3.3.1 Description of the research setting
This study was undertaken in Tasmania, Australia, which is a small State of approximately 68,119 square kilometres with a population of
510,20067. It has a government run three tier ambulance service whereby
Voluntary, Paramedic and Paramedic Intensive Care, Emergency Medical Services (EMS) provide the only public emergency medical response state wide.
Much of the services provided by Tasmanian paramedics can be understood as rural emergency service because Tasmania is recognised as a predominantly rural state. In a study it is important to clarify the way
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rurality has been operationalised as a term in the thesis. The Australian Institute of Health and Welfare (AIHW) recommend the use of the Australian Standard Geographical Classification (ASGC) when
determining an areas remoteness classification (AIHW 2011). When using this classification method there are no areas within Tasmania classified as a ‘Major City’ with the four largest population areas of Hobart and
Launceston classified as ‘Inner Regional’ and Devonport and Burnie classified as ‘Outer Regional’. Almost all of the other areas in Tasmania according to ASGC are classified within a ‘remote’ classification area except for a very few of the regional centres classified as ‘Outer Regional’. Within Tasmania the Local Government Area classifications use only the two terms of ‘Cities’ and ‘Municipalities’ to classify each of the population areas, those populations classified as a ‘city’ in this model are those four major locations mentioned above (Hobart, Launceston, Devonport and Burnie) which fall into the ASGC as either Inner or Outer Regional areas.
Ambulance Tasmania regards Hobart, Launceston, Devonport and Burnie as urban based ambulance stations. In this study these urban centres are used in this study to classify an ‘Urban Paramedic’ in Ambulance Tasmania as they compare closely with the ASGC. Nevertheless, each of these urban stations have regional operations centres and all other paramedics working within these four regional operational stations will be classified as a ‘Rural Paramedic’.
The state ambulance service responded to approximately 70,000 incidents in the 2009-2010 financial period and had 255 salaried paramedic personnel with a total number of 49 response stations (Commision 2011). There is a significant proportion of ambulance
response to rural emergencies and many Paramedics work in both areas and even when an ambulance crew is rostered to an urban centre they may respond several times during their shift to emergencies in rural areas. As discussed in the introduction, this is specialised work that requires targeted AAM paramedic training.
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In Tasmania, the base education for paramedics EMS training has developed over the past ten years from a Diploma to an Associate Degree8. After this foundational qualification has been successfully completed Paramedics undertake a six month in-house Intensive Care program and then an optional short course in AAM which includes tracheal intubation. In July 2006, the PILMAT trial resulted in 58 Paramedics
qualified in AAM state wide and the Tasmanian Ambulance Service employed 145 salaried paramedic staff and had 503 volunteer officers (Commision 2011). The voluntary staff provided initial ambulance
response in many of the remote centres with salaried paramedics working in many of the rural communities.
At the time of this study, the Tasmanian Ambulance Service was one of the smallest in Australia and had a culture within its practitioners of self- development and continuing education. AAM was a much desired skill set which was frequently discussed amongst this paramedic workforce and there was strong desire for more paramedics to participate in the PILMAT training.
3.3.2 The Participants
Participation in this study was voluntary and all permanent employees of the government ambulance service. The only inclusion criterion for participation in this study was paramedics who volunteered to take part in the initial PILMAT study and Figure 6 depicts the relationship between the PILMAT trail and this current study.
By selecting all the paramedics from the PILMAT trial to be involved in this study ensured the total population was included, both those
paramedics who were AAM training and a small number who had not been trained in AAM. The inclusion of the total population meant there was no requirement to select a sample of the population.
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Figure 6: The details of the relationship between the PILMAT trial and this study
The majority of paramedics (77%) meeting the inclusion criteria were AAM qualified and had varying levels of tracheal intubation experience, with a small number not having completed the AAM training and thus had no tracheal intubation experience. The participants were not exposed to a formal AAM skills maintenance or continuing educational program at the time of this study. The participants were located state wide in all the urban
Total number of Paramedics in 2006 145 AAM qualified paramedics 58 (40)
Not AAM qualified paramedics 87 (60) Paramedics involved in PILMAT trial 88 (61) PILMAT participants sent the questionnaire
88 (100) Questionnaires returned 35 (40) AAM qualified 27 (77) Interviews 5 Non-AAM qualified 8 (23) Interviews 1 PILMAT trial This study
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operational centres and in a number of the rural ambulance stations. There were no specific exclusion criteria and all participants in this study were current practicing salaried paramedics and held certification in ILMA practice with the majority also holding AAM certification.
3.3.3 Ethical Considerations
Ethics approval for this study was obtained from the University of Tasmania Human Research Ethics Committee (Tasmania) Network, approval number H9503, by the submission of a ‘Social Sciences - Minimal Risk’ application form. The application included an ‘invitation to participate’ letter which included consent to participate, which is attached as Appendix 5.
Each paramedic who matched the inclusion criterion was invited to participate and involvement in the study was on a voluntary basis. The information sheet and an invitation to participate were sent to each
paramedic in writing via Australia Post to their private residential address. The information sheet briefly explained the purpose of the research, why they were chosen to participate, the security and anonymity of the
information they will provide, and the formal approval granted through the University of Tasmania.
The anonymity of the participants was assured in the first instance by the questionnaire being anonymous and containing no personal
information with demographic details only. The researcher was unaware of the participants who were involved as the questionnaires were distributed by an independent body and as previously mentioned the questionnaires had no personal information included. The participants were assured in the information letter they received the information they provided would be kept secure and confidential with no means of recording or identifying the individual respondent. During this study there were no ethical issues which arose from either the data collection or storage processes.
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