Paramedicine

Many New Zealanders are familiar with paramedics and emergency medical technicians (EMTs) – as well as other paramedicine workforces like ambulance drivers – from encounters with our ambulance services. We have 898FTE paramedics, 68FTE EMTs and 416FTE advanced care paramedics currently registered to practice in New Zealand.

However, our paramedic workforce increasingly provides care in a range of settings, including in primary care; and our ambulances are increasingly places to provide care on the move, and are not just vehicles to take people to hospital. Advanced care paramedics, who have completed additional training, can provide an even wider range of services to people in the community.

Unlike many other health workforces, Health NZ employs almost no paramedics or EMTs. Our national ambulance services are provided by two national providers – Hato Hone St John and Wellington Free Ambulance – and paramedics are mostly employed either by these two providers, or in primary and community settings (though the latter is still relatively rare).

Because Health NZ does not employ many paramedics or EMTs, we have relatively poor data about gaps in our paramedicine workforces. Historically, we understand that ambulance providers have faced shortages of paramedics; but recent graduates have struggled to find employment, and we understand that services do not face significant shortages of paramedicine staff.

This owes in part to the strong, modern pathway for registration in paramedicine – which allows people to first become EMTs, and then learn while working to upskill to become a paramedic. This results in good advancement opportunities; particularly with advanced scope paramedic roles increasingly used in a wide range of services. However, it has led to a smaller EMT workforce, with cohorts of EMTs recruited out of Australian programmes by some ambulance providers in recent years.

There is also increasing demand to employ paramedics in other settings; though usually these roles are more suitable for experienced paramedics rather than new graduates. These include:

• In primary care, where they can work with similar scope to a nurse in providing care alongside a general practitioner for certain conditions and minor trauma.
• In connecting people who have needed hospital-based care back into the community – for example, by helping get people home after they’re discharged, and ensuring that they’re safe and supporting to care for themselves with whānau.

There are further, yet untapped opportunities to use paramedics better in settings such as aged care, and to provide mobile, primary care to communities. These opportunities both require more experienced and advanced scope paramedic capacity, and in some cases changes to funding to make these models of care attractive.

All this means that we expect to need to grow our paramedicine workforce over time – but we have relatively poor information about the extent to which we need to do so.

Our paramedical workforces are a major opportunity for our health system: paramedics have a broad, generalist skill-set that can be applied to a range of contexts, and have very well-designed training pathways which make it relatively easy for a diversity of people to train as paramedics. Lower levels of current pressure mean that we can work to shift models of care to use paramedics in new settings without risking destabilising our ambulance services.

Because EMTs can progress readily to become paramedics, it’s much easier to give people some training so they can start working, earning and supporting whānau; and then continue to support them as they progress towards a full paramedicine qualification. Advanced scope paramedic roles take this further, creating career development opportunities for people once they’ve become paramedics – and extending their scope of practice to be able to do more.

However, recent struggles matching new paramedicine graduates to work show that if we are to build a sustainable pipeline to use paramedics in a wider range of settings, we will need to expand the array of graduate roles and pathways available to our new paramedics. Otherwise, limits on the supply of paramedics and EMTs needed in our ambulance services risk limiting our ability to train for other settings.

Paramedicine is a profession in good health – in that it has strong fundamental settings in place, both regulatory and training, which we want to maintain and build on. So long as we can ensure good graduate pathways, we think paramedicine is well-set for success. To do so, our focus over the next three years will be on:

• Establishing roles for new paramedics. Focusing on good transitions to paramedical practice and roles for new graduates is essential to keep our paramedicine workforce in New Zealand, and in health. We want to build on the work done in Comprehensive Primary Care Teams in primary and community settings, to create more of these roles in services which haven’t traditionally employed paramedics – like general practice, hauora Māori providers and aged care.
• Improving dual registration. We can make paramedics even more flexible practitioners by giving them dual registration into other allied professions where we have shortages – like anaesthetic technicians – in just one additional year of study. This is a great opportunity to take advantage of a short-term excess of new paramedics to grow other allied workforces where we also need growth, and build versatility.
• Focus on advanced scope paramedics. Expanding opportunities for paramedics to train as advanced scope paramedics, both as part of ambulance teams and outside of traditionally paramedicine settings (such as in primary care), means that the paramedics we have can do more – and have better career pathways as they progress.

The above will start to support our long-term focus for paramedicine. Longer-term, we expect to focus on establishing new models of care in primary and community settings which make better use of paramedicine workforces to provide acute and ambulatory care; and on ensuring the models adopted by our ambulance services are best designed to meet the needs of all New Zealanders – particularly those in rural and provincial communities who are least well-served today.