Table 1

International drivers of change and responses

Personnel and competenciesProblemsResponses
UK1 paramedic per ambulance, work with Emergency Care Assistants to provide emergency care and transportationIncreasing and evolving types of demandsRegular updates of British Paramedic Association ‘core competencies’ necessary for practice
Trials of ‘Paramedic Practitioners’ and introduction of ‘Emergency Care Practitioners’ with extended skills
Canada4 levels (Emergency Medical Responder up to Critical Care Paramedic) with increasing competencies; exactly what, varies between provincesRural communities
Inter-provincial variation in training, funding, skills, etc
2011 National Occupancy Profiles (national) include health promotion, patient safety6
USA4 levels (Emergency Medical Responder up to Paramedic) with increasing capabilities up to advanced life supportIncreased demand on public services since introduction of Patient Protection and Affordable Care Act 20101996 Emergency Medical Services Agenda for Change: integration with community services, acute and chronic care, health monitoring
2007 National Scope of Practice Model standardising care7
‘Skilling up’ Advance Emergency Medical Technicians because cheaper than paramedics
AustraliaTitles, skills and responsibilities vary between provincesRural communities
Difficulty recruiting—long hours, problem maintaining skills, etc
Queensland: role expansion and ‘expanded scope’ of rural practitioners 8
South Australia: ‘multi-skilling’ and partnership working with other services. 9 The ‘Rural Expanded Scope of Practice’ incorporated health education, screening and minor injury treatment 10
France4 levels (Emergency Medical Technicians have transportation vehicles up to Mobile Intensive Care Units with high-tech equipment and an emergency doctor and nurse on board)French EMS prioritise providing the most appropriate patient management on scene, compared with the swift transportation to hospital favoured in the UK. They have no paramedics but staff vehicles with combinations of specially trained nurses and physicians 6
  • EMS, emergency medical services.