Advancing clinical practice and innovation
Time: Thursday 11 September 2025, 11:50 – 12:30
Location: Room 1
Palliative paramedicine: A time series analysis of pre-hospital guideline efficacy in Victoria, Australia
Mostyn Gooley1,2, Belinda Delardes1,3,
Sarah Hopkins3, James Oswald1,3,
Cheryl Cameron1,4,5, Emily Nehme1,3
1Monash University, Melbourne, VIC, Australia.
2Queensland Ambulance Service, Brisbane, QLD, Australia.
3Ambulance Victoria, Melbourne, VIC, Australia.
4Canadian Virtual Hospice, Winnipeg, Manitoba, Canada.
5McNally Project for Paramedicine Research, Toronto, Ontario, Canada
Introduction: Paramedics play an increasingly important role in the delivery of palliative care, particularly within community settings and in conjunction with existing palliative care services. Despite the growing presence of paramedics in this field, the influence of dedicated palliative care clinical practice guidelines on paramedic clinical decision making remains unclear.
Aim: This study aimed to evaluate the effect of a newly introduced ambulance service palliative care guideline on the frequency of supportive medication administration and rates of non-transport to hospital.
Methods: A retrospective cohort study was conducted using electronic patient care records from January 2014 to June 2023. Patients of all ages receiving palliative care who were attended by paramedics in Victoria, Australia were included. Pre- and post-guideline data were compared, and interrupted time series analysis was utilised to assess changes attributable to the guideline.
Results: The study included 31,579 patients, with a median age of 75 years (IQR: 64–84), and 56.4% were male. Overall, 25.8% of patients were not transported to hospital. While there was no significant change in the trend of supportive medication use following guideline implementation, there was a statistically significant monthly increase in non-transport rates (0.2%, p = 0.007), resulting in a total increase of 9.9% by the end of the study period (p = 0.020). Subgroup analyses revealed notable monthly increases in non-transport for patients presenting with pain (0.3%, p = 0.003) and those attended after-hours (0.3%, p < 0.001), with cumulative increases of 29.7% (p < 0.001) and 22.6% (p = 0.001), respectively.
Conclusion: The implementation of a palliative care clinical practice guideline was associated with a significant increase in non-transport decisions by paramedics, suggesting support for greater continuity of care within the community and reduction in unnecessary emergency department attendance.
Behind the guidelines: Unpacking how paramedic CPGs are really made
Sonja Maria1, Matt Wilkinson-Stokes2,
Adam Moon3, Michelle Thomson4, Joel Ballard5, Lachlan Parker6, Fraser Watson7, James Oswald8
1CSU, Bathurst, NSW, Australia.
2Melbourne University, Melbourne, Victoria, Australia.
3NSWA, Sydney, NSW, Australia.
4SAAS, Adelaide, SA, Australia.
5AV, Melbourne, Victoria, Australia.
6QAS, Brisbane, QLD, Australia.
7StJohn, Auckland, None, New Zealand.
8AV, Melbourne, Vic, Australia
Background: Clinical practice guidelines (CPGs) are fundamental tools in paramedicine, shaping clinical decision-making and standardising care. However, little is known about how CPGs are developed within Australian and New Zealand jurisdictional ambulance services. This study aimed to investigate current CPG development processes, identify barriers and variations, and highlight opportunities for improvement.
Methods: A qualitative descriptive study design was used. Eleven CPG developers representing all jurisdictional ambulance services in Australia and New Zealand participated in semi-structured interviews. Thematic analysis was conducted using Braun and Clarke’s framework. Reflexivity and methodological rigour were maintained throughout, with interviews coded independently and collaboratively analysed by a multi-disciplinary research team.
Findings: Three major themes were identified. First, CPG development is a complex, multi-layered process often lacking formal project management and hindered by limited resources, minimal formal training, and inconsistent stakeholder consultation. Second, the value of CPGs is frequently under-recognised by some health services, contributing to low prioritisation and inadequate funding. This affects development timelines, research capacity, and sustainability. Third, a variable approach to team composition, reliance on voluntary capacity, and inconsistent use of evidence appraisal frameworks (e.g., GRADE, AGREE II) challenges the consistency and rigour of CPGs. Despite these challenges, participants expressed a strong commitment to improving transparency, inter-service collaboration, and the quality of paramedic guidance.
Conclusion: This study highlights significant variation and structural limitations in CPG development processes within jurisdictional ambulance services. Addressing these challenges will require investment in formal training, dedicated resources, and shared national efforts. Promoting a standardised, evidence-based approach to CPG development has the potential to improve paramedic practice and patient outcomes across Australasia.
Translating delphi-derived advanced practice paramedic capabilities into regulation, education and practice
Alessia Restiglian1, Lorna Martin1, David Long2, Louise Reynolds3,4, Tony Walker1,5,
Ben Meadley1,6, Ashleigh Finn3, Alan Batt1,7, Alecka Miles8, Tania Johnston9, Brendan Shannon1
1Monash University, Department of Paramedicine, Melbourne, VIC, Australia.
2University of Southern Queensland, School of Health and Medical Sciences, Ipswich, QLD, Australia.
3School of Nursing, Midwifery and Paramedicine, Faculty of Health, Australian Catholic University, Australia, Melbourne, VIC, Australia.
4Safer Care Victoria, Melbourne, VIC, Australia. 5Victoria University, Sunshine, VIC, Australia.
6Ambulance Victoria, Melbourne, VIC, Australia.
7University of Toronto, Toronto, Ontario, Canada. 8School of Medical and Health Science,
8Edith Cowan University, Perth, Western Australia, Australia, Perth, WA, Australia.
9Faculty of Science and Health, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia, Bathurst, NSW, Australia
Introduction: The emergence of Advanced Practice Paramedics (APPs) in Australia necessitates clear national standards to guide practice, regulation, and educational frameworks. This Delphi study identified essential capabilities for APPs, yet translating these into actionable outcomes across regulation, education, and practice settings remains critical. This presentation analyses how the Delphi results inform and enhance these key professional domains.
Methods: A modified Delphi methodology was employed over four iterative rounds to establish consensus among subject matter experts. Panel members, identified using the Knowledge Resource Nomination Worksheet, represented expertise spanning clinical practice, education, organisational leadership, and regulatory bodies. Proposed capabilities were drawn from international frameworks and existing literature, then subjected to structured review and refinement. Consensus was defined as ≥70% agreement among participants.
Results: Of the experts invited, 43 consented to participate. A final set of 33 capabilities was agreed upon, achieving 96% overall consensus. These capabilities were categorised across four domains: Clinical Practice (14), Leadership and Management (10), Education (7), and Research (2). Feedback from each round informed the refinement of capability statements to ensure clarity, relevance, and applicability within the Australian healthcare context. Delphi-derived capabilities significantly inform regulatory processes by clarifying role delineation, thereby facilitating standardised endorsement and accreditation criteria. Educational curricula are enhanced through clearly defined learning outcomes aligned with nationally agreed capabilities, promoting consistency across training programs. Professional practice implications include improved clinical governance, increased practitioner autonomy, clearer interprofessional collaboration pathways, and strengthened accountability frameworks.
Conclusion: The structured translation of Delphi outcomes into regulation, education, and practice has potential to significantly enhance the integration and impact of Advanced Practice Paramedics within Australia’s healthcare system. Future efforts should focus on continuous review and adaptation of these frameworks to maintain relevance and effectiveness.
Time-and-motion study of community paramedics in an Australian ambulance service
Matt Wilkinson-Stokes1, Mike McDermott2, Michelle Tew1, Di Crellin1, Celene Yap1,
Timothy Makrides2,3, Ray Bange4,5, Marie Gerdtz6, George Braitberg1,7
1University of Melbourne, Melbourne, VIC, Australia.
2Ambulance Tasmania, Hobart, TAS, Australia.
3University of Tasmania, Hobart, TAS, Australia.
4University of the Sunshine Coast, Sippy Downs, QLD, Australia.
5University of Central Queensland, Rockhampton, QLD, Australia.
6La Trobe University, Bundoora, VIC, Australia.
7Austin Health, Heidelberg, VIC, Australia
Background: Ambulance services globally have employed the Community Paramedic model of care for over 30 years to assist in managing non-emergency requests. However, how they function on scene with patients is unknown.
Aim: To quantify the time and actions of Community Paramedics on-scene with patients.
Methods: A Time-and-Motion methodology, using continuous observation by an external observer, was adopted within a post-positivist paradigm. A tailored recording instrument was developed collaboratively with clinicians. For 22 consecutive days, a researcher accompanied Community Paramedics and recorded them on-scene. Results were bootstrapped, and the structure of the standard case mapped.
Results: 77 cases were observed. Tasks on scene were highly heterogenous and tailored to the presenting patient. Community Paramedics were fluid in their patient approach, transitioning between tasks three more times than necessary in a linear approach and multitasking routinely (mean 4mins, 95%CI 3-4). Actions taken in over 80% of sampled cases were ‘history taking’ (9mins, 95%CI 8-9), ‘observations’ (5mins, 95%CI 5-6), ‘discussing diagnosis’ (3mins, 95%CI 2-3), and ‘paperwork’ (22mins, 95%CI 22-23). 57% of patients were transported (51% Emergency Department; 6% Urgent Care) and 13% referred (6% GP; 3% nursing; 3% Urgent Care; 1% medical specialist). The most common vital signs were heart rate/Sp02 (96%), blood pressure (90%), and temperature (81%); other vital signs were measured in under 40% of cases. 10% of cases had a specialist intervention performed; these included 8 (33%) of the 24 available. In the sample, Community Paramedics spent 53% of their time completing paperwork or transporting, 28% gathering data, 9% discussing options, 7% treating, and 3% referring or consulting.
Conclusions: In this sample, Community Paramedics performed a small number of targeted actions. Vital signs were used sparingly, and additional scope of practice rarely employed. Time consumption was dominated by paperwork and transportation. A template of the ‘standard’ case is presented.
Paramedic education and workforce development
Time: Thursday 11 September 2025, 11:00 – 11:20
Location: Room 2
“Death is a normal part of the job, not a failure”: Preparing paramedic students for death on scene
Natalie Anderson1,2, Eillish Satchell1,2,
Bruce Tseng3
1The University of Auckland, Auckland, New Zealand.
2Health New Zealand, Auckland, New Zealand.
3AUT University, Auckland, New Zealand
Introduction: While the management of cardiac arrest is a core component of paramedic education, the most common outcome — death on scene — is rarely discussed or simulated. Termination of resuscitation, breaking bad news and supporting grieving families are challenging aspects of real-world paramedic practice. However, learning is often left to on-the-job experience. To address this, we developed a dedicated module and included it within a paramedicine undergraduate course. Understanding student perceptions of this emotionally and professionally challenging learning is essential for curriculum development.
Aims: To evaluate a structured learning module designed to prepare undergraduate paramedic students for withholding or ceasing resuscitation, breaking bad news, and supporting bereaved family members.
Methods: A mixed-methods study was conducted with paramedic undergraduate students who had access to the module in late 2024 and early 2025. The module included a lecture, case-based learning, actor-led simulations of patient death, and debriefing. Students were invited to complete an anonymous online survey or participate in focus groups.
Results: Fifty-seven students completed the survey, and 23 participated in focus groups (46% total response rate). Students valued simulations involving patient death and identified communication with distressed family as a core paramedic skill. Some remained concerned about uncertainty and acute grief responses and expressed a need for stronger mentorship and modelling.
Conclusion: Students reported that this module helped prepare them for the emotional and ethical complexity of patient death on scene. They noted little prior discussion of death, dying and bereavement and wanted it integrated more broadly across their training. Simulation with actors, combined with structured debriefing, can effectively support the development of non-technical skills critical for paramedic practice in emotionally complex situations.
Under pressure – Rise to the occasion or sink to your level of training: Using high-frequency simulation to build job-ready paramedic graduates
Jean-Paul Veronese, Nancy Jakstas, Malcolm Boyle, Patricia Lee
Griffith University, Gold Coast, QLD, Australia
Background: Clinical competence is essential for paramedicine graduates who are expected to make rapid, high-stakes decisions in unpredictable environments. Ensuring students reach a practice-ready standard requires structured, evidence-informed assessment strategies. While simulation-based education is widely used, few studies have explored how high-frequency simulation combined with structured performance-based assessment (PBA) tracking supports competence development over time.
Aim: To investigate the impact of high-frequency simulation with structured PBA tracking on the development of clinical competence and summative exam performance in undergraduate paramedicine students.
Methods: This retrospective analysis examined PBA outcome data from two core paramedicine courses (second- and third-year) in 2024. Students participated in weekly simulation practice scenarios, scored using a structured PBA tool. Practice scores were grouped into tertiles to examine performance trends over the trimester. Summative exam results were compared with practice scores using Pearson’s correlation, paired t-tests, and hierarchical regression. Ethics approval was granted (GUHREC: 2024/073).
Results: Practice frequency averaged 4.6 simulation scenarios per student in both year levels (SD 1.4 and 1.7 respectively), with 222 simulations recorded in second year (n=48) and 187 in third year (n=41). Significant improvements in mean competency scores were observed across the trimester for both cohorts, with increases in performance from early, mid, and late practice sessions to final exam scores (p < 0.05). After adjusting for student year level and mean practice score, practice frequency was found to be a significant predictor of exam outcomes (B = 3.46, p = 0.009), meaning that higher practice frequency improved exam scores. Student year level and mean practice score were also significant predictors (p = 0.005 and p = 0.002, respectively).
Conclusion: High-frequency simulation with structured PBA tracking significantly improves clinical competence and summative exam performance. Embedding this formative assessment approach provides scalable evidence of student development and supports AHPRA-aligned accreditation standards in paramedicine education.
Improving rural mental health outcomes with community paramedics: A mixed-method feasibility trial outcome
Laura Hemming1, Evelien Spelten1, Ruth Hardman2, Ricardo Angeles3, Louise Reynolds4,5,6, Gina Agarwal3
1Violet Vines Marshman Centre for Rural Health Research, Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
2Sunraysia Community Health Services, Mildura, Victoria, Australia.
3McMaster University, Hamilton, Ontario, Canada.
4Safer Care Victoria, Melbourne, Victoria, Australia.
5Australian Catholic University, Melbourne, Victoria, Australia.
6La Trobe University, Bundoora, Victoria, Australia
Introduction: People living in rural Australia face several unique challenges regarding their mental health, which are compounded by difficulties accessing healthcare. Community paramedicine offers a novel approach to healthcare that may overcome some of the barriers and address the healthcare needs of this population. This study aimed to explore whether a feasibility trial of a community paramedicine programme, CP@clinic, can lead to improved mental health outcomes in rural older adults.
Aim: This study aims to identify the social and mental health needs of CP@clinic clients and to determine whether attending CP@clinic leads to any improvements in their needs.
Methods: The CP@clinic feasibility trial ran from 2022-2024 in Mildura, Victoria. During this time, 205 clients accessed a clinic and were surveyed at each visit using an established database, assessing key outcome measures such as quality of life, loneliness and mental health. Qualitative interviews were also conducted with a subset of participants to explore participants' experiences, benefits of participation and suggestions for improvement.
Results: Around half of the clients attending CP@clinic reported experiencing anxiety or depression. These participants were more likely to smoke, binge drink, have mobility issues, experience pain, experience food insecurity and income insecurity and be socially isolated. Participants reported that the CP@clinic program helped to improve their mental health both directly, through receiving referrals to appropriate healthcare providers and indirectly through improvements in determinants of mental health spanning physical and social domains.
Conclusion: This study found a clear overlap between mental health, physical health and social health needs of CP@clinic consumers. There is a clear need for an accessible community service that addresses the mental health needs of older adults living in rural Australia. CP@clinic has demonstrated improvement of the mental health and wellbeing of this population and should be scaled up and evaluated effectively for this purpose.
Declining ambulance offload delays in the post-COVID era: An interrupted time series analysis
Edward Stacey, Liam Hemingway, Cam Gosling, Brendan Shannon
Monash University, Frankston, Victoria, Australia
Background: Ambulance offload delays and emergency department (ED) overcrowding have constrained ambulance service capacity. During the COVID-19 pandemic, these issues worsened, and in Victoria, fewer than 62% of ambulances currently offload patients within the target 40-minute timeframe. This study investigates how offload delays and ED length of stay (LOS) have changed pre-, during, and post-COVID.
Methods: Using a population-based dataset of all ED presentations at a large health service between January 2018 to Aug 2024, we applied an interrupted time series analysis to monthly median ambulance offload times and ED LOS, stratified by whether patients were admitted after the ED or not. ARIMA models were used to detect level and slope changes across the three periods.
Results: A total of 529,261 ED presentations were included across the included time periods with no significant changes in demographics or health service usage noted. For non-admitted patients, ambulance offload time increased significantly post-COVID by 12.70 minutes (p < 0.001), followed by a monthly decline of 0.62 minutes (p < 0.001), falling 9.8 minutes below the projected counterfactual by August 2024. Among admitted patients, post-COVID offload times increased 14.21 minutes (p = 0.07), with a subsequent monthly decline of 0.73 minutes (p = 0.01), trending 8.1 minutes below the counterfactual. By contrast, ED LOS rose sharply post-COVID: 53.60 minutes for non-admitted (p < 0.001) and 124.83 minutes for admitted patients (p < 0.001), with only partial monthly reductions (1.25 and 0.89 minutes, respectively).
Conclusion: Ambulance offload delays have improved and now sit below pre-pandemic projections. These results imply improved ED flow practices or handover models. However, persistently elevated ED LOS-particularly for admitted patients continues to delay ambulance turnaround and poses a system wide risk. For paramedics, the findings stress the importance of whole-of-system coordination, including discharge planning, inpatient flow, and alternative community-based pathways to preserve paramedic service responsiveness.
Workplace safety and wellbeing
Time: Thursday 11 September 2025, 11:50 – 12:30
Location: Room 1
Assessing the incidence and prevalence of violence towards paramedics in Ontario, Canada
Justin Mausz1,2, Mandy Johnston1, Alan Batt3,4, Walter Tavares2, Elizabeth Donnelly5,6
1Peel Regional Paramedic Service, Brampton, ON, Canada.
2University of Toronto, Toronto, ON, Canada.
3Monash University, Clayton, VIC, Australia.
4Queens University, Kingston, ON, Canada.
5University of Windsor, Windsor, ON, Canada.
6Charles Sturt University, Bathurst, NSW, Australia
Introduction: Occupational violence in healthcare is a complex problem, with a recent study estimating the prevalence of violence in two Toronto Emergency Departments (ED) at 1.15 incidents per 1,000 ED visits. Similar data for paramedics are sparse, in part because of a lack of standardized reporting infrastructure.
Aims: Leveraging a novel reporting system embedded in the electronic patient care record (ePCR), our objective was to assess the prevalence of violence against paramedics in multiple services in Ontario and compare it to ED data.
Methods: The External Violence Incident Report (EVIR) gathers quantitative and qualitative data about violent encounters, documented by the paramedic at the time of event. Paramedics filing an electronic patient care report are prompted to complete an EVIR if they experienced any form of violence during the 9-1-1 call. We reviewed EVIRs from twelve paramedic services in Ontario, using descriptive statistics to characterize the violence. We calculated an overall pooled rate of violence per 1,000 9-1-1 calls.
Results: A total of 1,140 paramedics filed 2,867 violence reports (mean 2.11 [±3.85] reports per paramedic), with 56% of reports documenting a physical or sexual assault and 9% (n=265) indicating the paramedic was physically harmed. Most (50%) of the violence occurred at the scene and 80% of reports listed the patient as the perpetrator, with substance use (49%) and mental health (35%) cited as contributing factors in a large proportion of cases. We found a pooled rate of 2.52 (95% CI 2.51-2.52) violent encounters per 1,000 calls (range 0.58 - 4.53). The rate of physical assault (range 0.42 - 2.68) had a pooled rate of 1.42 assaults per 1,000 calls (95% CI 1.41-1.42).
Conclusions: Paramedics appear to experience violence frequently and have an overall risk of violence more than twice that of healthcare workers in ED settings.
Click it or risk it: How education and policy drive paramedic seatbelt use
Lyle Brewster
Charles Sturt University, Bathurst, NSW, Australia
Introduction: Paramedic safety during patient transport remains a critical concern, with seatbelt non-use identified as a key risk factor. Previous research has suggested that both individual characteristics (such as formal education level) and organisational factors (such as awareness of a seatbelt policy) may influence restraint compliance, yet these relationships have not been simultaneously examined.
Aims: To examine how education level and policy awareness influence forward-facing seatbelt use in the back of an ambulance under no-patient, stable-patient and critical-patient conditions.
Methods: A cross-sectional survey of registered paramedics captured self-reported seatbelt use frequency in the patient care seat for each patient acuity level. Education was categorised as Year 12/TAFE–Associate, Bachelor’s degree, or postgraduate qualification. In a parallel analysis, respondents were stratified by whether they were aware of their organisations' seatbelt policy. Pearson’s chi-squared tests assessed overall associations; standardised residuals and Bonferroni-adjusted post-hoc p-values identified cell-specific deviations.
Results: Seatbelt use differed by education: when no patient was aboard, vocational paramedics were least compliant (35 % never belted vs ∼10 % among Bachelor’s and postgraduates; χ² = 19.27, p = 0.0051). No differences emerged with a stable patient (χ² = 9.24, p = 0.162). Under critical patient conditions, postgraduates had the highest “always” use (8.7 %) while vocational staff had the highest “never” use (80 %; χ² = 21.20, p = 0.0037). Finally, awareness of a formal seatbelt policy significantly boosted compliance in critical cases (χ² = 18.75, p = 0.0065).
Conclusions: Formal educational attainment and explicit policy awareness both independently predict improved seatbelt compliance, particularly in the absence of a patient and during critical care transport. Targeted interventions—including tailored training for paramedics with vocational qualifications and enhanced policy communication—could strengthen paramedic safety culture.
Body worn cameras for paramedics: Perceptions on safety and workplace challenges
Clare Sutton1, Lucia Wuersch1, Alain Neher1, Larissa Bamberry2
1Charles Sturt University, Bathurst, NSW, Australia.
2Charles Sturt University, Albury, NSW, Australia
Introduction: Paramedics in Australia face a growing challenge of occupational violence (OV), with incidents occurring at a notably high rate. This issue has been identified as a significant factor affecting predominantly young and inexperienced workers, leading to increased burnout and higher turnover during the early stages of their careers. There is limited research on how Body Worn Cameras (BWCs) impact rates of OV among paramedics, and the effect of BWCs on the work of frontline emergency service personnel remains largely unclear.
Aims: The aim of the study is to better understand how BWCs impact OV and the workplace health and safety (WHS) of paramedics, as well as their perceptions of using BWCs in their professional practices.
Methods: This research employs a mixed-methods approach, integrating both quantitative and qualitative analyses through surveys and in-depth interviews with frontline paramedics. Quantitative data analysis was processed using established SPSS protocols, and qualitative data underwent thematic analysis using NVivo 12 software. The findings from 189 questionnaires were triangulated with the themes that emerged from 22 interviews with frontline paramedics and station-based managers. The ethics approval number from the Human Research Ethics Committees (HREC) is H22366.
Results: A substantial majority of participants had an overall positive perception of BWCs. However, the data on OV was inconclusive, indicating a need for further monitoring to determine any significant changes due to their introduction. Participants strongly believed that BWCs alone would not solve the issue of increasing OV and should be part of a broader strategy, including risk management and de-escalation training, to improve paramedic WHS.
Conclusion: BWCs should be considered as part of a comprehensive approach to enhancing paramedic wellbeing. Training on BWCs must be integrated into a wider OV management program, encompassing situational awareness, risk mitigation, conflict resolution, and de-escalation techniques.
Causes and consequences of paramedic fatigue and sleep loss: A qualitative analysis of the paramedic perspective in an Australian context
Sian Wanstall1, Amy Reynolds1, Brandon Brown1, Meagan Crowther1, Robert Adams1, Anjum Naweed2
1FHMRI Sleep Health, Flinders University, Adelaide, South Australia, Australia.
2CQ University, Adelaide, South Australia, Australia
Introduction: Paramedic work is complex and demanding, and performed in safety-critical, high-pressure and resource constrained environments. The additional burden of shift work, fatigue, and sleep loss, which are common features of paramedic work, have implications for clinical performance, safety, and paramedic well-being. Despite known prevalence of fatigue and sleep loss in paramedic cohorts, an in-depth understanding of contributing causes and subsequent consequences from the worker perspective remains under-explored. Thus, utilising the worker perspective to inform interventions for paramedic fatigue and sleep is limited.
Aims: Using a systems-thinking lens, this study aimed to understand and describe the causes and consequences of fatigue and sleep loss among Australian paramedics.
Methods: Based on a qualitative approach grounded in pragmatism, semi-structured interviews were conducted with thirty registered Australian paramedics. We used a scenario-based task designed to elicit detailed accounts of fatigue and sleep loss in challenging workplace scenarios experienced both when rested, and when fatigued. Data were analysed inductively using conventional content analysis.
Results: Paramedics (31.0±5.4 years, 5.5 years average experience) identified causes of sleep loss and fatigue across the system, including paramedic work factors (driving, partner) (30%), dynamic shift (no breaks, continuous work) (16%) and static shift (night shift, on-call) (14%) factors, individual vulnerabilities (job stress, preparedness) (15%), ambulance resourcing and workload (12%), broader health system constraints (ramping) (9%), and family responsibilities (5%). Fatigue and sleep loss were connected to impacted paramedic mental (emotional dysregulation and distress) and occupational (job stress, job dissatisfaction) well-being (51%), impaired clinical performance (decision making, emotional labour) and reduced patient-centred care (39%), impaired safety (8%) and reduced resourcing (absenteeism, attrition) (3%).
Conclusion: Various system-level factors contribute to paramedic fatigue and sleep loss, with perceived wide-ranging implications for service delivery, patient and worker safety and paramedic well-being. A need for informed, system-level supports and management approaches is evident.
Equity, access and patient-centred care
Time: Thursday 11 September 2025, 11:50 – 12:30
Location: Room 2
Healthcare disparity in ambulance service delivered telehealth amongst patients with limited English proficiency
Ricky Lam
Queensland University of Technology, Brisbane, Queensland, Australia.
Queensland Ambulance Service, Brisbane, Queensland, Australia
Introduction: Since the Covid-19 Pandemic, the increased adoption of telehealth practices by health providers including ambulance services has led telehealth to be a widely accepted and effective means of health service delivery. Telehealth is often an alternative service offered in general practitioner, allied health, and outpatient settings, negating the need for patients to attend an in-person appointment. Although existing research highlights disparities in conventional telehealth usage and outcomes amongst patients with limited English proficiency (LEP), there is limited research in the emergency ambulance service context where medical presentations may be more acute or urgent.
Aims: The aim of this study is to therefore identify disparities in ambulance service delivered telehealth between patients with LEP and English proficient patients.
Methods: 104734 telehealth incidents between the 1st of July 2023 to the 31st of December 2023 from a jurisdictional state ambulance service in Australia were included for data analysis. Ambulance telehealth specific metrics were evaluated for ambulance dispatch rates and alternative pathway referral rates post telehealth interaction with an ambulance telehealth clinician. Descriptive statistical analysis was conducted to compare the LEP cohort to the English proficient cohort.
Results: LEP patients were less likely to be referred to an alternative care pathway by an ambulance service telehealth clinician compared to those who were proficient in English. LEP patients were also more likely to be dispatched an ambulance post an ambulance telehealth interaction.
Conclusion: The results indicate that ambulance service delivered telehealth may have difficulty in providing appropriate and accessible alternative healthcare pathways to patients with LEP. Higher ambulance dispatch rates for LEP patients may also suggest over-triaging practices due to assessment difficulties. More qualitative research involving the perspectives of patients and clinicians is required to understand the challenges associated with providing equitable access to healthcare to LEP patients through ambulance service delivered telehealth.
Mortality in non-transported falls patients attended by road-based EMS in Aotearoa New Zealand
Samuel Dijkstra1,2, Bridget Dicker1,2,
Sarah Maessen1,2, Andy Swain1,3,
Graham Howie1,2, Verity Todd1,2
1Auckland University of Technology, Auckland, Auckland, New Zealand.
2Hato Hone St John, Auckland, Auckland, New Zealand.
3Wellington Free Ambulance, Wellington, Wellington, New Zealand
Introduction: Falls-related visits account for 20% of emergency department presentations in those aged 65 and older. Over 40% of this age group experience at least one fall annually, which can result in serious injury, disability, or death.
Aims: To determine the 30-day mortality rate among falls patients who were not transported following ambulance attendance, and to examine the relationship between mortality and patient demographics and clinical characteristics.
Methods: Falls cases from the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) that were attended but not transported by a Hato Hone St John ambulance in 2023 were included. Descriptive statistical analysis was completed in SPSS.
Results: We included 18,436 non-transported, low acuity falls cases, representing 4.8% of EMS attendances in 2023. The 30-day mortality rate was 3.3% (n=613 cases). Mortality was higher in males (60.0% of mortality cases, n=368 vs. 43.0% of survival cases, n=7664), ≥65-year-olds (92.4%, n=566 vs. 72.5%, n=12,937), non-Māori (92.2%, n=565 vs. 89.4%, n=15,610), low deprivation areas (16.7%, n=101 vs. 12.0%, n=2,082), and cases attended at home (88.6%, n=543 vs. 80.2%, n=14,292)(p<.05). Abnormal vital sign measurements were significantly associated with increased mortality (p<.001), with overrepresentation of cases with low temperature (<36.0°C; 20.1%, n=104 vs. 14.2%, n=2,107), low systolic blood pressure (<110 mmHg; 13.2%, n=70 vs. 4.4%, n=700), high heart rate (≥90 bpm; 33.2%, n=189 vs. 25.5%, n=4,349), and high respiration rates (≥21 rpm; 18.2%, n=107 vs. 7.8%, n=1,362).
Conclusion: The 30-day mortality rate in non-transported falls cases was 3.3%; higher than the 1.9% previously reported amongst all low-acuity, non-transported patients. Most deaths (92.4%) occurred in cases over the age of 65, highlighting increased clinical risk associated with non-transport in older patients following a fall. Vital signs may help identify high-risk patients. However, vital sign records were limited; for example, 17% of the cohort had no temperature recorded.
Frailty documentation in the prehospital setting: An observational cohort study
Lorna Martin1, Liam Hemingway1,
David Anderson1,2,3, Belinda Delardes1,2,
Lucinda Peacock1,4, Emma Bourke-Matas1, Kelly-Ann Bowles1
1Monash University, Frankston, VIC, Australia.
2Ambulance Victoria, Doncaster, VIC, Australia.
3The Alfred, Melbourne, VIC, Australia. 4NSW Ambulance, Sydney, NSW, Australia
Introduction: Frailty is a multidimensional syndrome affecting 15-20% of community-dwelling older adults, associated with increased hospitalisation and mortality. While frailty screening is well-established in hospital and primary care settings, the prehospital environment remains less understood. Paramedics are uniquely positioned to observe frailty indicators in the home, but the extent and consistency of frailty reporting is unclear.
Aims: This study aimed to (1) identify the patient demographics most likely to have frailty documented by paramedics, and (2) describe the patterns and methods of frailty reporting in prehospital patient care records.
Methods: Retrospective analysis of patient care records (PCRs) from a jurisdictional ambulance service over 12 months. Deductive analysis of PCRs was conducted by three independent investigators using predefined categories related to frailty. Mixed-effects logistic regression examined factors associated with frailty reporting, including a random intercept for paramedics to assess inter-paramedic variability.
Results: Of 3,633,737 patient care records, frailty was documented in 0.5% of cases (n=18,811), with 90% of reporting in patients aged ≥57 years. Among documented cases, 90% were classified as frail. Frailty reporting was significantly more likely in older, lighter-weight patients and those with medical presentations. Documentation methods varied: 48.2% used subjective descriptions, 27.5% used yes/no statements, and only 12.2% used the Clinical Frailty Scale. The most commonly documented frailty domains were mobility issues (18.9%) and weight/malnutrition (13.7%). Substantial inter-paramedic variability in reporting likelihood was observed.
Conclusion:. Frailty documentation was infrequent and inconsistent, with substantial inter-paramedic variability and limited use of validated assessment tools. The predominant focus on physical indicators such as mobility and weight suggests paramedics may not fully appreciate frailty’s multidimensional nature. These findings highlight the need for standardised reporting procedures, clearer documentation guidelines, and targeted education to improve the quality and consistency of prehospital frailty recognition.
Development of a national implementation strategy for the Palliative Paramedicine Framework to standardise best practice across Australia.
Sophia Flanagan-Sjoberg1,2,
Oluwatomilayo Omoya1,3, Josephine Clayton4,5, Paul Simpson6, Mark Boughey7,8,
Meredith Makeham4, Madeleine Juhrmann1,5,9
1Flinders University, Adelaide, SA, Australia.
2SA Ambulance Service, Adelaide, SA, Australia.
3Queen Elizabeth Hospital, Adelaide, SA, Australia.
4The University of Sydney, Sydney, NSW, Australia.
5HammondCare, Sydney, NSW, Australia. 6Western Sydney University, Sydney, NSW, Australia.
7University of Melbourne, Melbourne, VIC, Australia.
8St Vincent's Hospital, Melbourne, VIC, Australia.
9University of Technology Sydney, Sydney, NSW, Australia
Introduction: Caring for patients with life-limiting illnesses is a core component of paramedic practice. Aligning paramedics’ scope of practice with patients’ end of life wishes is essential to providing quality care to this population. In 2024, a 32-component Palliative Paramedicine Framework was developed through consensus methods with an international expert panel to outline the macro-, meso- and micro-level changes required to standardise best practice across Australia. Existing studies have not yet explored the challenges the sector, services, communities and individuals would face in implementing this Framework into routine care and the facilitators to overcome these.
Aims: To develop a national implementation strategy for the Palliative Paramedicine Framework.
Methods: Seven online semi-structured focus groups were conducted in early 2025, with 50 interdisciplinary experts including paramedic clinicians, extended care paramedics, ambulance service medical officers, paramedic educators, palliative care clinicians and people in the government and implementation science sectors. The Consolidated Framework for Implementation Research and the existing Framework informs the analytical lens. Reflexive thematic analysis, following Braun and Clarke's approach and an underlying social constructivist epistemology, is being employed.
Results: Analysis is currently underway and will be completed by the time of the ACP International Conference. Preliminary results highlight the importance of digital innovation, particularly paramedic access to electronic medical records as a key facilitator. Other themes include appreciating the jurisdictional nuance that exists between ambulance services, and geographic areas; providing quality education at both undergraduate and service levels; and implementation is not “one size fits all” and the strategy will take many formats to engage all stakeholders.
Conclusion: This implementation strategy will enable paramedics to deliver equitable, patient-centred palliative and end of life care across diverse settings. By addressing key facilitators and contextual challenges, it will provide guidance for integrating the Palliative Paramedic Framework into practice and guide system level change.
Research plenaries
Time: Friday 12 September 2025, 08:35 – 09:50
Location: Room 1
Reasonable compulsory overtime uncovered: What’s fair? What’s fatiguing? What’s fixable?
Matthew Ferris1,2, Kelly-Ann Bowles1,3,
Aislinn Lalor4,5, Alexander Wolkow3,6
1Department of Paramedicine, Monash University, Frankston, VIC, Australia.
2Queensland Ambulance Service, Kedron, QLD, Australia.
3Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, VIC, Australia.
4Department of Occupational Therapy, Monash University, Frankston, VIC, Australia.
5RAIL Research Centre, Monash University, Frankston, VIC, Australia.
6School of Psychological Sciences, Monash University, Clayton, VIC, Australia
Introduction: Reasonable Compulsory Overtime (RCO) refers to the work performed by paramedics between the scheduled end of a shift and their actual log off time – an often daily occurrence. While RCO can support continuity of patient care, it also contributes to paramedic fatigue, disrupts work-life balance and raises health and safety concerns. Most industrial agreements state paramedics cannot refuse RCO, but what is reasonable?
Aims: This study aimed to gain consensus on front-line paramedics’ perceptions of conditions that are reasonable and unreasonable for compulsory overtime.
Methods: A three-round online Delphi method was employed, involving frontline paramedics in metropolitan Australian areas. In Round 1, participants provided free-text definitions of RCO and voted for certain conditions of RCO. In subsequent rounds, they voted on conditions for consensus. A content analysis was performed on the qualitative responses and quantitative consensus was reached iteratively. Situations with ³ 80% agreement were said to be ‘reasonable’ or ‘unreasonable’.
Results: Over 145 paramedics from diverse regions and experience levels participated. Consensus was achieved in 17 (50%) of conditions. RCO was found to be reasonable in four conditions, and unreasonable in thirteen conditions – around themes of patient acuity, operational factors (i.e., ramping) or cumulative duration of overtime.
Conclusion: This study presents the first Australian paramedic-led perspective on what constitutes RCO. Although these findings alone may not decrease RCO, they offer a critical foundational step in workforce consultation for policy review. By clarifying these perspectives, this research supports the future development of evidence-based recommendations around RCO to improve both clinician and patient safety and system sustainability.
Paramedic care during death, dying and bereavement: A holistic model for responding to diverse family needs in out-of-hospital death
Eillish Satchell1, Tess Moeke-Maxwell1,
Merryn Gott1, Natalie Anderson1,2,
Bridget Dicker3
1Te Ārai Palliative Care & End of Life Research Group, School of Nursing, The University of Auckland,, Auckland, Auckland, New Zealand.
2Adult Emergency Department, Te Toka Tumai, Te Whatu Ora, Auckland, Auckland, New Zealand.
3Auckland University of Technology, Auckland, Auckland, New Zealand
Background: Caring for family during death, dying, and bereavement has been established as an important role of paramedics in out-of-hospital death. However, there is little evidence exploring the needs of Indigenous and culturally diverse families in end-of-life care. Addressing this gap requires culturally responsive approaches. Te Whare Tapa Whā, a Māori model of holistic health, offers a framework that can guide inclusive care of psychosocial, family and spiritual needs.
Aim: To explore the experiences of bereaved families in Aotearoa New Zealand and improve paramedic responses in out-of-hospital death.
Methods: Using qualitative methodology guided by kaupapa Māori research methods, we conducted interviews with bereaved family members who experienced an out-of-hospital death where ambulance services responded. A collaborative story production process was used to co-create electronic stories of family experiences. Data analysis was guided by Braun and Clarke's reflexive thematic analysis.
Results: We conducted 21 interviews with bereaved families, with nearly half of all families identifying as Māori (n=8) or Pasifika (n=2). Events covered a range of clinical scenarios, including both adult and paediatric deaths from cardiac, medical, suicide, and trauma causes. Findings show that families have emotional, cultural, and spiritual needs during death and dying, which were often unspoken and unmet. Using the experiences of bereaved families, we present Te Whare Tapa Whā as a model of responding to the needs of diverse families during out-of-hospital death.
Discussion: Responding to the needs of Indigenous and culturally diverse patients and family members remains an under-researched area of paramedicine. While traditionally applied to Māori health, the proposed adapted Te Whare Tapa Whā model can help to inform and support holistic culturally responsive family care in the event of a death. Integration of this model into paramedic education and practice presents an opportunity to improve care in these challenging and important situations.
Australasia’s female paramedicine workforce: Opportunities and barriers from a national survey
Liz Thyer1, Sascha Baldry1,
Aglae Hernandez Grande2, Alecka Miles2,
Fleur Sharafizad2, Verity Todd3
1Western Sydney University, Campbelltown, NSW, Australia.
2Edith Cowan University, Perth, Western Australia, Australia.
3Auckland University of Technology, Auckland, Auckland, New Zealand
Introduction: Internationally, female representation in paramedic workforces is changing, reflective of the population, but this change is not without challenges. Females are still underrepresented in management, experience a gender pay gap, and are impacted by inflexible employment models.
Aims: This study describes the comparative work experiences of females in the paramedic workforce in Australasia and consider enablers and barriers to their career progression.
Methods: This is a cross-sectional exploratory survey of paramedic personnel and students from Australia and Aotearoa New Zealand. A purpose-built survey collected demographic data, current employment information, workplace satisfaction, workplace flexibility, leave matters, motivation for the profession and future intentions from personnel and demographics, study matters, motivation for entering the profession and future intentions from students.
Results: The survey collected 1236 complete responses between September 2023 and January 2024. 693 (56.1%) self-identified as male, 520 (42.1%) as female, and 23 (1.9%) as non-binary or did not disclose their gender. Women were overrepresented in younger (20-29 years) age categories (37% compared to 20%) and were more likely to have caring responsibilities during childbearing years (20-49 years) (73% compared to 54%). Women were less likely to have post-graduate qualifications especially PhDs (1% compared to 4%) and were overrepresented in lower salary bands ($31-60K) (9% compared to 3%); they also felt less prepared to provide workplace clinical supervision (29% compared to 42% males).
Conclusion: Irrespective of the international move toward gender parity in paramedic workforces there are still inequities in the number of women holding advanced education and senior roles. This, alongside increased caring responsibilities and a perceived lack of preparedness to take on leadership roles, are perpetuating the gender divide which has ramifications for workforce retention and turnover. Small scale programs designed to address these issues have had positive impacts but need to be available across the sector.
