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| 1 | Pre hospital medical services and paramedic engagement in Australian health care - Improving the pathways of care through collaborative action显示文摘Paramedics Australasia(PA)is the national body representing paramedics engaged in delivery of pre hospital emergency health care.PA is thus uniquely positioned to provide insights into the role of pre hospital medicine in the continuum of care.Every day in Australia,patients are placed at risk of harm within the health-care system.These risks are particularly notable in pre hospital care where paramedics must often tend for patients under adverse operating conditions and per-form interventions that carry significant risks.Paramedics must make clinical judgements that may profoundly affect patient outcomes-often with no access to patient history.Pre hospital medicine has changed dramatically in recent years.Paramedic practice has evolved as a unique discipline combining medicine,public health and public safety.Contemporary pre hospital medical care is now provided by professionally qualified practitioners.These developments have been built on a strong evidence base demonstrating the capacity to enhance patient outcomes through appropriate clinical interventions.Paramedics and pre hospital service providers alike have had to overcome many challenges in this journey,not the least being the education,recruitment and retention of a professional workforce and the difficulties in funding the infrastructure upon which to build a comprehensive emergency response capability.The PA vision for pre hospital medicine is based on the premise that it is an essential part of primary health care and that its seamless integration into health care will better meet patient needs that might otherwise remain unfulfilled.Paramedics can provide a variety of community health services that are crucial in the provision of more comprehensive care,especially in rural and remote communities.PA has endorsed the philosophical approach to health care outlined in the 15 National Health and Hospitals Reform Commission Health Care Principles,and recommends the translation of those principles into the pre hospital medicine environment.Given those principles it is inexplicable how paramedics have remained unrecognised as health professionals and pre hospital medicine has been ignored as part of the health care reform process.Embracing the National Health and Hospitals Reform Commission principles should see pre hospital medicine forming not only part of the local health care system but also meshed into the fabric of the community.There should be community engagement in the assessment and evaluation of pre hospital medicine care and the regulation of practitioners under a national system of professional registration.These processes will better enable the benefits of holistic care to be realised.Despite the excellence and dedication of the paramedic workforce,PA recognises that formidable challenges remain in health care delivery.These include issues of equality and access,demographic coverage,safety and quality,as well as other workforce and resource issues that affect patient outcomes.Paramedics can assist in identifying and resolving many of these issues.Australia’s health system should provide suitably rapid pre hospital medical responses with levels of care appropriate to the circumstances of each patient.Paramedics moreover hold competencies that can provide prevention,evaluation,care,triage,referral and health advisory services that can be mobilised to enhance community healthcare resources.Access to professional paramedic services should thus form an integral part of the care regime available to the community.This should be an inter-professional model of healthcare practice founded on contributions from a dynamic mixture of professional expertise at all stages of the patient journey.In PA’s view,the virtual absence of references to the role and funding of paramedic services as a key component of the health care system at a national level is a grave oversight.A nationally driven policy perspective is needed that integrates pre hospital medicine into the health system.Fulfilling the PA vision of health care requires significant change in the way paramedic services are funded and administered.It will need advice from the best available minds and committed leadership within government and the health professions to bring the already demonstrated benefits of paramedic practice to the community.Many issues need to be addressed including:(a)Sustainable funding models under national access and equity principles;(b)Education,clinical training,staff recruitment and retention;(c)Safety and quality standards and the minimisation of patient risk;(d)Extended community care models in remote and low-volume settings;(e)Clinical governance,service accreditation and practitioner registration;(f)Adequacy of evidentiary data collection to assess patient outcomes,support service evaluation and underpin research;and(g)Infrastructure integration including communication networks and dynamic referral to manage external events and cope with capacity constraints.PA strongly believes that these issues cannot be considered in isolation.Pre hospital medicine practitioners must be involved in contributing their expertise in conjunction with other health professionals so as to create a seamless system of best practice care beginning at the point of need-the patient.To fulfil that promise PA has outlined a vision for the delivery of pre hospital medicine as part of an integrated health care system.Only by incorporating the input of paramedic clinicians into that national policy and operational arena can the best patient outcomes be achieved. | Richard Brightwell Ray Bange | 2014 | Family Medicine and Community Health2014，2，4： | 4 |
| 2 | Identification of skills common to renal and iliac endovascular procedures performed on a virtual reality simulator显示文摘 | NEEQUAYE S K AGGARWAL R BRIGHTWELL R | 2007 | Eur J Vasc Endovasc Surg2007，33，： | 1 |
| 3 | The use of Merocel nasal packs in the treatment of epistaxis 显示文摘 | Pringle MB Beasley P Brightwell AP | 1996 | J Laryngol Otol1996，110，： | 1 |
| 4 | The use of Merocel nasal pack in the treatment of epistaxis显示文摘 | Pringle M B Baseley P Brightwell AP | 1996 | J Laryngol Otol1996，110，6： | 1 |
| 5 | Identification ofskills common to renal and iliac endovascular procedures per-formed on a virtual reality simulator显示文摘 | Neequaye S K Aggarwal R Brightwell R? | 2007 | Eur J Vase EndovascSurg2007，33，52： | 1 |
| 6 | Outcome of haematopoietic stem cell transplantation for adenosine deaminase deficient severe combined immunodeficiency显示文摘 | Hassan A Booth C Brightwell A | 2012 | Blood2012，120，17： | 1 |
| 7 | The use of Merocel nasal packs in the treatment of epistaxis显示文摘 | Pringle MB Beasley P Brightwell AP | 1996 | J Laryngol Otol1996，110，6： | 1 |
| 8 | Adventures at the interface of combinatories and statis- tical physics显示文摘 | BRIGHTWELL G R WINKLER P HARD C | 2002 | ICM2002，，： | 1 |
| 9 | Evaluation of molecular methods to determine enterotoxigenic status and molecular genotype of bovine,ovine,human and food isolates of Staphylococcus aureus显示文摘 | Boerema JA Clemens R Brightwell G | | 0，，： | 1 |
| 10 | Shadows of ordered graphs显示文摘 | Béla Bollobás Graham Brightwell Robert Morris | 2010 | Journal of Combinatorial Theory, Series A2010，，3： | 1 |
| 11 | A model for predicting thermal radiation hazards from large scale LNG pool flres显示文摘 | Johnson A D Brightwell H M Carsley A J | 1994 | Process Safety and Environmental Protection1994，，72： | 1 |
| 12 | Contribution of pa tient related differences to multidrug resistance in rheumatoid arthritis显示文摘 | Morgan C Lunt M Brightwell H | 2003 | Ann Rheum Dis2003，62，1： | 1 |
| 13 | The height of a random partial order:concentration of measure显示文摘 | Brightwell G | 1992 | Ann Appl Probab1992，2，： | 1 |
| 14 | Adventures at the interface of combinatorics and statisti- cal physics 显示文摘 | BRIGHTWELL G R WINKLER P HARD C | 2002 | ICM2002，，： | 1 |
| 15 | A comparison of packing materials used in nasal surgery显示文摘 | GARTH RJ BRIGHTWELL AP | 1994 | J Laryngol Otol1994，108，7： | 1 |
| 16 | Identifying the bacterial community on the surface of Intralox belting in a meat boning room by culture-dependent and culture-independent 16SrDNA sequence analysis显示文摘 | BRIGHTWELL G BOEREMA J MILLS J | 2006 | Int Food Microbiol2006，109，： | 1 |
| 17 | The use of Merocel nasal packs in the treatment of epistaxis显示文摘 | Pringle MB Beasley P Brightwell AP | 1996 | J Laryngol Otol1996，110，6： | 1 |
| 18 | The neurological morbidity of carotid revascularisation: using markers of cellular brain injury to compare CEA and CAS 显示文摘 | Brightwell RE Sherwood RA Athanasiou T | 2007 | Eur J Vase Endovase Surg2007，34，5： | 1 |
| 19 | The use of Merocel nasal packs in thetreatment of epistaxis 显示文摘 | Pringle M B Beasley P Brightwell A P | 1996 | J Laryngol Otol1996，110，： | 1 |
| 20 | The use of Merocel nasal packs in the treatment of epistaxis显示文摘 | Pringle M B Beasley P Brightwell A P | 1996 | J Larngol Otol1996，110，6： | 1 |
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