Paramedics in Australia
A paramedic in Australia is a health care professional who responds to and treats all types of medical and trauma emergencies outside of a hospital setting before and during transportation to an appropriate medical facility. Paramedics also work in the inter-facility transport environment where a paramedic will continue or upgrade medical care to a higher level while transporting a patient from one healthcare facility to another. Paramedics are able to treat patients in the pre-hospital setting, and can transport them to a hospital-based emergency department if deemed necessary. A new paramedic is evolving, the Paramedic Practitioner. The Paramedic Practitioner provides primary health care in a range of health settings and forms part of a multidisciplinary medical team. In Australia, use of the term paramedic is lawfully restricted to the use of those registered with AHPRA.
Definition of a paramedicEdit
Starting in December 2018, The titles ‘paramedic’ and ‘paramedicine’ became protected by law and only people registered with the Paramedicine Board of Australia (National Board) can legally call themselves a paramedic. According to the Paramedicine Board of Australia "From 1 December 2018 paramedicine becomes a nationally regulated profession under the Health Practitioner Regulation National Law (National Law) and the titles ‘paramedic’ and ‘paramedicine’ will become protected by law. This means that from 1 December 2018, only people who are registered with the Paramedicine Board of Australia (the Board) or who have applied for registration before 1 December 2018 will be able to lawfully call themselves a paramedic." Some people with exceptional circumstances have until February 28, 2019 to register if they wish to use the title of "Paramedic". Beyond that date, any person calling themselves a paramedic may be charged with an offence under National Law, (s 113(1)(a), s 116(1)(b), s 116(1)(c)and/or s 116(1)(d). 
Prior to being nationally regulated, the title paramedic was generally used to identify a person with a diploma or bachelor's degree in paramedicine. Most were employed by ambulance services, although those engaged in emergency health care in areas such as industrial sites or volunteer first aid services sometimes referred to themselves as a paramedic.
Some states and territories did have protection of title legislation to protect the use of the title of paramedic in that state to those who are qualified to use it (e.g. Health Services Amendment (Paramedics) Bill 2015 (NSW)). The qualifications were not specific educational qualifications but are generally those employed by their state ambulance service or those holding a qualification such as paramedic degree.
Education and trainingEdit
The Australian government indirectly regulates paramedic training by means of a series of nationally recognised numbered certificates through the Australian Qualifications Framework, intended to provide a relatively common level of competencies. Regardless, local standards are regulated by state governments, and standards and definitions of terms vary widely between states. Many individuals possessing Certificates I-III may work in industrial first aid, for commercial first aid companies, or as non-emergency transporters or emergency ambulance services (particularly as volunteers). Possession of a Diploma of Health Science or a Bachelor of Paramedicine is regarded as the minimum entry level for emergency work in most statutory ambulance services, although some ambulance services require much higher qualifications. Apart from paramedics, other titles are used by some organizations for emergency medical response personnel. First responders are sometimes utilized in remote areas to provide advanced first aid training until paramedics arrive. Transport officers work in a non emergency setting, usually transporting stable patients from one health care facility to another, or providing transport for non-ambulatory people to prearranged medical appointments at a health care facility.
A Certificate II in Emergency Medical Response is used by some organisations. The term is non-specific and unregulated, and is used by private first aid companies, volunteer organisations, workplaces and State ambulance services to describe many levels of advanced first aid training.
Patient transport officersEdit
Patient transport officers must, at a minimum, complete a course of training that will earn them a nationally recognised Certificate III in Non-Emergency Patient Transport. Again, the use of the term is unregulated.
Ambulance transport officer/attendantEdit
Generally speaking, the statutory ambulance services in Australia require training to a Certificate IV level as the entry level for basic life support providers. The one exception to this is the State of Queensland, which still permits entry at the Certificate I level, or at Certificate IV. Though in other states like Victoria a Diploma of Paramedical Science (Ambulance), is required to transport more acute patients. This is possible in either the state run ambulance service (AV), or in some of the private ambulance transport companies.
Paramedics in Australia's statutory ambulance services are all educated to advanced life support Level (ALS). The base qualification for a paramedic is a diploma or bachelor's degree (in health science, paramedic science, emergency health or paramedicine) or a postgraduate diploma (pre-master's – for health professionals converting to paramedicine). Some paramedic degrees are dual, that is with another discipline, for example Bachelor of Paramedicine/Bachelor of Nursing.
In some states, paramedics can still undergo an in-service (post employment) diploma or advanced diploma level of education. This involved on-the-job training using the nationally recognised diploma with several years of supervised practice. Post-employment training is slowly being phased out in most states of Australia, with New South Wales being one of the last to continue to use it in a limited way. Victoria and South Australia have completely ceased all in-service education, with other states gradually reducing post-employment training as the supply of graduate paramedics from universities meets industry demands. Generally and increasingly, the standard for entry into practice requires graduation from a university.
Intensive care, critical care or mobile intensive care ambulance paramedicEdit
Intensive care (IC) paramedics, or mobile intensive care ambulance (MICA) paramedics, have completed post-graduate education that allows them to have a primary role of supporting paramedics by providing in-field stabilisation and mobile intensive care. Graduates have completed a university-level post-graduate diploma in Intensive Care Paramedical Practice, Emergency Health (MICA Paramedic) or equivalent in addition to their base qualification and graduate (internship) program.
The Australasian health landscape is changing, with ever increasing demand, particularly due to increasing chronic co-morbidity, aging populations, increasing range of technological interventions requiring a health workforce that is innovative and flexible. The Paramedic Practitioner role is an opportunity to better utilise the skills and competencies of a long-term member of the health workforce. The Paramedic Practitioner is defined as; “A Paramedic Practitioner is a Paramedic who has undergone top up education to be able to: order and interpret tests (pathology/imaging); perform physical examinations; prescribe medications (including restricted drugs); refer to specialists and/or allied health; and provide or delegate treatment in any health environment”  Education of a Paramedic Practitioner is at Master degree level with the ability to complete further education to graduate with a Doctor of qualification(Consultant Paramedic Practitioner). Training time to become a Paramedic Practitioner, including undergraduate studies, internship, clinical practice and post graduate studies, is around ten years. The key role for Paramedic Practitioners is to provide a medical service with a range of community centred aims; - Keeping people from declines in health by using preventative health measures - Keeping people safe in their home and community - Keeping Doctors in their community - Keeping Emergency Ambulances available - Keeping Emergency Departments presentations down - Keeping patients in Primary Care & out of hospital - Keeping healthcare effective and cost efficient - Keeping up in a changing world of health care 
Unlike educational programs in the United States, Canada and other countries, graduates from an Australian university degree in paramedicine are not usually considered 'road ready' by statutory ambulance authorities. Although their academic credential is internationally recognized, in order to be a fully recognized paramedic, University graduates must complete an 'internship year' with an EMS agency. This can only be done once the graduate student has been hired by the EMS agency.
Clinical scope of practiceEdit
Please note that these terms and qualifications vary slightly between states. These are the minimum qualifications, but some states require more advanced training to hold these positions. For example, in Victoria, "Ambulance Transport Attendants" (ATA) (who primarily work for non-emergency private companies) are now required to hold a Diploma, and the term "Ambulance Paramedic" (Victoria) can also be referred to as "Advanced Care Paramedic" (Queensland).
In some locations, volunteer first responders are used by ambulance services to begin basic treatment before a paramedic arrives. Their training is a high standard of advanced first aid. In some states volunteer "Ambulance Officers" have similar training to First Responders.
Patient transport officerEdit
Patient transport officers (PTOs), or ambulance transport officers, provide non-emergency patient transport. PTOs provide a pre-booked, non-urgent service that includes home to hospital and hospital to hospital transfers. In some states, PTOs may occasionally be required to act as first responders to emergencies. This is usually limited to situations where it would take significantly longer for paramedics to arrive at the scene than a nearby patient transport crew, or where patients that are assessed to be low-risk and require a low level of care in transit. Also, as many patient transport ambulances carry a second stretcher, non-emergency ambulance officers can be utilised to assist emergency crews in incidents involving numerous casualties. In Victoria, PTOs & AAs will respond to Medium Acuity 000 calls that are dispatched through the ESTA Referral Service.
Ambulance officer / Ambulance transport attendantEdit
This is the basic level of pre-hospital emergency care. These paramedics hold a Certificate IV Health Care (Ambulance) (previously known as Certificate IV in Emergency Care), or equivalent, and are trained in basic life support skills.
Paramedics practice includes all components of the basic life support level and the further enhancement of IV cannulation, drug therapy (oral, intramuscular injection (IM), intravenously (IV), narcotic pain relief, anti-emetics, cardiac arrest, respiratory drugs, etc.), fluid resuscitation, advanced airway management (usually a laryngeal mask airway [LMA], or endotracheal intubation and Cricothyroidotomy in Western Australia) and the maintenance of infusions. Paramedics perform extensive physical assessment, blood examinations (e.g. random glucose test), interpret electrocardiograms (ECG), SpO2, temperature, and provide care for a range of patients from the new born to the elderly.
Intensive care, critical care or mobile intensive care ambulance (MICA) paramedicEdit
ICP or MICA paramedics are able to practice intensive care procedures such as endotracheal intubation, surgical airways, rapid sequence intubation (RSI), nasotracheal intubation, chest tube insertion, and drug infusions (e.g. Adrenaline, Salbutamol, sedation, thrombolytics etc.). IC or MICA paramedics practice under clinical practice guidelines independently of medical control. The Council of Ambulance Authorities is currently lobbying for an expanded scope of practice to permit more primary care by advance care paramedics, including the role of paramedic as independent practitioner.
Rescue or special operations paramedicEdit
Some ambulance services employ paramedics specially trained in rescue or special operations techniques. Officers can be trained in areas such as road crash rescue, vertical rescue, confined space and trench rescue. They learn navigation skills, four wheel driving, urban search and rescue, and chemical biological and radiological procedures.
Retrieval or flight paramedicEdit
Retrieval or flight paramedics work on fixed wing and helicopter aircraft in many states, performing both emergency and routine transport operations. They are generally considered to be extremely highly trained in emergency medical care, but also aviation medicine, rescue and aviation emergencies. In some states this role is performed by a Flight Nurse or Flight Doctor with specialist qualifications in Intensive Care or Emergency Medicine who is then supported by a Flight Paramedic who is usually credentialed at Critical Care, IC or MICA level.
Paramedics are employed by various public and private service providers. The state run ambulance services are activated by the 000 (or 112 for mobile phones) emergency number. Paramedics may respond to medical incidents in a conventional ambulance, sedan, 4WD, rescue vehicle, helicopter, fixed-wing aircraft, motorcycle or even bicycle or foot at large public gatherings. There are also private transport ambulances which are crewed by Patient Transport Officers (or sometimes Ambulance Attendants and/or nurses). They generally transport non-emergency patients between hospitals and other health settings such as nursing homes. In Australia paramedic salaries range to over $130,000 a year, depending on location, experience, supervisory responsibilities and overtime.
Paramedics Australasia is one of two professional organisations that represent and deliver Professional Development for paramedics www.paramedics.org. The Australian and New Zealand College of Paramedicine (ANZCP) is the other.
During late 2019, Australia's first specialist paramedicine college was founded, The Australasian College of Paramedic Practitioners (ACPP) www.acpp.net.au. The sole aim of the College is to introduce Prescribing Paramedic Practitioners and Paramedics into Primary Health Care. ACPP has been instrumental in supporting the development of the Deakin (University) Medicine Master and Doctor of Advanced Clinical Practice (Paramedic Practitioner). ACPP has achieved many strategic alliances with Medical, Nursing and Allied Health organisations who are supportive of ACPP push to introduce a Paramedic Practitioner model. ACPP is the only paramedicine organisation who has membership of the National Prescribing Service  It will be interesting to watch the development of Paramedic Practitioners into the future. The College celebrates Paramedic Practitioner Day on the 10th October every year. The day came about after the announcement of the introduction of Paramedic Practitioners into the Victorian Health System by the then Minister of Health and Ambulance Services the Hon Jill Hennessy.
Industrial representation varies from state to state. Registered paramedic unions in Australia include Ambulance Employees Australia (AEA), which represents paramedics in Victoria, Queensland, Western Australia, and the Northern Territory. The Health Services Union is another registered union in the industrial field.
Unregistered organisations include Australian Paramedics Associations (APA), Victorian Ambulance Union (VAU), and the Emergency Medical Services Protection Association (EMSPA).
VAU was established in 2019 as a breakaway organisation from the AEAV after a dispute between members and United Voice during a union merger with the National Union of Workers. Members were concerned about losing their autonomy and governing rules within the AEAV. The rules of the AEAV are the same since the merger.
The Emergency Medical Services Protection Association (EMSPA) represents a new chapter in legal and industrial representation and protection for paramedics and employees. EMSPA is a professional organisation representing nearly 2000 paramedics in New South Wales, Queensland, and Victoria in industrial and other work-related matters. Established in 2005 by paramedics seeking improved representation on employment-related matters, this association has been extremely successful in representing the rights and entitlements of paramedics since its inception and as a result continues to grow in membership numbers.
Prior to the 1970s, most ambulance services in Australia were staffed by paid and volunteer staff called "drivers" or "ambulance drivers", "bearers" or "ambulance bearers". Qualifications were often no more than possession of a first aid certificate or a home nursing course certificate. Some were trained to administer Trichloroethylene (an anesthetic/pain relief), while bandaging and splinting skills often formed the core of training sessions. The Victorian Civil Ambulance Service (VCAS)in 1970, introduced the Mobile Intensive Care Ambulance (MICA) program. Victorian Ambulance Services followed up in the mid 1980s with the continuing education programme (CEP)7 "Defibrillation" which introduced manual defibrillation to all ambulance officers who were not MICA paramedics. In the 1970s Queensland commenced formal training blocks at the Ambulance Officer's training College, based on the Victorian Ambulance Officer's Training Centre or AOTC. The AOTC model duplicated in most Australian States until the introduction of University education. Over the next few years, some ambulance officers throughout Australia were trained in varying levels of coronary care, allowing them to treat patients with both manual and semi automatic defibrillators. The use of semi automatic defibrillators and 3 lead ECG cardiac monitoring became standard in New South Wales and Queensland. By the 1990s Queensland Ambulance Service trained recruits in conjunction with South Brisbane TAFE. After completing a three-year course, graduates were presented with an associate Diploma in Heath Science (later a Diploma) and became "Qualified Ambulance Officers". Existing staff completed bridging courses. From the mid 1990s Charles Sturt University, and Victoria University offered Bachelor Degree conversion courses for qualified ambulance officers and paramedics. In 1999 Victoria University offered the first pre-service Bachelor of Health Science (Paramedic), this was closely followed by Charles Sturt University and Flinders University. Today, University Bachelor degree qualifications in Paramedicine are the only pathway to gaining employment with Australian ambulance services except NSW.
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