Mod 1 lecture 2- Modern Period of Paramedicine Notes

The Vietnam War significantly advanced pre-hospital medicine.
- Use of IV fluid replacements.
- Advanced wound care techniques.
- Trauma surgery procedures.
Shift in approach:
- Korean War (early 1950s) - minimal en-route care.
- Vietnam War (late 1960s) - clinicians provided care during transport via helicopter.
Paradigm shift from simple patient retrieval to en-route clinical care.

Military medicine advancements influenced civilian ambulance services.
Key reports in the late 1960s:
- 1966 White Paper (US): "Accidental Death and Disability of the Neglected Disease of Modern Society." Highlighted high motor vehicle accident death rates due to lack of safety measures (seat belts, airbags).
  - Death rates were approximately 10 times higher than current rates despite fewer cars.
- The Miller Report (UK): Focused on ambulance service provision, paramedic training, and equipment.
- 1969 Symposium (Australia): Royal Australasian College of Surgeons, AMA, and Medical Association of New Zealand advocated for ambulance reforms to reduce mortality and morbidity.

Resuscitation medicine was emerging.
- CPR invented in 1960.
- Mouth-to-mouth resuscitation invented in 1957.
- Advances in anaesthesia and defibrillation.
Early innovators explored applying these techniques outside hospitals.
- 1966 - Belfast: Professor Frank Pantridge created the cardiac ambulance with doctors and nurses providing in-hospital level resuscitation.
  - Early defibrillators were large (refrigerator-sized).
- 1969 - Perth: Similar trials with positive results.
Cardiac arrest survival rates were near zero before the late 1960s.
Community CPR gained traction in the 1970s.

Development from trauma and cardiac care advancements.
Training ambulance officers in advanced medical skills.
Rationale: Doctor shortages, delays in ward-based response, cost-effectiveness.
First paramedic program: Freedom House experiment in a low socioeconomic black community in Pittsburgh.
- Empowering underserved communities through training.
- Key figures: Dr. Nancy Caroline and Dr. Peter Safar (inventor of mouth-to-mouth resuscitation in 1957).
Los Angeles County Rescue Hire Unit: First paramedic vehicle carrying specialized equipment.
- Inspired the TV show "Emergency" (1973).
Other early programs: Medic One (Seattle), North Carolina.

1971: Introduction of the Mobile Intensive Care Ambulance (MICA) program in Victoria.
- Initially staffed with doctors and paramedics, transitioned to fully paramedic-staffed in 1973.
1976: New South Wales Intensive Care Paramedic program.
Early paramedics faced challenges of identity, class, and status.
Early equipment included the LifePak 5 defibrillator and Haemocell (early blood replacement fluid).

Early services were often community-based (district services in NSW).
Amalgamation into larger state ambulance services:
- NSW amalgamated in 1977.
- Queensland in 1991.
- Victoria in 2008.
- South Australia: Evolved from a mix of services to St John, then a non-profit, and finally a government service in 2008.
- Tasmania: St John and other services transitioned to government control in 1982.
- Northern Territory and Western Australia: Still partly operated by St John.
- ACT: Fire brigade, then Canberra Ambulance Service (1955), integrated into government in 1990.
Standardization benefits: Uniform training, equipment, purchasing power, and better resourcing.

Formal training for ambulance workers began in the 1960s.
1961: Victoria and NSW established training schools.
1994: Charles Sturt University (CSU) introduced the first paramedic degree (conversion degree for existing paramedics).
1998: CSU transitioned to a pre-employment degree.
Shift from vocational entry to university-based education.
Development of paramedic academics (researchers, educators).

Two phases of paramedicine:
- Late 1960s to early 1990s: Establishing paramedics as standalone health practitioners.
- Since the 1990s: Focus on innovation and advanced practice.
Key innovations: Bachelor's degrees, referral pathways, telehealth, thrombolysis (clot-busting drugs), 12-lead ECGs, stroke services (CT scanners in ambulances), critical care paramedics, extended care paramedics, community paramedics, primary care paramedics, and academic paramedicine.
2018: Paramedics became a nationally regulated health profession in Australia, followed by New Zealand.
UK paramedics have been regulated since 2000.
Canadian provinces are moving towards similar regulation as Australia.

Potential technologies: Ambulance drones, telehealth, big data, connectivity, AI.
Increased autonomy and decision-making capabilities for paramedics.
Emphasis on research and evidence-based practice.
Moving towards accessing information and using AI tools for decision-making.
The tutorial on Monday will discuss these future issues further.