User:Sunray Major/EMS Australia

Emergency medical services in Australia have some unique characteristics that make the provision of emergency services problematic. Firstly, the area of Australia is the size of mainland U.S.A. or most of Europe, but with the total population of perhaps two major U.S. or European cities, at less than 21 million. Secondly, Australia is a first world country and thus the expectation is that Australians will receive emergency care equal to any other first world country.

The size of the country meant that Australia was probably the first country to have ambulance services operating in every state. Australia also went down the path of developing dedicated and independent ambulance services rather than hospital based or fire/police based service based.

History

Historically, St John Ambulance played a big role in developing the states' ambulance services. In the early days, most rural towns probably developed their own ambulance centre. Volunteers received their first aid training from the St John Ambulance Association and thus may have even been members of St John Ambulance Brigade. In the states of South Australia, West Australia and the Northern Territory, St John Ambulance became the state service.

Over the course of the 20th Century each state evolved from hand carried litters, to horse drawn buggies to converted or modified vehicles to purpose built ambulances whilst training evolved from uniformed first aiders to the current standard of highly trained paramedics.

State Services

Northern Territory

St John Ambulance Australia is the statutory ambulance service in Northern Territory (NT). The NT is a large, sparely populated territory with 1 city, 2 large towns and dozens of scattered communities. Most of the roads are dirt. The NT service is the youngest of all of Australia's services being established on in 1952.

The ambulance service in the NT arose directly out of the volunteer units (divisions) that were founded in each town. After a while the government gave a contract to the organisation to provide ambulance transport.

Initially all services were provided by volunteers but during the 1970 the first paid officers were employed. Today, the service consists of paid officers in the populated towns and volunteers in other centres.

St John Ambulance still maintains many volunteer units of first aid volunteers. Most Ambulance volunteers are recruited from these units. The first aid volunteers provide the presence at many public events and in some cases may transport minor cases to hospital from that event.

The ambulance services is funded from individual and family subscriptions and government funding.

Queensland

The statutory EMS provider is the Queensland Ambulance Service (QAS). It was formally constituted in 1993 to become an autonomous division of the Department of Emergency Services (DES). DES transitioned to the Department of Community Safety (DCS) following changes to departments in the 2009 state government elections. The DCS also operates the Queensland Fire and Rescue Service (QFRS), Emergency Management Queensland (EMQ) and Corrective Services (QCS). The QFRS and EMQ manage a significant number of volunteers in Rural Fire Brigades and State Emergency Units respectively.

During combined services operations (e.g. motor vehicle accidents), the Queensland Police Service provide command and control, the QFRS conduct actual rescue operations and the QAS provide medical care. The only exception to this is helicopter "dustoffs" (medical evacuations). In this case, the QAS have specialist crews and paramedics who fly on EMQ or community based aeromedical rescue services..

The QAS provides the service in the majority of towns that have an ambulance presence. The smallest stations may consist of a single officer. Most stations will have a few volunteers, known as Honarary Ambulance Officers who work alongside permanent officers.

Other small towns may have one of two options - Hospital based transport. Most communities in Cape York have a Queensland Health clinic with a basic Toyota "troop carrier" ambulance consisting of a single stretcher, oxygen and first aid equipment. The crew consists of one or two Registered Nurses from the local clinic and an indigenous driver. The nursing staff usually stabilise the casualty and evacuate them by RFDS if necessary.

Combined QAS/QH Arrangements Some QH hospitals and clinics double as QAS stations. The QAS supplied and maintained vehicles and trained community volunteers as drivers. The Director of Nursing of the clinic is also the QAS Office in Charge. If the driver is called in, Queensland Health pay them as casual staff.

Changes to the law in the late 1990's made it possible for other organisations to provide "patient transport services" (transporting patients between hospitals or clinics). Red Cross provides this service.

The QAS is funded through the controversial compulsory levy charged on all electrical bills. It remains controversial because some people who own/rent both a house and a business are paying two ambulance fees.

South Australia

St John Ambulance Australia was the statutory ambulance authority until the mid 1990's. Protracted industrial problems saw the South Australian government put the service to tender. The successful winner began the South Australian Ambulance Service. SA is a large, sparely populated stated so like the Northern Territory and West Australia, the service in the populated areas consists mostly of paid paramedics and the service in the rural areas consists of volunteers.

As in the other states, the high quality of volunteer training means that the residents of rural communities still received fast and skilled treatment en-route to the hospital.

St John Ambulance also maintains many volunteer units of first aid volunteers. The first aid volunteers provide the presence at many public events and in some cases may transport minor cases to hospital from that event.

The ambulance service is funded from individual and family subscriptions and government funding.

Western Australia

St John Ambulance Australia WA Ambulance Inc is the statutory ambulance service in Western Australia. WA is a huge, sparely populated stated. In effect, there is a heavily populated around the Perth-Albury region and there is the rest of WA. The division of the ambulance service reflects this. In the populated area, the ambulance service is staffed by permanent paramedics while the country service is staffed by volunteer officers supported by small number of permanent officers.

St John Ambulance also maintains many volunteer units of first aid volunteers. Most Ambulance volunteers are recruited from these units. The first aid volunteers provide the presence at many public events and in some cases may transport minor cases to hospital from that event.

The ambulance services is funded from individual and family subscriptions and government funding.

Training and Qualification Structure

In Australia, all vocational training qualifications must be registered through each state's Training Recognition Council. Initially this meant that each state ambulance authority had its own set of qualifications. Movement between states was difficult as the qualifications seldom aligned. There were anecdotal reports of officers having to retrain from scratch in order to gain employment in a different state despite many years experience. However, the Federal Government vocational training agenda called for the establishment of "national training packages" which while allowing for flexibility, called for nationally consistent qualifications. Eventually the Health Training Package included a raft of Ambulance training qualifications in paramedical studies, communications and management.

Today, while, titles may vary from service to service, the qualifications are basically the same.

Patient Transport Officers

All states and territories have PTO. These officers possess a Certificate III in Patient Transport. Their role is to drive clinic vehicles that transport otherwise stable patients from home to hospital or clinics and back again. They are basically a medical taxi service. A holder of a Certificate III qualifications usually works under the direction of a supervisor. They are able to work by themselves but have limited ability to make judgements.

Ambulance Attendants

In Northern Territory, Queensland, South Australia, Tasmania and Western Australia, the ambulance attendant is usually a volunteer officer and has completed a Certificate IV in Basic Emergency Care. A holder of a Certificate IV level qualifications may provide supervision and may work independently but works under the direction of a profession. Enrolled Nurses/Licenced Practice Nurses would be an equivalent.

Paramedics

The term Paramedic has replaced the traditional term "ambulance officer". Paramedics possess a three year Diploma of Paramedical Studies.

Advanced Care Paramedics

In Queensland, graduated paramedics complete additional training to become ACP's. ACP are able to administer a greater range of drugs. The position of ACP recognised that in a large state like Queensland, the volume of work to maintain competence in advanced skills was not high enough in rural areas.

Intensive Care Paramedics

Also called Mobile Intensive Care Ambulance (MICA Paramedics), ICP respond to any case requiring advanced life support intervention. All metropolian, both capital and region, centres have ICP staffed ambulances on-duty 24 hours a day. ACP wanting to become ICP must apply for a student position and undergo a further 12 months training in order to qualify.

This standardisation of Australian qualifications is now resulting Australian trained paramedics working at level overseas and vice verse.

The Future

University Qualification

A number of Australian universities are now offering 3 year full time degrees (Bachelors) as the pre-employment qualifications for future paramedics. The same universities already offer Diploma conversion degree courses, and postgraduate paramedic qualifications from certificate to Masters.

A Future Contraversy?

At present all states are still providing the 3 year apprenticeship style diploma course but both Queensland and Victoria are talking about eventually phasing out the paid student position in favour of university training.

This may prove controversial as students provide the back bone of ambulance staffing. However the nursing profession successfully made the transition from hospital based to university based education in the 1980 so it would be reasonable to expect the ambulance service to do like wise.