role does work in with Andy and I do report to him, it's also more broadly about doing clinical education across the whole organisation, breaking down the boundaries, running education for nurses and doctors. That's a really big thing for us to have.

“It's a big thing for our industry, but it's also a big thing for RFDS to have that pre-hospital emergency clinician input into what the rest of the organisation is doing. It's been really positive and we've broken down a lot of barriers through education, and we’re certainly feeling a lot more collaboration across the entire space, so it's been great.”

The professional opportunities afforded to RFDS paramedics are myriad and encompass a growing number of placements in different clinical practice settings, from offshore work on oil and gas rigs to onshore industrial and community paramedicine and, most recently, rotary flight retrieval.

However, given the vast expanse of the Western Australian outback and the distances involved, paramedics are often working autonomously in extremely remote locations and are operating under expanded scopes of practice, with specific skills and attributes required for such environments.

Andy said the work spanned the health continuum, from the higher-acuity level through to primary healthcare. For offshore work, the emphasis is on keeping the people working on those platforms and sites safe and healthy.

“It's extremely expensive and very difficult to get people on and off these sites,” he said. “Our role is to try and keep them there if possible, but also to be able to do the big jobs and make the big decisions when required. That lends itself to changes in the scope of practice, because one of the one of things that needs to be very clear is that scope of practice is determined not by the title that you have but by the choices that the organisation makes for you. The paramedics in this team have an extended scope because RFDS sees value in that.

“One of the beauties of the team and the way we're building it is that, across the board, different professions and levels operate under the same clinical guidelines. Some might use a particular skill set and some people might not unless it’s under consult, but they are still there within the guidelines and it affords an understanding of each other’s role, and that's part of building continuity in this team.”

In a shift away from more conventional hierarchical healthcare structures, the RFDS’s multidisciplinary team operates with an ethos of professional equality and a culture of flexibility and adaptability. In meetings and trainings, everyone has the opportunity to speak and contribute, everyone’s opinion is valued, ideas are shared and discussed, and the leadership role is assumed by the person best suited for the particular situation or individual case requirement.

They are also ensuring that paramedics are given opportunities to work across the different RFDS work environments to better understand how the organisation operates, learn from other clinicians, and prevent professional siloing in one sphere of practice.

“We've got many different types of paramedics,” Matt said. “One of the keys to what Andy's trying to do with the team is to make sure that people are able to work across those different work domains so that we're not siloing people into ‘you work on an offshore platform and that's all you do’, but trying to give people opportunities to work across those different domains and also work with the rest of the organisation as well.”

And while some paramedics may work on site-specific contracts, they will undertake group workshops and trainings alongside other RFDS health practitioners. A recent three-day in-house workshop brought together people from across the different sites, irrespective of their qualifications and profession.

“Doctors, nurses and paramedics all did the exact same training, there was no difference between them,” Matt said. “The whole idea is to show them that we value all of their skill sets and that everybody has something to contribute. This is one of the reasons Andy and I were attracted to these roles at RFDS, because there are not that many opportunities to be able to do what we're doing at the moment.”

RFDS paramedics initially come in on a contract basis and following that are employed on a full-time basis, although there are other employment options. The service also offers reliever positions and both short and long-term contracts, offering flexibility for those looking for a change of pace or a new career opportunity and for those who might not want to commit to a full-time position in an area of practice with which they are unfamiliar.

The biggest challenge for incoming RFDS paramedics is the austere environments in which they will work, requiring situational awareness, effective communication, the ability to problem- solve, and psychological readiness.

“You have to come with some experience,” Andy said. “But what we're really looking for - far above the number of letters behind your name and whether or not you’re an Intensive Care, Critical Care, or Extended Paramedic or anything else - is, are you the kind of person who is able to solve problems and maintain a calm demeanour? Are you able to lead in those environments where the resources are limited? Those are the kinds of characteristics we're looking for.

“Finding good staff is like finding gold, and we want to show them that when they come to us, that we value them and that we do everything we can to support them.”