Frontier and remote paramedicine practitioner models

For the past 50 years paramedic services and paramedic roles in high-income nations have evolved in response to changes in community needs and expectations. The aim of this article is to review paramedic models of service delivery, with an emphasis on models that have the potential to improve the health and wellbeing of frontier and remote populations.

Paramedic models of relevance to rural and frontier settings were identified from searches of CINHAL and Medline, while key paramedic-specific journals were individualy searched in the event that they were not indexed. Search terms were ambulance, paramedic and EMS. These were then combined with model* and rural, remote and frontier. These findings were then synthesised.

During the 1950s and 1960s the volunteer transport model, based on the values of community informed self-determination, developed to meet local needs for transport to local hospitals and medical services. Somewhat later, the technological model, characterised by professionally staffed and managed paramedic systems providing prehospital using advanced technology and technically skilled staff, became the dominant model in metropolitan and regional settings. Paramedic practitioner models are now emerging that are part of integrated prehospital systems. These provide a range of services to prevent injury and illness, respond to emergencies and facilitate recovery, and contribute to efforts to produce a healthy community.

Implementation of paramedic practitioner models in frontier and remote settings raises challenging policy and practice issues, including changes in scopes of practice, design of education programs, self-regulation of paramedics, and reimbursement.