Lessons From Down Under
The U.S. is home to just about every type of EMS system imaginable; still, none are quite like St. John Ambulance in Western Australia (SJAWA).
St. John Ambulance in Western Australia covers the largest area of any single ambulance service in the world—2,525,500 square kilometers, a third of the total landmass of Australia. That’s roughly 975,000 square miles, or almost six times the size of California. With about 2.4 million people, the population density of Western Australia is less than one person per square kilometer. That makes for some long and lonely ambulance rides, and it also necessitates some creative EMS work to address the unique challenges of providing statewide ambulance service.
St. John Ambulance has 160 locations operating throughout the rural areas of Western Australia, serviced by more than 3,500 dedicated volunteer EMS providers and 70 career paramedics. These providers travel in excess of 1.6 million kilometers within the country area annually. They transported more than 54,000 people in 2011–12, an increase of 23.8% over the previous year. It makes for an interesting case study in community paramedicine.
St. John Ambulance first trialed a community paramedic initiative in 2008. Following the successful trial, nine community paramedics were appointed in early 2011. More have been added incrementally in the ensuing years, and SJAWA expects to see a total of 21 CPs operating through the Western Australia region by mid-2013.
Announcing the addition of two new community paramedics in March 2013, SJAWA General Manager of Country Ambulance Services Julian Smith said since the community paramedic role was introduced for regional Western Australia, local sub-centers have received more support, particularly with volunteer recruitment and training.
“The underlying role of the community paramedic is to provide support and mentoring for local sub-centers,” Smith said. “However, the full scope of the role varies according to the needs of the area in which they are based. With remote areas in particular, community paramedics will work closely with the WA Country Health Service (WACHS) to help achieve whole-of-community health goals.”
According to SJAWA’s 2011–12 annual report, with volunteer ambulance officers in the rural regions of Western Australia putting in more than “3 million hours over the course of the year to ensure local communities have received vital ambulance services,” its community paramedics are “fundamental in assisting us to improve ambulance services for communities living in regional and remote Western Australia.”
A Council of Ambulance Authorities (CAA) report from 2009 also described the role of SJAWA’s community paramedics as:
• Providing support in the local community to maximize the number of volunteer ambulance officers.
• Responding to ambulance calls as necessary as a complement to the volunteer operations.
• Providing an extended scope of practice to assist the community and Department of Health in areas where the provision of such services is not viable through the traditional health model.
The responsibilities of the SJAWA community paramedic are generally location-specific. Dependent upon health department resources in each location, the scope of practice could be modified to fill gaps at particular locations, including:
• Assisting local medical facilities in fulfilling community demand for services as required by the health department on a location-by-location basis.
• Assisting hospital staff at particular times or with specific skills in the absence of other appropriate medical staff.
• Providing health “cover” in a location when other health resources, e.g. local doctors and nurses, are unavailable.
Clearly one lesson U.S. EMS systems employing community paramedics can take from SJAWA’s model is that community paramedics can act effectively as a patient’s primary caregiver when no other is available. Additionally, community paramedics are ideal mentors for volunteer providers because their scope of care necessitates a broad knowledge of individual patients’ backgrounds and medical histories. Particularly in a super-rural setting such as the western United States, community paramedics who regularly see patients without easy access to primary physicians can be good teachers for volunteers who don’t get to respond to calls with the frequency of providers in more urban settings, allowing the volunteers to gain experience with a wider variety of medical conditions.