International drivers of change and responses
| Personnel and competencies | Problems | Responses | |
|---|---|---|---|
| UK | 1 paramedic per ambulance, work with Emergency Care Assistants to provide emergency care and transportation | Increasing and evolving types of demands | Regular updates of British Paramedic Association ‘core competencies’ necessary for practice Trials of ‘Paramedic Practitioners’ and introduction of ‘Emergency Care Practitioners’ with extended skills |
| Canada | 4 levels (Emergency Medical Responder up to Critical Care Paramedic) with increasing competencies; exactly what, varies between provinces | Rural communities Inter-provincial variation in training, funding, skills, etc | 2011 National Occupancy Profiles (national) include health promotion, patient safety6 |
| USA | 4 levels (Emergency Medical Responder up to Paramedic) with increasing capabilities up to advanced life support | Increased demand on public services since introduction of Patient Protection and Affordable Care Act 2010 | 1996 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 |
| Australia | Titles, skills and responsibilities vary between provinces | Rural 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 |
| France | 4 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.