Case Study Overview
4.4 Rural Case ‘RESP’ model
The second rural case study used is the proposed model of paramedic
practitioner referred to as ‘RESP’ (Rural community engagement, Emergency
response, Scope of practice extension, Primary health care) and arises from a
study of existing innovations in rural Australia aiming to identify an
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135 2006). As such, the units of analysis selected for this project are from areas of
innovation as examined in the study by O’Meara, Walker et al. (2006).
Within this study, paramedics identified as working within a ‘RESP’
framework are from the East Coast of Tasmania, as well as Mallacoota, and
Omeo in Victoria.
Some demographic information concerning the three units of analysis within
the ‘RESP’ case study is presented in Figure 4.4. The Glamorgan /Spring Bay
shire, encompassing the Tasmanian East Coast area has an RRMA
classification of R3 which refers to an other rural area (population < 10000),
as does Omeo in Victoria. Mallacoota in Victoria has an RRMA classification
of Rem2 which refers to an other rural area (population < 5000) (Australian Institute of Health and Welfare 2004).
The East Coast of Tasmania is an area of approximately 4000 sq kms and is
one of great variation in geography, from beachside townships to mountain
ranges and farmland. Populations vary greatly in holiday periods, with
townships such as Coles Bay having a growth from a permanent residency of
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State Location Population Males Females Median
Age Aged > 65 yrs (%) Working (%) TAS St. Helens 1786 889 897 41-53 25.0% 30.1% St. Marys 538 266 272 40 13.7% 29.4% Break O’Day 5553 doubles in summer 2843 2710 43 16.8% 30.9% VIC Omeo 234 increases in winter 117 117 37 12.4% 60.3% Mallacoota 1041 increases in summer 527 514 43-47 19.6% 38.7%
Figure 4.4: ‘RESP’ units of analysis: demographic summary (2006)
Source: (O'Meara, Walker et al. 2006: 10)
This growth is similar to Mallacoota in Victoria where the population can
increase by approximately 8000 at holiday times. The township of Mallacoota
is the last official township on Victoria’s east coast before the New South
Wales border, it is 25km off the main thoroughfare, the Princes Highway, and
523 KM from the capital Melbourne. Being a seaside village the township
relies on tourism and fishing as main sources of income (O'Meara, Walker et
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137 Omeo, situated on the Great Alpine Road in South East Victoria also relies on
tourism, especially during winter. The main industry in the area is farming,
primarily cattle and sheep. The local area includes the surrounding smaller
townships of Ensay, Swifts Creek and Benambra (O'Meara, Walker et al.
2006: 31; Omeo Business and Tourism Association 2008).
In all three regions, medical services vary, as outlined in Appendix J.
Innovative paramedic services in these areas emerged in response to locally
driven demands for and by medical services. In 1997, medical services to the
Tasmania east coast region were in a state of flux. The Tasmanian
Government had proposed the closure of St Marys Hospital, while the local
doctor at St Helens was experiencing a workload to the stage of feeling the
need to take a necessary break. Ambulance services consisted of a volunteer
Red Cross service at St Marys and Tasmanian Ambulance Service volunteers
at St Helens, with other volunteer units further south. Because of these issues,
the government pledged a dedicated intensive care paramedic service to the
region. This was different to other paramedic services such as at Smithton or
Zeehan in that the paramedic was to work as a sole practitioner and as an
adjunct to varied volunteer units rather than being crewed specifically with
one particular unit. Rather than operate under the characteristics of a
‘Sufficing’ model with a traditional standard of paramedic care, the ‘East
A comparison of the practice of rural and urban paramedics: bridging the gap between education, training, and practice. Peter Mulholland
138 partnership with volunteers, hospitals, general practitioners, and the
community (O'Meara, Walker et al. 2006: 12).
A similar theme of overworked local doctors appeared in the development of
the paramedic for the Mallacoota region. In 2002, two doctors were working
from a private medical clinic and having 24 hour on call responsibilities for
the entire area. There were four volunteer ambulance officers and the nearest
hospitals with fully staffed emergency departments were at Bairnsdale,
Victoria, 242km away, and Bega, NSW, 114km away. The situation
worsened with local doctors threatening to leave the area, and the East
Gippsland Division of General Practice approached Monash University
School of Rural Health for assistance. With funding from the Victorian
Department of Human Services, a process called Transforming Rural Urgent
Care Systems (TrUCs) provided a framework to assist rural communities with
urgent care response (O'Meara, Kendall et al. 2004). Workload numbers did
not warrant a full time paramedic crew model for the area and so, with
community consultation, the Paramedic Community Support Coordinator
(PCSC) was introduced (O'Meara, Kendall et al. 2004; O'Meara, Walker et al.
2006: 31).
Similar to the ‘RESP” paramedic in Tasmania the Victorian PCSC is a solo
practitioner, works in response to local needs and requirements, and is
A comparison of the practice of rural and urban paramedics: bridging the gap between education, training, and practice. Peter Mulholland
139 member of the local health care team. As well as introduction at Mallacoota,
at the same time the Omeo region also emerged as a PCSC location. Although
Omeo health services included a local public hospital and emergency
department, pre hospital care was still in the form of ambulance volunteers.
Placement of a PCSC at Omeo offered an opportunity not only for support
and for training of volunteer units but the potential to work with local medical
staff in an established medical centre. This potential has seen realization and
is evidenced by mention in several Omeo District Health annual reports
(Omeo District Health 2005: 9; Omeo District Health 2006: 12,13; Omeo
District Health 2007: 11).
In both Mallacoota and Omeo, the PCSC works Monday to Friday and is not
required to be on call, in this way each area requires only one paramedic.
Volunteers provide the primary pre-hospital response. However, even though
call duties are not a job requirement each PCSC is ‘called out’ after hours if
additional expertise is required. This is different to the Tasmanian east coast
paramedic, two of whom rotate through four days on then four days off, being
on call each day.
The numbers of cases attended by the East Coast paramedics in Tasmania for
the year 2006 was 921 (Source: Tasmanian Computer Aided Dispatch
System). For the same year, there were 323 cases attended by paramedics in
A comparison of the practice of rural and urban paramedics: bridging the gap between education, training, and practice. Peter Mulholland
140 of cases paramedics were dispatched to in 2006 on the east coast of Tasmania
are mentioned in Appendix L, with the most common being inter-hospital
transfers, falls, cardiac, unknown events, and falls.
4.5 Summary
The case study strategy comparing rural and urban paramedic roles utilizes
three separate case studies. One examines the urban paramedic and two look
at differing models of rural paramedic practice.
The urban case is composed of units of analysis chosen from traditional
models of paramedic practice in Tasmania and Victoria. In this traditional
model, intensive care paramedics work with colleagues who may be at
different stages of qualification. Of the two rural cases, one represents the
‘Sufficing’ model where intensive care paramedics work alongside volunteers
and the other represents the ‘RESP’ model, which sees innovative paramedic
practice in local communities.
The following chapter offers results from a comparison of the urban case with
both of the rural cases, in addition to a comparison between each of the rural
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