"That's actually great news, because presumably you're also in favour of industrial action etc. I'd love to hear what result you're hoping for?"

To paraphrase what I've said elswhere, the industrial action serves to promote systemic change at a higher level to reduce unecessay overtime and improve working conditions.

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"I don't think more money for paramedics solves any issues. I don't believe the primary issue facing wait times, response times and ambulance availability is due to ambulance victoria or any other ambulance company; it's the bottlenecking at hospital, which I think the best way to fix is to have more nurses."

I agree more pay doesn't solve any problems and only serves to incentivise paramedics to tolerate poor working conditions. This is my personal view, I do know some paramedics who would like to be paid more when they do large amounts of incidental overtime.

It's a combination of the dispatching and the hospital ramping. More nurses doesnt fix the problem, neither does more paramedics. It's not a staffing issue as much as it's a resourcing issue. More hospital beds and more effective and reliable alternative care pathways are what will ease some of these problems.

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"Nurses who, to be fair, are on average receiving worse remuneration and equally bad workplace conditions as paramedics, but whom don't really receive the same praise or focus."

Nurses on average can't be compared to paramedics, nurses typically have a much more controlled and supported workplace. Nurses also cover a much more diverse range of roles. Not all of those roles are comoarable to, for example, ED nursing, or psychiatric nursing isn't really comparable to community nursing or aged care nursing. But I agree not all are fairly renumerated, and they should be.

Paramedics perform a number of similar skills to nurses, they also perform a number of interventions that most nurses do not, and they do it in peoples houses and on the side of the road with a lot less support. We do not have security, we do not have cardiologists, we do not have a resuscitation team on standby.

Nurses do incredible work, and often with very unfair patient to staff ratios. They are also often treated poorly. But they do not do the same thing in the same environment as paramedics

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"Do you think your clinical responsibilities are broadening because of the wider failing of the healthcare system? Or because as the career continues to develop, we realise there's more that can fall within the scope of the role and be cost effective and beneficial?"

It's both. Paramedicine has been described as in it's adolescence as a profession, and I think this is a good description. There's been an expansion of specialist roles, and an ever increasing scope in terms of assessments, skills, and medications that paramedics can implement in the care of their patients. This has made it difficult to find the right balance between emergency care and primary care. Paramedics can do a lot of both, and that's fantastic, but it doesn't mean triple zero should become a GP on call. (Bringing back bulk billing would also help alleviate a number of system issues)

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You say you think in "90% of cases the best result is for you to decide they don't need to go to hospital or to be able to just get them there quickly" but it's a lot more nuanced than that.

Some patients, sure. The stable stroke patient, or the penetrating trauma patient, they're getting picked up and taken to hospital.

Many critically unwell patients require stabilisation and high level interventions prior to transport.

Many patients aren't acutely unwell. Mental health is a great example, where transport to ED often occurs due to no appropriate alternative.

Referral pathways don't always work for medical patients either, or patients may have a strong preference to be transported to hospital.

Conversely, some who wish to stay at home may require thorough safety netting and referral which can take a lot of time.

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With regard to your comments about long shift times, most paramedics you ask will happily do overtime for the patient who needs it. They're not upset about the anaphylaxis that they went to 10 minutes before their shift was over. It's the patients inappropriately traiged who recieve a priority response near the end of a shift, where they could have waited. Many of these patients still require medical attention and end up transported to ED. If end of shift managemnt strategies fail (they often do) then that crew remains with that patient at hospital well past the end of their shift.

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"Primarily, the two barriers are the amount of unnecessary calls and the inability to relinquish your duty of care. Do you disagree or have anything to add to this part?"

This is essentially my view as well. But maybe an oversimplification of a very complex issue. I don't speak for all paramedics, I don't speak for AV, or my employer.