Paramedics The Problematic Autonomy of Australia's Paramedics

The paramedic is a critical contributor to the effectiveness of Australia's collective healthcare system as well as of the numerous states that comprise the nation. As critical first-responders endowed with the skills, knowledge and training to provide onsite emergency and acute treatment either prior to or while transporting a patient to a hospital facility, paramedics are essential to the protection of the public health. And yet, few healthcare professions remain as hazily defined, poorly represented or shabbily treated as Australia's paramedics. As the discussion here below will demonstrate, this condition is largely a product of the fact that the occupation is allowed to operate relatively independently from the licensure, certification and centralized oversight that mark the career development of other healthcare service professions. This definitional limbo is a major cause for the long-standing absence of consistency for a qualified and state-sanctioned paramedic as well as for more recent developments such as the profession's decision to depart from the Health Services Union (HSU).

In fact, the paramedic profession has only recently attained acknowledgement as something more than a strict service-profession. In other words, the medical credibility of the profession has long been subject to undermining. According to the text by Reynolds & O'Donnell, "while the term paramedic has been adopted in recent time, paramedics were formally known as ambulance officers. Across Australia paramedics work in a voluntary capacity or are employed by ambulance services to treat and transport patients to and from hospital and are able to instigate various forms of medical treatment."

As the discussion hereafter will show, there is an ever-growing need to acknowledge and redress the inconsistency and decentralization of the paramedic profession. Both out of respect to the critical functions performed by members of this profession and to the patients who will be treated by them, it is incumbent upon us to find ways of bringing central control, meaningful oversight and improved working conditions to the field.

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Indeed, this condition points to the primary issue facing both the profession itself and the broader health system in Australia. That is, the status of the paramedic remains in one sense undefined in said health system. This is because the legal definition of a paramedic remains in a state of flux, a condition largely attributable to the profession's state of autonomy. According to the text by Reynolds & O'Donnell (2008), "while paramedics act independently, they provide a vital conduit for patients requiring medical assistant between out-of-hospital care and formal care settings. Despite this, the standing of the paramedic is still considered as an associate profession (ABS 2006i) with their inclusion into the health system yet to be fully realised (Reynolds 2004)." (p. 201)

Given the critical role played by the paramedic in ensuring that emergency medical situations are stabilized, that immediately required treatment is performed and that transport is conducted safely and efficiently, we can scarcely afford to overlook what is a problematic gap in inclusion. By creating a scenario where career development, job performance and professional association occur separate from and outside the boundaries of the healthcare system on the whole, Australia has succeeded in undermining the value, quality and efficiency of its paramedics. The result is also a permeating discontent within the occupation, a condition which may threaten to dramatically reduce the number of paramedics in service to Australians. This could have dire consequences for the overall functionality of the healthcare system, where a short supply of critical first-responders could be the difference between life and death for patients in urgent need of assistance. Underlying this danger is the issue of worker morale. The poor legal definition of paramedic and the general state of ongoing change in which the profession finds itself have conspired to damage commitment and morale industry-wide. In fact, in some states, this damage is readily evidenced by the attitudes of working paramedics.

For instance, a survey recently conducted in Victoria reveals a startling lack of job satisfaction among its paramedics. According to the research, "about 600 paramedics took part in the survey which found 55 per cent planned to quit in the next five years. Fifty-four per cent of those surveyed said they would take a job interstate where they could earn more money. Paramedics are planning industrial action after pay negotiations with the State Government failed. They want a 30 per cent pay rise over three years. The Government has offered 5 per...

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What is implied here is a key impasse for Australia's paramedics. Namely, low collective pay is likely a symptom of the inconsistency that has historically greeted the occupation. In fact, there may be a case made that resistance to improving the conditions for Australian paramedics is a product of the desire to keep pay rates modest. However, this orientation may be increasingly difficult to maintain. In the same article by ABC News (2013), it is indicated that demand is ever-increasing within the field. The heightened need for ambulance workers is at once a cause for improved oversight within the field and a contributor to the fact that this oversight remains fleeting. This is because the lack of regulatory oversight does make this one of the more accessible positions in the healthcare industry. For many who desire to provide medical services but who lack the finances, time or skill-set to be formally trained in an affiliated medical profession, working as a paramedic can prove an excellent middle-ground.

However, given the low morale for those already steeped in the profession, as well as the lack of quality control for those now entering the occupation, the benefits of paramedic autonomy are clearly outweighed by the negative consequences. In fact, it is increasingly evident that the lack of central authority for this occupation is diminishing the public rights of both paramedics and the people they serve. According to the text by Hannan (2013), it isn't necessary to compare the paramedic profession to other medical professions in order to demonstrate the need for improvement. To the contrary, Hannan's text demonstrates that paramedics should be eligible for the same basic rights and protections that other public service providers enjoy. According to Australian Paramedics Association secretary Wayne Flint, there is a collective discontent in the field that extends from this sense of public neglect. According to Flint, "all that ambulance paramedics want is the right many other workers, including the fire brigades and police, already have: the ability to focus on paramedics' issues, and represent our interests across the board, every day of the year. . . We want to end the neglect that we've experienced under the Health Services Union, which has seen paramedics lose entitlements.'" (Hannan, p. 1)

Wayne Flint's comments lead us to consider a prime example of the difficulties that the profession has faced in gaining access to its rights. In recent weeks, the occupation has made headlines as its New South Wales constituency undergoes an ignominious split with its representing Union. According to recent headlines, the Australian Paramedics Association of NSW is in the process of extricated itself from the embattled Health Services Union (HSU). HSU has become embroiled in fraud, scandal and upheaval. With the ouster of its leadership and the ongoing legal battles that its former members must now face, the HSU has clearly underserved or its exploited the associations that are joined under its representation. Here, the absence of its own centralized Union shows the paramedic profession is a state of considerable difficulty. According to its own report, the Australian Paramedics Association is departing from the Union because it has not only damaged the goals of the profession through its corruption and illicit activities but also because even prior to the revelations of malfeasance, the HSU often left the Association to its own devices.

Accordingly, the text by Walsh (2013) reports that "in a submission to the Industrial Relations Commission (IRC), the Australian Paramedics Association (APA) is arguing the HSU has provided poor representation and its finances are in a bad way. APA Secretary Wayne Flint says his group which is also known as the Emergency Medical Service Protection Association (EMSPA) has acted as a union since 2009. 'we seemed to fill in the gaps which HSU either didn't bother to or couldn't fill for paramedics,' he said. HSU East has faced ongoing scandals about its finances, and all positions were vacated when it was put in administration last year." (Walsh, p. 1)

This denotes a Union that is ill-suited to represent anybody, let alone a profession that would be better served through its own professional union. Indeed, it may be argued that the relative independence of paramedics from the medical field might be redressed through better collective representation. Without question, organizations such as the HSU show a detachment from the more direct goals driving the profession today. In addition to the need for better pay and better working conditions, unionization by paramedics should help to push forward the slow by steady progress toward professional recognition that has been underway for…