Participant suggestions for managing non-urgent EMS demand: ideas affecting on-scene paramedics
| Addressing overtransportation to EDs by paramedics | ‘I want to see people who have like an actual acute problem that can’t wait until tomorrow, because that’s what I’m good at fixing. People presenting with like vague abdominal complaints, who’ve got normal obs, and they’re 22 years old, or they’ve come in with COVID, and their sats are normal, like, I just *grimaces* you know, it just doesn’t… it’s a… it’s a real drain.’ #25, Medicine (ED), Clinician ‘We should have a look at that case…as opposed to having a blanket rule going, “From now on every back pain must be transported.”’ #2, Paramedicine (Intensive Care), Clinician ‘The philosophy of ambulance is often a bit about a one night stand, right? Come in, wham bam thank you ma’am. Drop her at the hospital, you know, nice seeing you, never see you again.’ #66, Consumer Representative (Referring to paramedics leaving people at home) ‘That makes me less afraid than having all these people in my waiting room…The ED is a time sink where badness happens.’ #25, Medicine (ED), Clinician ‘Don’t bring everybody to us.’ #75, Medicine (ED), Policy (State) ‘These complex tier patients need a different sort of process of how we approach them. Walking in, throwing a blood pressure on, taking their temperature, firing 50 questions at them, and then ten seconds later, “Oh well. Get in the ambulance then.” That’s not an approach.’ #51, Paramedicine, Clinician-Researcher |
| Paramedic services recognising the move away from hospitals and towards primary care | ‘People will still fall through the cracks if they don't have a GP at the centre of their care.’ #21, Paramedicine, Academic ‘The future is not hospitals. You know, the future is primary care.’ #85, Paramedicine, Policymaker (National) |
| Viewpoints on hiring more paramedics | ‘I would say, number one, hire more paramedics.’ #57, Consumer ‘The solution’s not to put more emergency paramedics on. You’re just shoving more into a system that’s already full.’ #14, Paramedicine, Academic ‘You can put more paramedics on in every State. Is it going to fix the problem? No, it’s not. It just means more paramedics will be lined up at the front door of the hospital.’ #62, Parliamentarian |
| Viewpoints on Urgent Care Centres | ‘The commonwealth Urgent Care Centres have been tried previously. They’ve all universally failed every other time. I can’t imagine that this investment is going to last beyond the decade. And so we’re going to have to work out a solution that doesn’t necessarily depend on those.’ #5, Chief Officer (State) ‘Urgent care is problematic in Australia, which is not set up for it. It’s falling over in New Zealand.’ #64, Medicine (ED), Policy (National) ‘My personal experience has been all of (my patients) have ended up having to go to hospital anyway.’ #99, Medicine (GP), Clinician |
| Multidisciplinary teams working to full scope, including pharmacists, nurse practitioners, and allied health | ‘The primary healthcare system is very medical-centric. The models that we currently deliver, our fee for service model, it focuses around an individual practitioner. It doesn’t facilitate multidisciplinary teams. And yet all of the science tells us that, particularly with an ageing population, management of chronic disease, it is the multidisciplinary team methodology that will deliver the best outcomes for patients and the best system response.’ #30, Chief Officer (National) ‘Too often it is medicine and nursing. You know, pharmacy, physio, everyone outside of medicine and nursing needs to be included.’ #48, Paramedicine, Clinician-Academic ‘We’re still so MBS obsessed.’ #41, Medicine (GP), Policy (State) |
| Increasing all-hours virtual EDs | ‘I would love to see a 24 hour virtual care clinic…a lot of this stuff happens after hours.’ #7, Paramedicine, Clinician ‘A big part of (success) is decision support through the virtual ED and expanding the availability of medications and referral pathways that paramedics have available to them.’ #65, Paramedicine, Manager |
| Revising undergraduate paramedic education to reflect the reality of the role | ‘We’re not training them for the job that they do…they’re not trained to deal with probably 50% of what they’re exposed to, and they turn around and just go, “Oh, they’re complex.” Well, yeah. That’s the reality.’ #51, Paramedicine, Clinician-Researcher ‘Having a, I don’t know, a subject on “When can I be super confident that the GP can see this in 3 days’ time”, would be really helpful.’ #99, Medicine (GP), Clinician ‘One of my jobs as a team leader is going speak to the interns about everything primary healthcare, and there’s just big blank faces.’ #1, Paramedicine, Manager ‘Early in the degree, early, early, early.’ #20, Paramedicine, Academic ‘At an undergraduate level…we set people up for disillusionment and failure.’ #5, Chief Officer (State) ‘I don’t know what the hell we’re supposed to be teaching them? I’m just not too sure what paramedics do.’ #6, Paramedicine, Academic |
ED, emergency departments; EMS, emergency medical services; GP, general practitioner.