Training & Resources: Equipping Paramedics for the Right Environment

What are the different skills and resources needed in rural and urban settings? That's what our latest guest is here to help us unpack. Gayle Christie is the Medical Director at St John WA, bringing deep expertise in pre-hospital care across vastly different operational environments. Right now, paramedics working in rural settings face challenges that their metro counterparts simply don't, and vice versa. We cover:

• What are the biggest resource and training gaps between rural and urban ambulance services?
• What skills are uniquely critical for rural paramedics, and what does urban practice demand instead?
• How do we retain skilled clinicians in regional and remote areas?
• What does the future of targeted, context-specific training look like for ambulance services?

Brought to you by Corvanta and the CAA.

Transcript

SPEAKER_02 0:00

I just want to thank you for your leadership in this space. It's so unheard of to have a doctor actually see some of what you're saying. So, what is the future for paramedicine?

SPEAKER_01 0:11

I think if we look at the healthcare system as it is, we look at our aging population, we look at the expanding populations in regional and rural areas, paramedicine undoubtedly is going to play a pivotal role in whatever the future healthcare looks like. Whether we like it or not. I think the days of doctors governing everything needs to be put into the distant past, which would probably make me unpopular. So any specialist services don't really exist outside of Perth, which makes it really challenging for paramedics in regional areas because they don't have that safety net that metropolitan paramedics have.

SPEAKER_02 0:52

Welcome to Ambulance Insights, your go-to for the latest conversations covering all things ambulance. And I'm Lindsay Mackay.

SPEAKER_00 0:59

And I'm Henway Lee, and this is the Great Divide series where we tackle one of the biggest challenges in the pre-hospital care setting, bridging the gap between urban and rural ambulance services.

SPEAKER_02 1:09

Each episode, we bring in experts to share their stories and spark conversations that matter. So, with over 20 years of experience, today we are joined by a leader in emergency and pre-hospital medicine. She's the medical director at St. John's Ambulance WA and a consultant emergency physician at Sir Charles Gardiner Hospital. With an impressive array of qualifications, including fellowships in emergency medicine, intensive care, and medical education, she is a passionate advocate for paramedicine and a driving force behind advanced career pathways for paramedics.

SPEAKER_00 1:44

Gail Christie, welcome to Ambulance Insights. So I'm stuck between two Scots. Just for everybody, you'll have lap subtitles if you need them.

SPEAKER_02 1:52

Oh, you're a lucky fella.

SPEAKER_00 1:54

Gail, so you're uh you're a mountain biker, a trail runner. Can you tell me about the last uh trail running event you uh you participated in?

SPEAKER_01 2:04

So the last one I tried to participate in got cancelled because of bushfires. But yeah, so the last big one I did was a few years ago now, Feral Pig, which was a hundredk Ultra Trail, which is always fun. The last smaller one I did was the Bustleton triathlon, so those three of us did it. I always put my hand up for the run, going, yeah, 10k, that'll be that'll be nothing, except Bustleton had an unexpected heat wave and I almost died. Nearly quit after 5k. So yeah, no more triathlons for me.

SPEAKER_02 2:35

I feel like that was the most Scottish thing. No, almost died into 10k from heat. Yeah. It was only 20 degrees.

SPEAKER_00 2:47

We're talking about the very real differences in how care is delivered and accessed and experienced depending on where you live.

SPEAKER_02 2:54

So if we start with the simple one, because we'll take it easy on you. The great divide, when you think of ambulance services, paramedics, what does that mean to you?

SPEAKER_01 3:04

The big kind of glaring one for us here in WA is the fact that it's an enormous land mass and we've got an ambulance service which is we try not to split it, but is essentially split between a metropolitan ambulance service and uh a rural or regional ambulance service. You know, how how do we get equity across across training, across skill sets? Healthcare in in WA especially is is really centralized to Perth. So any specialist services don't really exist outside of Perth, which makes it really challenging for paramedics in regional areas because they don't have that safety net that metropolitan paramedics have where you know you can take your patient to what's likely to be definitive care. Whereas when you're smack bang in the middle of nowhere, hundreds of miles from Perth, and thousands even, the hospital you're taking your patient to is very likely not going to be definitive care. It's potentially they need a a different set of skills, a different ability to manage patients for longer periods of time with complex illnesses. And that's really challenging to try and navigate, I think.

SPEAKER_00 4:09

That's a great segue into my first question. Do you think there's a case for rural paramedics to have an extended scope of practice in comparison to their urban counterparts either here in WA or or or anywhere in Australia or the world?

SPEAKER_01 4:23

Oh, absolutely. And it's it's something I'm I definitely have my eye on for for WA, but it's very easy to say yes they do. What the difficult part is is how do you actually introduce that safely, and both for the clinicians and also for the public, and that's the big challenge is trying to keep that skill set training currency valid for people who work thousands of kilometres away from a metropolitan area, that that's really challenging. So, yes, and how do we do it is the more difficult part of that question, I think.

SPEAKER_02 4:56

I think so, and I think every service around the world experiences that with different contexts. But I know you've been doing some sort of great work in the space within St. John's around different scopes of uh and trying to upscale paramedics. So one of the ones that I was thinking when we were saying there was really around the extended care paramedics. So you that's something that WA is really focusing on at the moment.

SPEAKER_01 5:17

Yeah, so that's been I I've got quite a few passion projects in these paramedic pathways because to me, you should come into paramedicine like I did as a doctor going into medicine. Do your basic training and then go, right, what next? And traditionally I feel paramedics haven't had that what next. It's been you become a paramedic and and that's and that's as far as it goes. So for me to really capture people and keep them in the profession, have some longevity and and keep the great people so they don't leave and do medicine, which is a terrible mistake. It's creating those pathways and avenues for them to go, what next, and have something to aim for. So the extended care paramedics was one that I'd been harping on about for years and years and years that I wanted to bring it in. And so it's probably about two and a half years ago that eventually it got the tick so that we could roll out a pilot project. The really interesting thing about how I wanted to roll that one out in WA was that I want it to be led by and designed by frontline staff and paramedics rather than it being a top-down leadership designed model. And so employed a paramedic lead and basically gave them carte blanche to go and what does an ACP service look like? And I think because of that it's been a huge success. So we're just over a year now of the pilot project of extended care. Unfortunately, it's only in metropolitan Perth at the moment. We we do want to roll it out into country areas. And it's been a raging success, is the only way I can describe it. The staff love it, the patients love it, the amount of compliments we get from patients who've had the extended care paramedics go out to them is quite exceptional. And when we look at the the healthcare system these days and the the lack of access to care in the community, extended care has really added um benefit, certainly to our communities, but but a valuable pathway for our paramedics too.

SPEAKER_00 7:15

Gail, you touched on the sort of traditional, I guess, pathway of paramedicine. You you you get your your uni degree or your apprenticeship and and y you're sort of done as a paramedic. What are some of the professional demarcations for paramedics having extended scope of practice or gaining extended scope of practice?

SPEAKER_01 7:37

I think it's challenging for paramedics, and it's something I sit on a few uh committees within the Australian College of Emergency Medicine, and it's something there's there's definitely conversations about within that college as well, is what does it look like for other allied professions to be recognized as specialists. My first journey down that pathway was with critical care. Because that's why I originally joined St. John Ambulance, was to build that critical care service. And I've been a really passionate advocate for getting that skill set recognized because at the moment it's not and it varies between each state. So a critical care paramedic or an extended care paramedic in, for example, New South Wales or Victoria looks nothing like what ours does. And that's problematic in that one, it doesn't really give that speciality credibility that it needs because it looks very different across different sites, and two, it makes it very difficult for people to move in between services. And that's one of the great things about medicine is that as an ED consultant, I could pick up and go over to Queensland tomorrow and work as an ED consultant, but it's not the same for a paramedic who's got an extended skill set at the moment. So I think it's really important that there is some kind of standardization and recognition of those scopes of practice. And I know there's work obviously going on right now through the paramedicine board in Australia to try and get that off the off the ground. But I think in order for paramedics in those roles to get the the respect that they deserve doing those extended roles, we need to have some kind of recognition of those extended scopes of practice.

SPEAKER_02 9:17

Yeah, I think that's some great points, especially when we talk about that extended scope. And we um in a previous episode we spoke to Tony Walker and and he talked about, you know, um sometimes the competition between different states, and he talked about some healthy competition between Victoria and um and WA, which um we may go into in a bit. But one of the things that I was thinking there when you talked about it is do you think there's organizational and kind of cultural challenges between all having all the different state services and actually having that translation of skill set? So being able to track because we obviously know what's challenging for paramedics to move. Do you think it's also cultural?

SPEAKER_01 9:53

It's a difficult one. I think at a paramedic level, probably not so much. Most of the kind of conferences and things I've gone to where I've interacted with, and particularly the crit care side of things. There's there's no real we're better than you or or anything like that. And and there's there's I certainly don't don't feel that. I think the divide probably comes higher up in the organizations rather than at the frontline level. But I think that's starting to move, and I think there is a a greater appreciation and understanding that there needs to be some standardization of paramedicine across states because we're all essentially doing the same thing with slight nuances. And I think actually you're gonna have more power as a profession if it's standardized across states.

SPEAKER_02 10:40

Yeah, if we're walking in the same direction. I definitely know from the NHS. You know, I worked for one service, and when I took a position with the next one, they just handed me a couple of new CPGs and said, that's your professional, it's your job to learn this and come on in. And that was the end of it. There was no anything really.

SPEAKER_01 10:57

Yeah, whereas now you're looking at months of a direct entry programme and then mentoring and you're like, we really have to do that in any other nursing and and and medicine, you wouldn't have to do that. So we need to look at how to streamline that. And I think we are getting there, but obviously paramedicine's still quite new as a registered healthcare profession. So there's it's still quite early on in the journey.

SPEAKER_00 11:20

You mentioned nursing and medicine there. How do we ensure that the extension of paramedic practice is sort of integrated with other disciplines and the broader health system to I guess minimise that duplication and it and ensure I guess we're providing value for money and that there's integration with the broader system?

SPEAKER_01 11:40

That's a really interesting and probably very politically loaded question, I think, at the moment. So probably one that needs to be um dealt with kids' gloves. I think there's there's there's a lot of tension amongst healthcare professions at the moment. We certainly witnessed it here when we rolled out critical care on road, that there was very much a feeling of toes being stepped on, where the traditional boundaries of what a paramedic does and then what the emergency department does was now blending into one. And that that was quite challenging for us to navigate for several months. But we've got there and actually built really good relationships with most of our emergency departments, and a lot of it's just about the education of why we're doing what we're doing in the field of paramedicine, and that actually we're not taking away from what you do in the emergency department. This is all about the patient journey, and we're all part of that patient journey, and sometimes that care needs taking that little bit closer to the patient, which means it steps out of the traditional realms. And I think sometimes in medicine, and I can probably say this because I am a doctor, so I've got free reign to slag doctors off, is that we're quick to forget that we were in the same position a while ago. So with emergency medicine and anesthetics, there was exactly the same tension with AD doctors shouldn't be putting patients to sleep, we shouldn't be doing RSIs. That's the anaestetis realm. So we had exactly that same tension of stepping on toes, professional borders getting blended, and we had to come through that, and we came through the other side, and that's okay, and now we've got that same tension with paramedics going, yeah, but that's what we do. You can't do that. And I think it's just time to maybe I hate to say grow up a little bit, but we need to accept that we're all part of the same patient journey. And there's definitely going to be crossover, probably more so I think with with medicine and paramedicine than than nursing and paramedicine at this stage. Although potentially in regions that might be a little bit different. But I think we all just need to accept that healthcare's changing, it's it's fluid, and these professional hierarchies and boundaries need smash down, is my opinion anyway.

SPEAKER_02 13:54

I think it's some great points you made there. I can I feel like people will be listening and nodding along the because they've all experienced it for sure. When I think about your role, because I also uh know that you're um you work as an academic with um Curtin University. Do you think there's a a a kind of greater role that the universities can play or a more of an advocacy role around trying to prepare paramedics and those additional skill sets for what this future may look like, especially as you mentioned, because APR are obviously developing the framework for the kind of future for a kind of extended scope of paramedicine?

SPEAKER_01 14:30

100%. I think I'm quite lucky. I've got I sit on both the consultative boards for both our universities here in WA, and they're both very open to industry feedback on what should we be doing differently in our undergraduate and postgraduate programs because they're acutely aware that they're dealing with it from an academic standpoint, but what's actually happening in industry. And we've had some really robust discussions, and I've always found them to be very open to listening to ideas about what industry needs in terms of preparing paramedics, and they've certainly taken on some of the ideas that we've fed back. Because paramedicine's changing. It's no longer you get a triple zero call, you pick your patient up, and you take him to hospital. That those days are are long, long gone. And we need to be preparing paramedics to be managing the patients for an awful lot longer and to have that critical thinking, which is something that has not traditionally been encouraged within paramedicine, sadly. But now it's incredibly important that they start on that critical thinking journey very early on, but also to prepare them for the fact that it's not always gonna be foot to the floor, blue lights and sirens on. The majority of the work, the same in the emergency department now, is low acuity, high complexity work. And people need to be prepared that that that's what's gonna that's the majority of your work. And it might put some people off because they want the adrenaline and the drama, but it's actually equally as challenging and equally as satisfying to manage those patients if you've got the skill set to do.

SPEAKER_00 16:03

Yeah, great points. Go you touched on before some of the the training barriers in in implementing some of these services into rural. How how do you balance or have you got some ideas in how you balance that sort of low frequency advanced skills with the sort of low case exposure and skill erosion that you might have in any rural area, whether it's Perth or um northern BC in Canada?

SPEAKER_01 16:32

Yeah, that's that's incredibly challenging. So there's there's a number of things that I've always got ten different things on the burners, thinking about what what what next. Because I think you have to. And with country, there's there's an awful lot of what next that we can be doing in in regional areas. So at the moment, for example, in WA we don't have thrombolysis pre-hospital. So I think we're probably the only state that doesn't carry thrombolytics. Uh and I think there's a really good case for us having them in some of the regional areas, not in metro, because we're so close to PCI capable hospitals. But within regional areas, I think there is a case for it. But before you even get to that step, the first part of that is actually educating paramedics in interpreting ECGs correctly. There's a whole load of skill sets that you can successfully do remotely. There's other skill sets, like, for example, endortoil intubation that you can't that needs that hands-on supervision practice. So I think you need to pick very carefully what you want to introduce and base that on how can you keep that currency up. So for things like the ECG training and thrombolysis, that to me is something that can be done quite successfully remotely. It can be done through VC training or one-on-one. But there's other skill sets that you've got to think what's the value and what's the actual harm if we don't do this properly? And a big one for me in that area would be things like advanced Airway. Obviously, we recently removed endocrine intubation from general paramedic practice, following on from pretty much what every other service has done a long time ago. And it's all evidence-based. And interestingly, that the crews were very supportive. There wasn't any real kickback from that. And I think that was partly the way it was rolled out, is that it was very evidence-based. It was like, look, you know, I don't want to take things away from you, but there's actually no good evidence for us doing this in cardiac arrest now that we have the second generation superglottics. A roll-on from that was obviously our critical care paramedics can still intubate, but they do drug-assisted, which is a very different kettle of fish. But we do recognize there's a small cohort of cardiac arrest patients that may benefit from endotrokeal intubation. So it's how do we introduce that framework back into the service safely? And so I've spent a long time writing a framework that will work for our clinical leads who work within metropolitan ambulance. And then the questions always come from some of the regional paramedics is, but what about us? And that's the big challenge is that they often feel left out and forgotten. Because most of the things that are brought into ambulance are brought in with a metropolitan lens. And then paramedics who are working in the country, arguably doing a much harder job most of the time, are left feeling that they've been left out of that equation. So the difficult for bit for me right now is thinking, what does that look like for our regional paramedics? How many can I reasonably take on to make sure that I can keep them skilled? And how do you pick the appropriate paramedics to upskill? Because just because you want the skill doesn't mean you should have the skill. So that's going to be a really challenging next step for me to look at. Because I do think there are some areas where it is warranted. So Bunbray is quite a large regional area, and then places down like Esperance and Albany, where in the summer there's a lot of tourist traffic and a lot of drownings, and those type of patients in particular may benefit from that. So it's how do you pick the areas that will warrant that advanced skill set? And then how do you introduce that micro-credentialing, so to speak? That's what you call it. How do you introduce it in a way where that practitioner is going to be upskilled and maintain that competency? And say for some things that's quite easy, and we can use technology to do that. For others, you really need that hands-on, and that's when it gets more challenging. And paramedics are actually often very good at giving me the answers. So, for example, that discussion round about Esperance was a case of, well, there's some anaestists down there who are really keen to help out. So that may be a way to look at it. But yeah, that's that's still a big question mark for me is how to introduce things like that safely.

SPEAKER_02 21:01

I love your approach, Gail, when you talk about everything sounds like such a continuous improvement cycle, which is not particularly common, I would say, from my experience across other states and even countries. You talked about removing ENT, which I remember hearing about, and then now talking about actually we can re-look at it for the future and how do we want to do that in that in a different way. I think that's really impressive. I just wanted to call that out because that's really good. And you talked so you touched on, I should say, so many good parts there, but there's one I feel like Hanway and I would be remiss if we didn't mention. And that is when we met with Tony Walker recently, he talked about cardiac arrest outcomes. And that we all, I think anyone that knows Tony knows that's very close to his heart. And we talked around AEDs in the community and the difference in um CPR outcomes for out of hospital cardiac arrests. And WA is that they are caught up and are on the heels. I think actually, maybe better by 1% at the moment than Victoria.

SPEAKER_01 21:56

I have to say congratulations to um Jason Belcher, he's our resuscitation specialist. specialist who's just he's so passionate in this area so a lot of that has to go to him. He's he's one of our paramedics who's he's come into that role and he lives and breathes cardiac arrest and he's really passionate about what can we do better. And so he's always in about amongst the training he's he's looking at trying to help expand the community response to cardiac arrest as well through our app he's always updating our guidelines on ceasing resuscitation when to start it when not to start it you brought in the duosequential defibrillation we were for once WA was was ahead of the mark on on a few of these things in cardiac arrest which was amazing. So yeah a lot of those improvements have have definitely come from his passion in driving those improvements. And yeah we're we're hot on the heels of Victoria so it's nice to have a bit of healthy competitions.

SPEAKER_00 22:56

I think the stat's just amazing though that when you can when you consider St John WA covers the single largest land mass but yet has very well nearly identical cardiac arrest outcomes as Victoria and only really a little bit behind King County when you consider King County as an urban area. I think it's remarkable.

SPEAKER_01 23:16

It's amazing because a lot of the ones in country it's volunteers who are going to these cardiac arrests and you know our volunteers are some of the most passionate individuals you're you're you're gonna get and I they they amaze me that they do their day jobs and then they're giving up their time to volunteer for ambulance for their communities and when you see some of the results that they're getting most of it is because a lot of the regional cardiac arrests happen because the towns are quite small, happen quite close to the hospital. But you've got to give kudos to volunteers in WA for the absolutely incredible work that they do. But it's a beautiful thing to watch our cardiac arrest results just keep getting better and better. It's fantastic and I get to see both ends of it because working in the ED we get to see the successful resuscitations getting brought in and I'll follow them up for the paramedics and there's nothing more satisfying I think for a crew to find out that that patient walked out of hospital two weeks later and is living a normal life. It's yeah pretty incredible.

SPEAKER_02 24:18

Yeah it definitely doesn't happen often I feel like we've got to do a little bit of a plug though so because Western Australia you use a different so a lot of the other areas are using GoodSAM but we've heard some great things about your app.

SPEAKER_01 24:30

What is the one that they use in WA So we've got our own little app the St John's First Responder app. I've got on my phone it basically just bleeps at you. So you just register with it and at the moment it's been rolled out and it's just St. John Ambulance staff that can respond. So the step we're looking at now is rolling that out so that community responders can also first respond. So it works the same it's just a different a different app. The first time it went off on my phone I had no idea what it was and I was like nice um and then I don't know how it happened but I was like I clicked yes I'll respond I jumped in the car I was halfway there and I get this phone call from SOC going are you going to that cardiac arrescue? How do you know that? Are you watching me? Ah he's everywhere.

SPEAKER_00 25:16

So they'd given a heads up to the crew going your boss is coming now was that one of your positive percentage increases when you arrived is that what you're doing in the instant just painted you talked about volunteers earlier and you know in a lot of places in regional Australia regional rural remote Australia volunteers are the are are the ambulance response. Is there anything a particular WA is doing around upskilling volunteers so that they they can help bridge that gap?

SPEAKER_01 25:51

So there is a lot going on in that space but I'm probably not the expert to talk about it. But their Karen Stewart who manages our kind of regional and remote arm of the ambulance services is very passionate in that area. I love going down to some of the stations particularly Southwest where you can jump in a car and just drive down and speak to the the volunteers they soak up knowledge like a sponge so once every six months I'll I'll put on an event down in the Southwest and it's open to all paramedics volunteers and local hospital staff if they want to and I just say to them pick a couple of topics and we'll talk about it. And I'm always absolutely astounded at the number of them that will turn up in their own time not getting paid just rocking up to learn something new. So that whole volunteer model is getting looked at as to how can you perhaps tier it and give some people a little bit more skills but I think that's a fine line to draw because at what point are you then asking them to do a paramedics job for nothing. And they're an incredibly passionate bunch who want to do as much as they possibly can for their communities but it's a it's a fine balancing act as to what you can reasonably expect a volunteer to do.

SPEAKER_02 27:10

I think that was a great point you just uh did a little uh intro there for Zair about Karen um because Karen's actually going to be joining us later today. She just couldn't join us at the moment but um we'll make sure we ask some of those good questions about the work that she's doing there. So that that would be great. You talked earlier about we obviously we started today by talking about the Great Divide and we've talked about some parts about technology. Telemedicine and especially in in paramedicine is so limited use and rollout and anybody that probably knows Hanwe and I know is close to our heart. We uh both have obviously worked within triage and pathways so um what do you think is the kind of future or how far do you think we can apply telemedicine within that kind of to bridge the divide between that metro concept?

SPEAKER_01 27:52

We're already doing quite a lot of it in WA I think the problem that we've got here is our internet and Wi-Fi is not the incredibly most reliable. We start looking at things like telestroke we've got the emergency telehealth service that's been on the go for a long time now and has gradually reached into to most regional areas whereas in the beginning it was just a few sites. And we've also now got even within metropolitan area the WA virtual emergency department so we are starting to take the hospital out to patients. And the good thing about that is we can actually blend that with paramedic skill sets so particularly if we think about the the virtual emergency department them being able to utilize our extended care paramedics and vice versa to manage cohorts of patients in the community the telestroke services that we've got that link in with emergency telehealth service. So there's a lot of that going on regionally. And then there's other kind of bits and pieces that are interesting in terms of things like those Google glasses that everyone keeps going on about. I don't know if any services is using them yet but there's potential really kind of interesting use for them in regional areas where you can get someone on the end of a phone or an iPad that can actually see what you're seeing at the scene. And there's I I see some use for them in in regional and remote areas particularly for volunteers at complex scenes or complex patients to get somebody essentially in the room there with them. But all of that of course costs a lot of money and you're gonna figure out how you're gonna be able to pay for all those innovations unfortunately none of none of that technology is cheap. And an internet signal as we all know yeah is dodgy outside of the centre of Perth good luck.

SPEAKER_00 29:36

Yeah you talked about that being a sort of limiting factor and w we know there's projects in a couple of states to get some things like Starlink and low earth orbit satellites into ambulances so hopefully that expands out as the technology becomes a little bit cheaper. And more are more able to expand out what's the uh Gail Christie vision for the future of paramedicine extended care practice for paramedics other than taking over the world I've always had a real soft spot and a real passion for pre-ostal medicine since I was a baby doctor.

SPEAKER_01 30:13

And I've watched paramedics be treated both positively and negatively within the healthcare system dependent on where I've worked as a profession and as a group of individuals I think they're some of the most passionate healthcare providers I've I've ever had the pleasure of working with they are a sponge for knowledge they want to learn they want to get better. They work in the most challenging conditions you can imagine and most of my hospital colleagues have very little idea of what that's like and now we're starting to get a curiosity about what's that like. So what is the future for paramedicine? I think if we look at the healthcare system as it is we look at our aging population we look at the expanding populations in regional and rural areas paramedicine undoubtedly is going to play a pivotal role in whatever the future healthcare looks like whether we like it or not as doctors as nurses whoever else they're gonna be pivotal. The things I would love to see happen is a real recognition of specialist practice within paramedicine so that is elevated to the same level as specialist practice within medicine and within nursing we've got clinical nurse consultants clinical nurse specialists and we should have the same within paramedicine. They already have that to a degree in the UK and it's something that I'm pushing very heavily for part of that journey was introducing the deputy director paramedicine role within our service. When I took over the medical director role I made it clear that I didn't want another doctor coming in as a deputy that this was the time to be forward thinking and that paramedics should be governed by paramedics doing myself out of a job here. Bringing on Andy Bell as the deputy director of paramedicine to me sends out a real statement to paramedics that you guys are at the table now. You are part of this discussion you're in the discussion about where we go from here. So yeah that recognition of specialist service that elevating paramedics within ambulance services right to the very top because that's where they should be I think the days of doctors governing everything needs to be put into the the distant past which would probably make me unpopular but I think an ambulance service should be governed by a paramedic. My crit care paramedics that I was heavily involved with their and still am with the internship and with their ongoing training my ethos with them is I want to train you to be better than me. And if at the end of your internship and the end of your training you're better than I am then I've succeeded. And so it's always just pushing them to be the best they can be and to get that recognised. Because that's the bit that I find really challenging right now. The Critcare paramedics if we take them as a group I think could run circles round an awful lot of experienced ED doctors because they are so passionate and so dedicated and and get exposed to things that no one in the hospital ever will thankfully or otherwise and they need to have that recognition of what they do as do the extended care paramedics. Having prescribing rights right now is there's so much red tape and so many barriers to paramedics getting extra scope of practice and extra skills it's always a oh no they shouldn't have that or that's too hard or maybe in the future and we just need to rip those barriers down. I think looking at other pathways where else can we get paramedics into into that research and education role so really get them recognized and there is another clinical pathway. So having it as a as a career the same as medicine the same as nursing with that same respect and same recognition is where I see the future of paramedicism going. And just advocating as strong as I possibly can for that so their voice is heard.

SPEAKER_02 34:14

I definitely feel like that's the Gail Christie Ambulance Service is one that I'm gonna be coming on board to that sounds like what a great vision. I mean I just want to thank you for your leadership in this space it's so unheard of to have a doctor actually see some of what you're saying. It's fantastic to hear so I thank you so much for joining us it's been fantastic great conversation and um we're gonna be chatting a little bit I know you have to head off but we're gonna be uh continuing this conversation with Karen Stewart as well from WA so thanks so much for your time I appreciate it