Stirling Christine M, O'Meara Peter, Pedler Daryl, Tourle Vianne, Walker Judi
University Department of Rural Health, Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
Rural Remote Health. 2007 Oct-Dec;7(4):839. Epub 2007 Dec 4.
This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.
Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.
The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.
ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.
本文探讨了护理人员在扩大职责范围内的社区参与如何促进初级卫生保健以及提高农村社区的整体应急响应能力。了解扩大职责范围的护理人员（ESP）如何加强社区医疗合作，对于农村地区来说是一项重要需求，因为这些地区劳动力数量少，需要创新。
在塔斯马尼亚州、新南威尔士州、南澳大利亚州和维多利亚州研究了澳大利亚农村地区ESP角色的四个案例，以收集有关可用于护理人员扩大职责范围模式的一致要素的信息。通过与关键利益相关者的半结构化访谈和组织文件收集定性数据。案例内和案例间的主题分析发现，社区参与是这些不同角色中的关键要素。本文严重依赖维多利亚州和塔斯马尼亚州案例研究的数据，因为社区参与是这些案例中特别突出的一个方面。
案例研究中的ESP增加了救护车服务与农村社区之间的互动，总体上对医疗保健有益，具体方式包括：提高社区响应能力；使社区与救护车服务联系更紧密；以及增加社区层面的健康促进和疾病预防工作。领导能力、管理能力和沟通技巧对于护理人员成功承担扩大职责范围的角色很重要。
农村地区的ESP可以通过积极的社区参与来改善医疗保健，这超出了直接临床技能的范畴，它扩大了其他社区成员的能力，并加强了服务与社区之间的联系。随着卫生服务机构寻求从卫生人力中获得最大效率，了解从业者和社区联盟可以带来的努力强化，为未来提供了重要方向。
