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Achievement of this level of integration will only be possible with the direct involvement of expert paramedic clinicians within the advisory, policy and operational governance framework of health care delivery. Placing paramedic services into perspective Australians rely heavily on paramedics and pre hospital medical service providers to respond to emergency and other medical incidents that occur away from established hospital emergency facilities. The pre hospital medicine sector is significant in the Australian context, and the Australian Productivity Commission reports that publicly funded Ambulance service organisations attended 3.3 million incidents nationally in 2012–2013 resulting in 4.1 million ambulance responses to attend to 3.2 million patients. Nationally the Commission notes that in 2012–2013 some 84.7% of hospital emergency department patients in triage category ‘resuscitation’ arrived by ambulance, air ambulance or helicopter service. Total reported revenue of ambulance service organisations in Australia was $2.6 billion in 2012–2013. These figures do not include private paramedic service providers or defence –related commitments. Nationally, revenue (in real terms) increased each year from 2008–2009 to 2012–2013, with an average annual growth rate of 4.5% . As a result of the varying funding arrangements ambulance service organisation air ambulance expenditure varies substantially across different jurisdictions. These basic statistics show the significant impact of the pre hospital medicine sector, which at some stage or other will touch the life of nearly every person in the community. It graphically demonstrates the ubiquitous nature of pre hospital medicine and the need for close integration with the broader primary care and hospital health systems to achieve optimal patient outcomes. It underscores the concern of the profession at the present isolation of paramedic services from national health care policy which creates significantly different operating environments for pre hospital health service delivery across different jurisdictions. While prevention and broader healthcare roles are embodied within the paramedic role descriptions and skill set, the popular perception of the paramedic role rarely reflects these elements. Community perceptions remain largely fixed on pre hospital medicine as consisting of an ambulance vehicle and its crew responding to an emergency and taking the patient to a hospital. Many policymakers hold similar perceptions of the roles and capabilities of the pre hospital medicine sector. One result is that key performance indicators consistently focus on physical response times and emergency performance indicators to the relative exclusion of other indicators of health care and patient outcomes. It was disconcerting to find this lack of understanding of pre hospital medicine as recently as 2008 in the report prepared by the National Health and Hospitals Reform Commission dealing with the Australian Health Care Agreements and performance benchmarks. The National Health and Hospitals Reform Commission document used the term “emergency” almost exclusively in the context of hospital based services, the word “ambulance” appeared twice referring to a transport vehicle and the term “paramedic” did not appear at all. That says much about the perceived role of public pre hospital medicine providers who handle over 3.3 million incidents annually!Those role perceptions are a hangover from the early beginnings of pre hospital medicine based mainly on transport and emergency responses to public safety and life-threatening events.
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