Year

2023

Degree Name

Doctor of Philosophy

Department

Graduate School of Medicine

Abstract

This dissertation examines the relationship between identity, professionalism and regulation in Australian paramedics. This project specifically focuses on the period during the transition to national registration of paramedics in Australia. Paramedicine has existed in some form in Australia for almost a century and a half with origin in 19th century military and civil ambulance corps. Major reforms in the latter half of the 20th century led to the advent of “modern” paramedicine and seen the profession grow exponentially in size, scope and complexity. University education for paramedics was introduced in Australia in the mid-1990s. Advanced medical skills considered ground-breaking in the 1970s and 1980s now constitute a basic part of the paramedic’s clinical toolkit. Education, research and governance have developed at a significant pace in the last few decades to support this growing profession and its broadening scope and function.

Today’s paramedics make complex, evidence-based and nuanced decisions about a range of health and social issues. An increased scope of decision making brings risk to the profession as the traditional “transport to hospital” paradigm of practice yields to a diverse set of complex treatment and referral options. Increasing employment outside of traditional statutory employers meant organisational governance, once the only form of oversight, became less and less suitable for regulating the profession. Also, issues existed with who could claim to be a paramedic as there was no standardised definition, scope or qualification levels. This increasing risk and complexity in paramedicine created a need for greater accountability. Regulation was invariably seen as the logical path for a discipline demonstrating increasing signs of professionalisation and greater levels of autonomy. After 10 years of lobbying, paramedicine was included in the National Registration and Accreditation Scheme for health practitioners in 2018, becoming the 15th profession regulated under this framework.

The move to professional regulation brings major change for Australian paramedics. Previously, the governance relationship existed solely with employers. Now regulation is a partnership between government and the profession. Paramedics have found to be both adverse to and fatigued by change, so this transition was not without challenge.

FoR codes (2020)

320219 Paramedicine

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.