Facilitators of expanded and extended scope of paramedic practice:
What makes them work?
Jakki Germann, David Lim, Leo McNamara, Vivienne Tippett
School of Clinical Sciences, Queensland University of Technology
Email: c113.lim@qut.edu.au
Objective
Better integration of health services and redefinition of health workforce roles through
expanding and extending traditional scope of clinical practice have been explored
nationally and internationally. This paper examines models of expanded and extended
scope of paramedic practice for attributes which facilitate such a practice.
Methods
An exploratory multi-case study analysis of Australia (Queensland), New Zealand,
Canada (Alberta) and the United Kingdom (London) expanded and extended
paramedic practices were analyzed.
Results
© Queensland Ambulance Service. Used with permission.
Successful models of expanded and extended practice harness the full capacity of the paramedic practitioner, and are
supported by enabling infrastructures, specifically: professional development/ education; clinical guidelines and policy
frameworks (boundary); access to physical infrastructure; clinical support from senior medical practitioners; and, ability
to directly refer to other health services (service integration). The scope of practice is however influenced by individual
employers’ capacity, perceived community needs and preference/ priorities. The potential for paramedic practice is
equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency
Standard provides the form and function for building on paramedic practice. Recognition of such paramedic practice
provides a structure for professional growth, process for career progression, support workforce retention, improves
healthcare and equity of access.
Micro
Recruitment
Autonomy
Meso
Location
Education
Stakeholder
engagement
Macro
Additional scope of
practice
Internal
Governance
Isolated Practice
Area Paramedic
(IPAP) (2006)
 Expression of
interest
 Advanced
Care
Paramedic
(or
equivalent)
 Selection
process
Somewhat;
in
accordance
with
protocols
Queensland
 1 year
Health approved  GradCert (AQF Level 8)
most rural and
 Combined the Rural and Isolated
isolated
Practice Endorsed Nursing program
communities
developed by the Queensland
only
Health and Australian College of
Rural and Remote Medicine chronic
disease strategy, using the Primary
Clinical Care Manual
New Zealand:
Unknown
Somewhat
Urban
 1 month equivalent of classroom and • Involvement of Council of
1 month practicum shadowing an
Ambulance Authorities
ECP
and Minister of Health in
 GradCert and Master (equivalent to
policy formulation
AQF 8 and 9)
 Wound care
 Suturing
 Blood sample
 Usual quality and safety
governance
 Direct contact with oncall Emergency
Physicians
Selection
process
(interview)
Limited
2 major urban
cities
 6 weeks classroom and 4 weeks
practicum shadowing Nurse
Practitioners in care facility
 Advanced diploma (equivalent to
AQF Level 6)
 Usual quality and safety Professional
governance
registration
 Direct contact with
Medical Director
(Medical Control) and
patients’ family doctors
Unknown
High degree
Urban
Honour and Master (equivalent to AQF Via NHS
8 and 9)
 Extra prescribing
and dispensing
rights
 Wound care
 Suturing
 Ability to directly
refer to community
and prehospital
support program/
homecare
 Extra prescribing
and dispensing
rights
 Specific direct
referral
Australia –
Queensland:
Extended Care
Paramedic,
Community Care
Paramedic
Canada –
Alberta:
Community Care
Paramedic
UK – London:
Paramedic
Practitioner,
Community Care
Paramedic
 At practitioner level
• Authorised to
 Supervision of project
 Involvement of the
practice under IPAP
delivery through
Council of Ambulance
• Health assessment
Queensland Ambulance
Authority in policy
of patient in
Service
formulation
accordance with
 Direct contact with on Partnership between
Health Management
call Emergency
Queensland Health,
Protocol
Physicians (Medical
Queensland Ambulance
Director)
Service, and James Cook
University
Legislation
 Post-hospital discharge
organised by discharging
physician
 Community initiated via
Alberta Health Services
and municipality, in
partnership with Alberta
College of Paramedics
 Usual quality and safety
governance
 Direct contact with
control centre for
medical direction
Amendment of
Health (Drugs and
Poisons)
Regulation 1996
(QLD) to allow
expanded
paramedic practice
Health Care
Professions
Counsel registration
Conclusions
The achievement of enhanced knowledge and skills has positioned the paramedic profession as a valuable part of the
healthcare team. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and
function for supporting expanded and extended paramedic practice.