Administration and Leadership, Columns

American EMS can Learn from Australian Systems

Issue 3 and Volume 41.

In January of 2000, I had the opportunity of starting medical school at Flinders University in Adelaide, Australia. As a Texas paramedic, I was naturally curious about getting involved with the ambulance service in South Australia. I was also certain that coming from an advanced EMS system in America, I could offer my advice in order to improve their system. What I found instead was a system so far advanced from most in the United States that it completely changed my notion of what EMS could be.

One of the lead visionaries of this evolutionary leap in EMS was one of my mentors, Hugh Grantham, MD, who currently serves as professor of paramedics and assistant dean in a premier ambulance studies program at Flinders University. Fifteen years later, I spoke with him about the current state of EMS education and practice in Australia.

How did paramedics in Australia go about making the transition from “technicians” to degreed “clinicians?”

The process of evolution was a staged change in both education and culture. In order to change the culture within the profession, educational understanding had to occur. To change the culture around the profession, respect—not just for the skill and nature of the dangerous job, but for knowledge and understanding— had to be generated. Each educational step forward allowed a corresponding change in internal and external culture to occur.

The paramedic whose handover was once disregarded and clinical records disposed of has now become the valued health professional and first link in an integrated system. As he stepped up through different levels of education, the cultural changes kept pace. Although a degree-level education is readily identifiable as a milestone, it would mean nothing if it wasn’t accompanied by the respect of other health professionals. The cultural changes that drive the respect are almost more important than the education that enabled them.

Paramedics in the U.S. struggle from relatively low wages, which results in excessive overtime work. How do you address this in Australia?

The issue of wages is really related to respect. It has been handled both well and poorly in Australia through negotiations between employers and unions. For example, I would pay tribute to the professionalism demonstrated by the ambulance union in South Australia. Rather than making noisy demonstrations and demanding change, the union has clearly pinned its colors to the mast of patient care since the early 1990s. When they came to make an appeal for professional wages, it was made quietly with professional dignity behind closed doors. The arguments were supported by good evidence of education and considered reasoning that admitted there was room for improvement. You’re only a professional when respected professionals acknowledge you as such.

What’s the most pressing issue in EMS practice in Australia at the moment?

It’s the same as it is for EMS education in Australia: The changing nature of the paramedic workload and how EMS systems must adjust to accommodate it. We’ll always have a small percentage of traditional emergencies that need a full paramedic crew, vehicle and equipment. The question is: Does that equipment and configuration cope well with the complex, time-consuming and challenging cases that are becoming the expected bread and butter? In the past, it was enough to have saved the life and moved the problem to an ED. Now, as a true health professional, a paramedic has to be equipped and supported to go beyond just transferring the problem. We’ve got to educate our paramedics to be good at this and gain satisfaction from it. We also have to provide an environment with the equipment, dispatch criteria and structure to support this activity.

How do you think EMS medicine will change in the next 5–10 years?

EMS medicine is going to change steadily as its role and expectations do. The most important change is that paramedics provide definitive care and an integrated, seamless interaction with the rest of the medical system. At the start of a patient contact story, a paramedic operating in an isolated silo of time, where they are autonomous and unsupported for a few minutes, will be a thing of the past. The modern paramedic will be part of an integrated medical system that shares care and responsibility from the start and continues their care to the end. This change is both a function of an increased need, and recognition of an increased ability in today’s EMS world.