Engaging rural communities in health care through a paramedic expanded scope of practice.
BACKGROUND
This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.


METHODS
Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.


RESULTS
The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.


CONCLUSIONS
ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.
University Department of Rural Health, Tasmania, University of Tasmania, Hobart, Tasmania, Australia. Christine.Stirling@utas.edu.au
Christine M
CM
Stirling
Peter
P
O'Meara
Daryl
D
Pedler
Vianne
V
Tourle
Judi
J
Walker
D017732:Air Ambulances; D001315:Australia; D003153:Community Health Services / Q000458:organization & administration*; D003256:Community Participation; D004634:Emergency Medical Technicians / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D015397:Program Evaluation; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration; D000078329:Workforce