Medical work and subsequently the work of paramedicine changed profoundly since the 20th century. Paramedics have developed from being stretcher bearers and horse-cart drivers equivalent in social status to cab drivers, to become among the most highly skilled clinicians within society with a unique and important role to deliver emergency healthcare
333 L Blanchard, C Hinnant and W Wong, ‘Market-Based Reforms in Government: Toward a Social
Subcontract’ (1998) 30 Administration and Society 483, 488, state that ‘One of the most important factors
in our conceptualisation of the social contract relationship is the presence of appropriate accountability and control mechanisms’.
in the pre-hospital setting. The professional development of paramedicine has been driven by a number of factors including the need for a transportation service for the sick and injured separate from public transportation; provision of definitive care for those with injury and disease as a purely charitable exercise; saving the lives of injured soldiers by removing them from the field of battle to definitive care as quickly as possible; and addressing the public health effects of industrialisation in a rapidly growing urban environment and the effects of technological and societal advances like the motor car. As demands from society, medical knowledge and technology has advanced so too has the role of the paramedic. This has necessitated an increase in education and training and, consequently, the need for an organised professional body to represent the discipline to improve wages, working conditions and status. Paramedics has therefore developed a number of the characteristics associated with professionals: expert knowledge; a unique public purpose; and a special relationship of trust with clients. They have not established a strong sense of professionalism or decision making guided by a code of conduct; rather they have relied on protocols developed by medical advisory boards. The reliance on employment largely by state-based ambulance services has also served to limit the autonomous development of paramedicine as has a lack of regulation to support paramedic self-regulation.
As noted in Chapter 2, Wilensky suggested that for an occupation to turn itself into a profession, there needed to be a broader set of structural and historical systems that contributed to a group’s transition to a profession.335 These included the establishment of a training school that evolved into university-based training, followed by the establishment of a local association that would grow into a national association.336 This chapter has shown that paramedics have clearly followed these steps but have yet to achieve the final two steps on Wilensky’s professionalisation trajectory: regulation by state-level licensing laws and the development of a code of ethics. It is not until these final elements are acquired that paramedics will be able to meet the five elements associated with being a profession: the provision of a public service fulfilling a unique purpose; that requires specialised knowledge and training; that provides them with technical and moral authority; which
335 Harold Wilensky, ‘The Professionalisation of Everyone?’ (1964) 70 American Journal of Sociology
137–58; Anne Witz, Professions and Patriarchy (Routledge, 1992).
allows them to organise and maintain a system of control over their own work and regulate with professionalism (code of ethics).
The aspiration to acquire ‘professional’ recognition has been considered the ‘gold standard’ of occupational status.337 In large part this is because, as discussed in Chapter 2, the privilege of self-regulation and having control over their work is something that many occupational groups seek. The professionalisation process for paramedics has not always been driven by paramedics, having at first commenced by necessity and in an ad hoc way in response to societal public health needs, and later been driven by medicine and medical research. However, over time paramedics have developed a unique public purpose and specialised knowledge and skills that have provided them with a moral and technical authority that they have leveraged into power to improve pay and conditions of work. This chapter has confirmed that paramedicine from its inception has displayed unique characteristics that involve working routinely in conditions that are to some extent unpredictable and uncontrolled, involving personal danger and risk. The next chapter explores how paramedics finally organised that power well enough to commence a formal professionalisation project with the aim of driving their professional status forward to gain control over their own work.
337 David Carr, ‘Professionalism, Profession and Professional Conduct: Towards a Basic Logical and
Ethical Geography’ in Stephen Billett, Christian Harteis and Hans Gruber (eds), International Handbook of
Are We There Yet? The Australian Paramedic
Professionalisation Project
The previous chapter identified that paramedicine, as a discipline, has evolved over time in a fairly ad hoc way in response to a variety of unrelated factors including societal need, advances in medical knowledge and technology, and industrial action taken at a discrete time and place for a relatively small group of practitioners. Despite the fact that a professional association commenced in 1970, and that paramedics organised to work collectively to have their skills and responsibilities appropriately recognised and remunerated through workplace agreements, there was little overarching organised, strategic national professional development of paramedicine.
Chapter three also established that the paramedic professionalisation process was, until relatively recently, largely driven by circumstances and groups other than paramedics. For example, their education evolution was driven by medicine, and later industry (ambulance service) and the tertiary education sector (shift to university learning). As noted in chapter three, the shift to the tertiary sector followed Wilensky’s professionalisation trajectory and although the shift was initiated by ASNSW and CSU, it was nonetheless, a significant step forward in the paramedic professionalisation process because it recognised the unique nature of paramedic work, their specialised knowledge and skill and their need for critical thinking capabilities in order for the discipline to move beyond protocol-driven practice. As described in the previous chapter, during the early 2000s, the profession gradually produced tertiary-qualified graduates who were able to conduct research into the specialised area of paramedic work. The discipline recognised the need for a discipline- specific journal in which to publish and disseminate this specialised knowledge. The
Journal of Emergency Primary Health Care (JEPHC),338 produced by the Australian College of Ambulance Professionals (now PA), was launched in September 2003 with the intention of ‘publishing to advance and promote the science of pre-hospital care research, management, education, clinical practice, policy and service delivery, providing a forum to respond to the professional interests of the multidisciplinary pre-hospital care
community’.339 This provided a mouthpiece for the profession to discuss and raise awareness of issues of professionalisation in a much more organised and collegiate way and in so doing created a public record of the Australian paramedic professionalisation project.
This chapter identifies what it is that paramedics hope to achieve from the professionalisation project. It does so by examining the literature and other data presented to various governmental inquiries on the professional development of paramedics. It uses the Freidson elements for a profession identified in Chapter 2 to assess how the paramedic discipline understands professionalisation, what they believe professionalisation will do for them and how they think they are going to professionalise. It then describes the push for professionalisation from within the sector and how governments have responded to claims for increased professionalisation by paramedics.