EMS World

JAN 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMS AROUND THE WORLD: PROFILING SYSTEMS ACROSS THE GLOBE 14 JANUARY 2019 | EMSWORLD.com S tereotypical images of Australia include vast, open bush land- scapes with bounding kanga- roos and sleepy koalas, sandy beaches, Foster's beer, and shrimp "on the barbie." These images may be a tourist marketing dream, but Australia's "tyranny of distance" is a formidable challenge for delivering emergency medical services. Australian ambulance services have been in operation since the late 1880s, when the then-British colony was becoming more industrialized. 1 With the reemergence of St. John (more correctly the Most Venerable Order of the Hospital of St. John of Jerusa- lem) in England, the charitable order com- menced both brigade transport operations and first aid training in its colonial outposts. A number of states relied upon St. John for the provision of ambulance services for some years, alongside funeral homes and railway and police ambulances, until state governments took over. State-Based Services Today ambulance provision remains orga- nized as state or territory-based services, principally through health departments. Only the Western Australia and Northern Territory ambulance services remain coor- dinated by St. John. Each state and territory now manages its own jurisdiction, legislation, funding, and insurance scheme. Nation- ally there are 1,520 locations with 1,367 first responder vehicles, 3,599 general trans- port and patient transport vehicles, and 94 ambulance aircraft. 2 The funding of each service is based on a mixed model. Funds are sourced from state government grants/contributions, fees from interhospital transfer services, charges to motor vehicle insurers, fees from uninsured patients, and subscription fees. Austra- lian ambulance services' total revenue for 2015–2016 was approximately $3 billion AUD ($2.14 billion USD). The national universal healthcare scheme (Medicare) does not fund or provide ambu- lance insurance. This means users pay for ambulance services, with transport charges and insurance coverage varying across Aus- tralia. Nearly 25% of the Australian public assumes that Medicare does in fact cover ambulance services. 3 If Medicare were to fund ambulance services, the base-level taxation would need to increase by 0.3% to cover the costs. 4 As a user-pay system, insurance is purchased directly from the ambulance service or as part of individual private health insurance. Those not insured may be charged a callout fee as well as mileage. Only two states offer free service, Queensland and Tasmania. 2 State-based ambulance services are organized based on activity: emergency and nonemergency patient transport as well as specialized teams such as rescue and spe- cial operations, aeromedical retrieval, and mental health. Employment To be employed as a paramedic in most states of Australia, you need to obtain an undergraduate bachelor's degree from an approved university. The "pre-employment model" for paramedic recruitment was part of industrial and education reforms that commenced in the 1980s. The primary ambulance employer body, the Council of Ambulance Authorities (CAA), supported the move from competency-based on- the-job diploma training to university edu- cation in the mid 1990s. There are now 19 approved universities in Australia and New Zealand providing paramedic education to nearly 7,000 enrolled students. 2 Ambulance services offer certificate-level training for vol- unteer officers. The scope of practice for paramedics also varies across states. The main representa- tion body, Paramedics Australasia (PA), has published role descriptors that overview various competencies. These include entry Volunteers and expanded roles are keys to coping with the country's widespread demand By Louise Reynolds, PhD AUSTRALIA'S TYRANNY OF DISTANCE

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