Sunshine Coast, Gubbi Gubbi and Jinibara Country

'Listening to patients, emphasising and understanding each individual’s context is very important.'

While working in the community as part of a Queensland Ambulance Service Local Area Assessment and Referral Unit (LARU), Senior Advanced Care Paramedic and university educator Dr Robbie King began to question if definitive home-based care, without transport to hospital, was beneficial for patients.

The LARU provides a less traditional, more “community paramedic” model of out-of-hospital healthcare that focuses on one-on-one care delivered by specially trained paramedic clinicians to people who potentially don't require two paramedics and an ambulance; lower-acuity presentations that often involve vulnerable people with potentially complex needs that aren't necessarily a medical emergency - cases that represent a significant proportion of ambulance call-outs.

“Initially I was concerned about what the outputs of non-conveyance (transport) situations were, was I qualified to do this, do I have the right training? And that led me down the path of realising that the only people who can really tell us if this is working are the patients themselves,” he said.

“I can reduce the number of people attending hospital, but is it actually that the right thing for them? The research was trying to tap into what the patients understood themselves as an outcome to guide paramedic education and novel models of care.”

His curiosity led him to embark on a PhD research project that culminated earlier this year in the publishing of his doctoral thesis “Exploring patients’ experiences of non-conveyance after receiving an emergency ambulance service response”.

His research analysed the characteristics of more than 1.5 million adult patients calling an ambulance in New South Wales between 2020 and 2021 and found that 12.6 percent were not conveyed to an emergency department. He interviewed 21 people from that category to better understand their experiences with paramedic and ambulance service healthcare.

“The research told us the story from the patient's perspective. Here are people reaching out for a Triple Zero service, with the concept that they will be transported to a hospital and this then not occurring. Did they find the care useful, was it what they required? What happened afterwards?

“Existing research basically said that these models can reduce the number of people going to hospital, but we still don't fully know how it affected their outcomes. Prior research often measured variables such as mortality rates, which is certainly important, but the fact that somebody didn’t die is a poor measure of quality.”.

The key takeaways from his research were that, overall, patients inherently trusted and valued paramedics as healthcare professionals, and that compassionate care combined with professional healthcare reinforced that bond. However, a lack of compassion undermined a patient’s trust and confidence and led to a continued reliance on emergency healthcare.

Demonstration of authentic compassionate care allowed paramedics to build relationships with their patients and help guide them in their decision-making processes by educating them about how they could address their issues, restoring their confidence to independently decide whether or not they needed to go to hospital.

“The way participants described it was, the paramedics listened to me, my concerns were validated by the paramedic; they were compassionate in the sense that they recognised the reason that I called wasn't necessarily an emergency, they recognised my vulnerabilities, but they also still dealt with me as a human being with individual needs.

“Participants also emphasised the need for clinical competence and not just the caring aspect. When that wasn't present, patients weren’t able to reinforce trust in the paramedics and they continued to seek healthcare. This demonstrated that if paramedics do show the right attributes and the appropriate care, then patients can reinforce the existing trust they hold for paramedics.”

Building relationships also bolstered patients’ health literacy by helping to educate them about how they can address their issues and the options available to them in the future, and empowering in turn them to take control of their own health.

During his research, Dr King also became attuned to how people contextualised their current health issues in the setting of their “circumstantial vulnerabilities”. This encompassed their previous experiences of healthcare and their individual psychosocial circumstances that had led to their perceived need to call an ambulance.

“When I asked patients to tell me about their experience, they almost all started telling me about their circumstantial vulnerabilities that were present way before the event occurred that led to the call for the ambulance service. Listening to patients, emphasising and understanding each individuals’ context is very important, rather than applying a blanket approach to the presentations.

“It’s very much about what's unique for that individual. The paramedic might have seen the same circumstances a hundred times, but that person needs to tell their story, to be heard, understood, and respected as an individual.”

Dr King’s research demonstrates the value and necessity for an improved understanding of, and respect for, the patient experience during paramedic-led healthcare.

“This research identified that there was a process that patients needed to go through. They started off vulnerable and dependent on others, by the end of the interaction, if they received compassionate and professionally competent care, they’ve realised that their circumstances weren't actually that bad and they were then able to rebuild self-confidence and self-efficacy to manage in the community without transport to hospital.”