Professional capabilities for registered paramedics

1. Practise ethically and professionally, consistent with relevant legislation and regulatory requirements

• Demonstrate understanding of: reporting obligations, legal responsibilities, legal requirements, ethical and professional reponsibilities and the legal and ethical boundaries of paramedicine practice
• manage personal, mental and physical health to ensure fitness to practice
• follow mandatory and voluntary reporting obligations
• apply the Paramedicine Board of Australia’s Code of conduct to their practice
• provide relevant information to a patient and demonstrate appropriate methods to obtain informed consent
• demonstrate knowledge of the Australia's healthcare systems, their standards and requirements.
• demonstrate understanding of the basic principles underpinning bio-ethics within paramedicine practice
• demonstrate culturally safe practice when providing healthcare services for Aboriginal and Torres Strait Islander Peoples
• exercise appropriate levels of autonomy and professional judgement in a variety of practice settings
• operate within the current legislation applicable to paramedicine practice, and
• practise in accordance with the applicable legislation governing the safe use of scheduled medicines by paramedics in the jurisdiction of practice

Legal responsibilities may include an understanding of responsibilities contained in relevant Commonwealth, state and territory legislation and regulations, specific responsibilities to maintain confidentiality, confirm informed consent and exercising duty of care.

Informed consent is a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved.

Principles underpinning bio-ethics must include: respect the rights of the individual, respect the autonomy of the individual, cause no harm, and advance the common good.

Relevant aspects of the Australian Health care system may include knowledge of service provision arrangements, the structure of the health system, points of access and the range of roles that paramedics may play within that structure.

Key elements of fitness to practise must include competence, professionalism, including a sense of responsibility and accountability, self-awareness and professional values, sound mental health and the capacity to maintain health and wellbeing for practice.

2. Provide each patient with an appropriate level of dignity and care

• Demonstrate understanding of the influence of socio-cultural factors on patient attitudes and behaviour
• display appropriate professional behaviour in patient interactions
• provide culturally safe care for all patients
• identify and respect appropriate boundaries between patients and health professionals
• assess each situation, determine the nature and severity of the problem and apply the required knowledge and experience to provide a response that is in the best interest of the patient/s, and
• facilitating advance care planning where appropriate

Socio-cultural factors may include those related to cultural and linguistic diversity, age, gender, disability, socio-economic, geographic locations; and identifying as Aboriginal and Torres Strait Islander.

Appropriate professional behaviour must include behaviour that:

• is culturally safe for Aboriginal and Torres Strait Islander patients to access safe and responsive healthcare, free from racism
• respects socio-cultural difference, is empathetic and non-discriminatory, regardless of individuals' or groups' race, culture, religion, age, gender identity, sexuality, physical or mental state, and
• respects, and so far as possible upholds the rights, dignity, values and autonomy of every patient. This includes their role in the diagnostic and therapeutic process and in maintaining health and wellbeing.

Cultural Safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practise is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practicing behaviours and power differentials in delivering safe, accessible and responsive healthcare free from racism.

• To ensure culturally safe and respectful practice, health practitioners must:
  • Acknowledge colonisation and systemic racism, social, cultural, behavioural and economic factors which affect individual and community health
  • Acknowledge and address individual racism, their own biases, assumptions, stereotypes and prejudices and provide care that is holistic, free of bias and racism
  • Recognise the importance of self-determined decision-making, partnership and collaboration in healthcare which is driven by the individual, family and community, and
  • Foster a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander People and colleagues.

3. Assume responsibility, and accept accountability, for professional decisions

• Recognise and respond appropriately to unsafe or unprofessional practice
• integrate organisational directives, policies, procedures and guidelines with professional standards, and
• apply relevant quality frameworks and processes to practice.

4. Advocate on behalf of the patient, when appropriate within the context of the practitioner’s practice as a paramedic

• Demonstrate understanding of the principles of patient advocacy and their application to paramedicine practice, and
• recognise when it may be appropriate to intervene on the patient’s behalf

1. Communicate clearly, sensitively and effectively with patient and other relevant people

• Establish rapport with the patient to gain understanding of their issues and perspectives, and to encourage their active participation and partnership in care and/or treatment
• communicate with the patient and/or other relevant people to collect and convey information and reach agreement about the purpose of any care and treatment
• convey knowledge and procedural information in ways that engender trust and confidence, and respects patient confidentiality, privacy and dignity
• respond appropriately to patient queries or issues
• use appropriate communication skills to effectively manage avoidance, confusion and confrontation particularly with those who cannot communicate verbally or physically
• identify and effectively manage communication barriers, including anxiety and stress, specific to individual patients and/or carers
• make appropriate adjustments to communication style to suit the needs of the patient including those from culturally and linguistically diverse backgrounds and Aboriginal and Torres Strait Islander people, and
• make provisions to engage third parties, including interpreters, to facilitate effective communication with patients whose first language is not English, wherever possible.

Communication needs may be influenced by English language skills, health literacy, age, health status, culture.

Appropriate adjustments may include the paramedic demonstrating an awareness of the ways that their own culture and experience affect their interpersonal style, and having an awareness of strategies to ensure this does not present an impediment.

Communication techniques must include active listening, use of appropriate language and detail, use of appropriate verbal and non-verbal cues and language, written skills and confirming that the other person has understood.

2. Collaborate with other health practitioners

• Establish and maintain effective and respectful collaborative working relationships as a member of a healthcare team
• demonstrate an understanding of professional roles and responsibilities of healthcare team members and other service providers and how they interact with the role of a paramedic
• follow accepted protocols and procedures and guidelines to give and receive relevant and timely verbal and written communication
• effectively supervise tasks delegated to other healthcare team members
• consult effectively with relevant healthcare team members and other relevant people to facilitate continuity of care, and
• make appropriate referrals, delegations and handovers to other healthcare team members and other service providers.

Healthcare team members may include registered health practitioners, accredited health professionals, volunteers, and licensed and unlicensed healthcare workers, police, fire and other emergency service personnel.

1. Make informed and reasonable decisions

• Operate within a framework of making informed, evidence-based, reasonable and professional judgements about their practice, with acting in the best interests of their patients as their primary concern, and
• make sensible, practical and culturally safe decisions about their practice, taking account of all relevant information and the best interests of the people who use, or are affected by the service being provided.

2. Use clinical reasoning and problem-solving skills to determine clinical judgements and appropriate actions

• Apply evidence-based practice principles along with critical and reflective thinking to resolve clinical challenges
• demonstrate a logical and systematic approach to problem solving and situation analysis
• analyse and critically evaluate the information collected to make clinical judgments
• recognise that clinical judgements involve consideration of conflicting information and evidence
• formulate a diagnosis informed by the patient assessment and analysis of context and situation, and
• identify the time criticality of treatment, referral, handover and where appropriate, transport.

Critical thinking may include skills in questioning, analysing, synthesising, interpreting, and cognitive reasoning, and the critical appraisal of literature and evidence.

Reflective practice may include critical self-reflection during and after a clinical challenge or experience. It may involve structured and informal reflection to review and integrate knowledge including cuturally safe practise and findings into practice.

3. Draw on appropriate knowledge and skills in order to make professional judgements

• Select or modify approaches to meet the needs of patients, their relatives and carers, reflecting culturally safe practice when practising
• practise situational awareness to changes in risks or hazards and change their practice as needed to take account of new developments
• using appropriate resources to support professional decision-making, and 
• demonstrate a level of skill in the use of information technology appropriate to their practice.

4. Identify ongoing professional learning, development needs and opportunities

• Demonstrate an understanding of legal and professional responsibilities to undertake continuing professional development (CPD).
• Critically reflect on personal strengths and limitations to identify learning and development required to improve and adapt professional practice.
• Seek input from others to confirm professional learning and development needs.
• Plan and implement steps to address professional learning and development needs, inclusive of culturally safe practice.
• Maintain records of involvement in both formal and informal professional learning and development activities.

1. Protect and enhance patient safety

• Follow patient identification procedures to confirm the correct match of patient with intended procedure, care and/or treatment.
• Obtain valid informed consent when possible.
• Identify and manage risks associated with patient transfers.
• Ensure when patients are required to be moved it is in a considered and safe manner.
• Identify and manage risk of infection, including during aseptic procedures.

Patient identification procedures for interfacility transfer and handover of a patient consistent with best practice approaches published by bodies such as the Australian Commission on Safety and Quality in Health Care publications.

Infection prevention and control risk management: Registered paramedics must demonstrate an understanding of transmission modes of healthcare associated and community-acquired infections (host, agent and environment); established practices for preventing the transmission including effective hand hygiene; and ability to implement NHMRC infection prevention and control guidelines.

2. Maintain safety of self and others in the work environment

• Demonstrate knowledge of legal responsibilities for health and safety of self and others.
• Identify safety hazards in the workplace and apply knowledge of responsibilities for notification.
• Use dynamic risk assessment processes.
• Use appropriate personal protective clothing and equipment.

Responsibilities for notification of safety hazards may include protocols or instructions, legislation and regulations.

3. Operate effectively in an emergency care environment

• Respond to urgent and non-urgent requests for assistance in a low risk manner in accordance with relevant road safety legislation, organisational directives, policies, procedures and guidelines.
• Use appropriate transport platforms considering clinical need, time criticality and environmental considerations. 
• Cooperate with and use the support of other emergency service and rescue organisations to facilitate coordinated extrication, transfer and transport of a patient in the most effective manner.

4. Maintain records appropriately

• Record information systematically in an accessible and retrievable form.
• Keep accurate, comprehensive, logical, legible and concise records.
• Use only accepted terminology in completing patient care records. 
• Review, communicate, record and manage patient information accurately, consistent with protocols, procedures and legislative requirements for maintaining patient records.

5. Monitor and review the ongoing effectiveness of their practice and modify it accordingly

• Monitor and evaluate the quality of practice and the value of contributing to the generation of data for quality assurance and improvement programs.  
• Consider feedback from colleagues and critically reflect on their own paramedicine practice. 
• Make reasoned decisions to initiate, continue, modify or cease care or treatment, or the use of techniques or procedures, and record the decisions and reasoning appropriately.

6. Audits, reflects on and reviews practice

• Demonstrate the principles, application and need for quality control and quality assurance in paramedicine practice.  
• Demonstrate an awareness of the role of audit and review in quality management, including quality control, quality assurance culturally safe practice and the use of appropriate outcome measures.  
• Maintain an effective audit trail and work towards continual improvement.  
• Participate in quality assurance programs, where appropriate or required.
• Reflect on practice and the application of such reflection to their future practice.
• Participate in case conferences and other methods of review.

7. Participate in the mentoring, teaching and development of others

• Participate in guiding the learning of others.
• Share knowledge with colleagues.
• Support healthcare students to meet their learning objectives.
• Share knowledge and experience relating to individual/group/unit problems with colleagues.
• Contribute to orientation and ongoing education programs.
• Demonstrates a commitment to participating in and contributing to the research process.
• Display leadership and role modelling of culturally safe practice as members of the healthcare team.
• Participate, where possible, in coaching and mentoring to help and develop colleagues.
• Participate, where appropriate, in teaching others including paramedic students, those of other health and emergency services, disciplines and developing less experienced paramedics.

1. Use patient information management systems appropriately

• Demonstrate knowledge of patient information management systems.
• Understand the importance of the need for accurate and timely patient documentation.
• Understand how the patient record forms part of the patient healthcare record.
• Understand the legal requirements that pertain to completing and maintaining health records.
• Ensure correct verification and management of information.

2. Assess and monitor the patient capacity to receive care

• Identify factors or conditions that may affect the patient behaviour and/or capacity to undergo the procedure.
• Identify patients most at risk; including those with mental health issues particularly Aboriginal and Torres Strait Islander Peoples. 
• Identify contraindications and limitations arising from the patient capacity to consent or refuse to receive care; determine appropriate adjustments to procedures; and, where appropriate, communicate these to the patient.
• Perform patient assessment and interventions in accordance with legislation, registration standards, codes and guidelines, including gaining informed consent.
• Identify and respond to a patient's deteriorating condition, or inability to undergo a procedure or treatment, consistent with duty of care and statutory requirements.

Patient capacity or behaviour may include pre-existing medical and/or physical and physiological conditions and other factors that may affect their capacity to receive care which incudes culturally safe care.

3. Understand the key concepts of the bodies of knowledge which are specifically relevant to paramedicine practice

• Understand the structure, function and pathophysiology of the human body, relevant to their practice, together with knowledge of health, human growth and development, disease, disorder and dysfunction.  
• Understand the principles and applications of scientific enquiry, including the evaluation of treatment efficacy and the research process.  
• Understand the theoretical basis of and the variety of approaches to assessment and intervention.
• Demonstrate applied knowledge of human anatomy and physiology sufficient to understand the nature and effects of injury or illness and to conduct assessment and observation in order to establish patient management strategies.
• Understand psychological and social factors, including intergenerational trauma that impact and influence an individual in health and illness.
• Understand the clinical sciences underpinning paramedic practice, including physiological, pharmacological, behavioural and functional.

4. Conduct appropriate diagnostic or monitoring procedures, treatment, therapy or other actions safely

• Maintain the safety of self, patients and those involved in their care.
• Practice safely and effectively across the full range of patient presentations and circumstances.
• Arrive at a reasonable working diagnosis.
• Position for safe and effective interventions.
• Demonstrate an applied knowledge of the indications and contra-indications of using specific paramedic interventions including their modifications.
• Modify and adapt practice appropriate and inclusive to a culturally safe practice to the environment.

5. Demonstrate the requisite knowledge and skills to participate in mass casualty or major Incident situations

• Demonstrate an understanding of the public health model for response to major incidents.
• Demonstrate applied knowledge of emergency medicine for a mass casualty/major incident event.
• Maintain currency with organisational directives, policies, procedures and guidelines relating to major incidents.

6. Formulate specific and appropriate patient care and treatment actions

• Adapt practice to meet the needs of different groups distinguished by, for example, physical, psychological, environmental, cultural or socio-economic factors within their authorised scope of practice.
• Demonstrate sensitivity to the factors which shape lifestyle that may impact on the individual’s health and affect the interaction between the patient and registered paramedic.
• Utilise knowledge, reasoning and problem-solving skills to determine appropriate judgements and actions.
• Prioritise the care provided to optimise safety and health outcomes for the patient and demonstrate a logical and systematic approach to problem solving in a culturally safe framework.