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Extended Care Paramedic 

What is it

ECP is a program delivered by Ambulance NSW that increases the clinical role of a small group of selected paramedics in: 

  • patient assessment
  • recognition and management of minor illness and minor injury presentations
  • the provision of definitive care
  • referral to community-based health services for a range of presentations.

How it works

ECPs are dispatched to emergency calls to undertake specific assessment and care management. Their scope of practice is guided by predetermined care pathways that are in addition to SC ambulance protocols. 

Clinical roles include:

  • replacement of catheters in emergency situations
  • provision of initial wound assessment and care (dressings/sutures) 
  • replacement of percutaneous endoscopic gastrostomy tubes
  • provision of falls screening and assessment for referral purposes
  • provision of aged care screening and assessment for referral purposes
  • commencement of pharmacotherapy administration.
Education and clinical practice for ECPs is undertaken at the Nepean Clinical School and Nepean Hospital, specific training and telephone support by geriatricians is provided to these paramedics in relation to:
  • clinical management
  • dementia and delirium
  • pharmacy – effectiveness and adversity in the elderly
  • falls in the elderly.

Resourcing

ECP are experienced paramedics that undergo specialised training. They operate out of a small single response vehicle. The ECP program has been both internally and externally evaluated. The cost effectiveness is realised through:

  • salary of a single paramedic response rather than a double crew
  • vehicle savings (ECP vehicles are less expensive to set up and lease as well as lower ongoing running costs)
  • a higher non-transport rate: an ECP average non-transport rate of 39.5% compared to SC 14%, and a regional ECP non-transport rate is 40–54%
  • reduced average case cycle time (CST) 60 minutes (10-20 mins less than average non ECP vehicle) due to non-transport.

Success factors

  • Support of a senior aged health decision-maker such as a geriatrician
  • Paramedics with good clinical skills 
  • Strong relationship with Residential Aged Care Facilities including through educating them on the model
  • Strong communication links with Emergency Department regarding those that require admission and opportunities to bypass ED.

Models in Operation

The dedicated ECP modules are located in Illawarra, across Sydney, Central Coast and Hunter.

Part of a double crew – The ECPs working as part of a double crew are located across the state at Murwillumbah, Port Macquarie, Tweed Heads, Leeton, Cootamundra, Armidale, Shoalhaven, Wagga Wagga and a number of metropolitan locations.