BackgroundProfessionalisation was cited as one of the key drivers for the recent addition of paramedics to the National Accreditation and Regulation Scheme (NRAS) making paramedics the fifteenth health profession in the NRAS. Self-regulation inherently shifts the basis of establishing professional identity and the formal authority for determining professional standards. This has increased discussion of professionalism in paramedicine, however, professionalisation and professionalism are often poorly defined concepts with a myriad of interpretations. MethodA scoping review was conducted to determine the available literature about professionalism and professionalisation in paramedicine. The review utilised 10 academic databases augmented with Google and Google Scholar to capture grey literature; 2740 results were refined to 53 sources for review.ResultsSeveral works on paramedic professionalisation explore elements such as autonomy and occupational characteristics. Others consider the process of professionalisation for United Kingdom (UK) and Australian paramedics. Education is discussed as a key factor in professionalism, while the increasing scope and diversity of roles in paramedicine is explored as indicative of professionalisation. Several UK papers relate professionalisation and culture to change processes within paramedicine and paramedic organisations. DiscussionAcademic work on professionalisation and professionalism in paramedicine appears sporadic and may benefit from explorations of a wider range of theories. Paramedicine has been described as constantly and rapidly developing around its practitioners rather than being a stable profession where practitioners enter with clear expectations of their ongoing identity. Further work is needed to understand the process of professionalisation that paramedicine is undergoing within its cultural and professional context.

In 2018, Australian paramedics entered the National Registration and Accreditation Scheme for Health Practitioners. The scheme represented a significant change in the way paramedics were regulated and able to self-identify. Equally, it brought substantial changes to the individual accountability and responsibilities of practitioners. Response to these reforms was largely positive; however, diverse views existed on the intent and impacts of the scheme. Paramedics were surveyed immediately before registration commencement to examine their views concerning the new regulatory framework. Supportive views included acknowledgement of regulation’s public safety function and potential advancement of the profession. Dissenting views predicted increased practitioner risk and degradation of working conditions. Importantly, this study explores how members of the same profession can have diverse views of the same regulatory scheme. This study supports the notion that paramedicine consists of diverse subcultures with differing worldviews. This presents challenges in ensuring cohesive professional engagement with regulation and the evolution of the profession.

Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. ResultsFifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health.  

Objective: Western Sydney University has implemented a rural interprofessional learning programme to promote collaborative care approaches to enhance crossdiscipline communications, improve knowledge and clarity of roles and improve patient care and outcomes. Design: Rural interprofessinal learning is an interprofessional educational approach, consisting of simulations of complex health events. Simulation methodology frames the study with a focus on human interaction. A mixed-methods evaluation has been conducted, incorporating pre-and post-event participant surveys along with semistructured focus groups. Setting: Simulations are conducted in the rural setting, including community settings, working farms and rural hospitals. Main Outcome Measures: Reflexive thematic analysis was used to identify themes measuring students' perceptions of interdisciplinary care, knowlede of other health discipline roles and skills and how they believe the exercise will influence their future practice. Facilitator feedback regarding the efficacy of the simulations was also recorded and analysed using reflexive thematic analysis. Participants: Care of simulated patient(s)/bystander(s) is primarily provided by paramedicine, nursing and medical students; however, increasing interest has expanded the programme to include students from a range of allied health professions.Simulations are facilitated by a multidisciplinary team of experienced practitioners and specialists. Intervention: Four rural interprofessional learning events have been held. Results: 120 students have participated in the evaluation. Findings include increased understanding of the contributions of other disciplines in enhancing patient care, team approaches, cross-discipline communication and a need to engage in collaborative care in future practice. Conclusion: Creating a collaborative learning environment creates a culture of multidisciplinary care, enhancing patient care and improving outcomes. The rural 128 | REED Et al. How to cite this article: Reed K, Reed B, Bailey J, et al. Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: Breaking down silos in tertiary health education.

Introduction Since 2018, paramedics in Australia have been self-regulated under the National Registration and Accreditation Scheme (NRAS) for health professionals. While paramedics and other health practitioners are self-regulated in many jurisdictions internationally, there has been little study of the impact on practitioners of the introduction of new regulatory frameworks. Method Paramedics undertook a survey in the month leading up the commencement of self-regulation collecting both qualitative and quantitative data. The survey was completed by 419 participants. This paper explores the analysis of quantitative data. Key results were cross-tabulated with demographic factors.  Results Participants indicated they had good broad knowledge of the regulatory scheme but were less confident on more detailed aspects. Most believed that patient safety and practitioner accountability will improve with registration however results were less clear on changes in scope, remuneration or employment opportunities. Questions on identity indicated that the primary factors in paramedic identity construction were employment status, qualifications and scope with impending registration the least important factor. Overall, 59% of participants supported self-regulation, however 25% indicated they held negative views. When cross-tabulated with demographics, years of service and initial qualification (vocational vs university) showed relationships with support for regulation. Conclusion The introduction of self-regulation represents significant change to both the governance of paramedics and entry to the profession. Uncertainty By some is indicative of the unique nature and impact of the change. However, there is wide agreement that the scheme will increase safety and accountability which are the key aims of professional regulation.

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Sense of coherence (SOC), the capacity to muster, believe in and value resources to support resilience, is a central component of the salutogenic approach to wellness. Assessing patients' SOC in a salutogenic model may be useful to paramedics as an adjunct to effective referral to care pathways other than via the emergency department and for predicting patient engagement. A tool to help direct practitioners in the prehospital environment towards the most appropriate resources for each patient's unique situation appears to be lacking. This article examines the literature around salutogenic and SOC theories and provides an overview of how a salutogenic assessment tool could be used in paramedic practice. Taking a multifactorial approach to determining health status and predicating patient capacity for adaptive coping may make health professionals better able to assist patients in overcoming health events and build health resilience to improve their future health outcomes.

INTRODUCTIONAmbulance use in rural and remote parts of Australia has been reported anecdotally to be lower than urban areas. Experiences of paramedics in rural locations gave rise to questions of whether this phenomenon was occurring and to what degree.METHODSData from Emergency Department (ED) records was obtained from the Hunter New England Area Health Service from 1 July 2008 to 30 June 2009. In total, 354,909 records were obtained. These records were de-identified and analysed to determine the method of arrival to ED, specifically in high acuity patients.RESULTSPeople from Inner Regional areas are 41.5% less likely overall and 27.7% less likely in serious health emergencies to attend EDs by ambulance compared to people in Major Cities. People from Outer Regional and Remote areas are 55.1% less likely overall and 27.9% less likely in serious health emergencies to attend EDs by ambulance compared to people living in Major Cities. Logistic regression modelling indicated rurality was a significant factor in ambulance use in adults in areas outside Major Cities and in children in Inner Regional areas. Age was a significant predictor of ambulance demand with older people using ambulance more.CONCLUSIONThis study indicates disparity between rates of ambulance use in urban and non-urban areas. The concept of unmet need should be considered as a more complex phenomenon than simply a utilisation gap and exploration of unmet need is warranted.A clearer understanding of how rurality affects ambulance use has a number of implications for ambulance services.