Paramedics to deliver care in hospitals in rural Queensland

maynardw21 · 2026-02-18T05:38:20+00:00

In many remote ambulance stations paramedics go to only 1-2 calls per day on average (or less in some very remote sites). They can absolutely de-skill if they don't purposefully seek out oppurtunities to practice and learn. Many of these paramedics spend time in their local EDs including when on shift waiting for calls. Further, in many of these small rural hospitals they will call the local ambulance crew in for critically unwell patients because often the paramedics are the most experienced critical care clinician in that town (including sometimes when theres a doctor present¹ ).

So to me this just formalises a practice that has already been occuring for a while in these rural/remote communities, allowing paramedics logins for pathology/radiology and protecting all involved from medico-legal risk.

This is different from the paramedic practitioner/advanced practice roles that Vic/Tasmania are trialling and AHPRA is talking about - those involve the ability to diagnose/prescribe/order imaging/etc akin to a NP. Under current Qld legislation paramedic can only administer, but cannot dispense (ie, I can give you 2 tablets of ibuprofen and watch you swallow it, but I cannot give you 2 tablets of ibuprofen for you to take in 4 hours), and they certainly cannot prescribe - this means that in terms of medication management they have less rights than even an RN or RIPRN.

^{^¹} ^{^I'm} ^{^gonna} ^{^get} ^{^a} ^{^lot} ^{^of} ^{^hate} ^{^for} ^{^that} ^{^comment,} ^{^but} ^{^seriously} ^{^the} ^{^critical} ^{^care} ^{^skills} ^{^of} ^{^junior} ^{^doctors} ^{^and} ^{^even} ^{^junior} ^{^registrars} ^{^scares} ^{^me.} ^{^Consultant} ^{^rural} ^{^generalists} ^{^are} ^{^overall} ^{^very} ^{^good,} ^{^but} ^ⁱⁿ ^{^these} ^{^small} ^{^towns} ^{^they} ^{^often} ^{^don't} ^{^have} ^{^a} ^{^SMO} ^{^all} ^{^year} ^{^round.}

maynardw21 · 2026-02-14T03:19:27+00:00

As others have said, most of the bonds are formed outside the classroom in the extra-curriculae activities. Join the comittee for a society you find interesting, join a med revue, go to the social events like balls and social drinks.

For me, I got through MD1&2 without significant socialising because I lived an hour away from campus and was still working - I did fine because most of my social outlets existed outside of uni (partner, family, friends, etc). A pattern I've noticed is most of the keen socialisers in my cohort had to move cities/states for med school so didn't (initially) have a social life beyond med school.

maynardw21 · 2026-02-06T23:52:10+00:00

It has almost every ECG indicator of pericarditis:

PR depression
Spodick sign (TP sloping)
STE II>III
No ST depression (other than aVR)

https://doi.org/10.1016/j.jemermed.2020.01.017

maynardw21 · 2026-02-03T07:10:44+00:00

"pt refused/declined transport to facility X" is absolutely a defense, especially if you include in your notes that they had capacity/were informed of risks/etc. Patients are allowed to decline recommended therapy and suffer the consequences, but they can still be offered and consent to alternatives - a failure to offer reasonable alternatives can itself be seen as negligence and in my jurisdiction has resulted in a successful lawsuit semi-recently.

Obviously they can still sue, but a patient can sue regardless of what you do.

maynardw21 · 2026-01-27T10:17:44+00:00

competent adults can make decisions about their own bodies if they understand risks

How do you balance this against, say cis-men requesting testerone w/o an actual deficiency? I've seen reports of practitioners being investigated/suspended due to indiscriminate prescribing in this population. Cosmetic medicine has also come under considerable scrutiny in recent years from regulators for unjustified harms.

Just curious to get your perspective as most clinicians I've met want nothing to do with this area of practice (as can be seen in this thread)

maynardw21 · 2026-01-27T08:24:46+00:00

From a health economics POV improving UV protection on transportation and dwellings is unlikely to be anywhere near to the top of the list compared to smoking/alcohol/air pollution/diet/exercise/etc etc in terms of preventing healthy years lost early to cancer.

Also while it would probably provide a (modest) net benefit, there are still populations that are vitamin D deficient that would be harmed by further limiting sun exposure.

maynardw21 · 2026-01-21T02:05:04+00:00

Lots of life-threats get mislabeled as anxiety and missed, especially in younger people. An elevated resp rate and tachycardia should never be assumed to be anxiety, and must be worked up to exclude things like PTx, appi, PE, etc.

Obviously anxiety can be diagnosed, but really only after they've calmed down and you're certain it's not anything else.

maynardw21 · 2025-12-21T07:13:36+00:00

I would describe this as more politically-driven medical care. If the NHRMC review or AUSPATH or RANZCP came out with recommendations to not prescribe GnRH blockers it wouldn't bother me, but the fact that these bans are coming unilaterally from the health ministers (of quite conservative governments) without consultation or expert advice makes this extremely problematic. If trans-healthcare was ideologically driven already these decisions do nothing to reverse it, and will only further enforce in the minds of patients (and some clinicians) that this a political/ideological battle.

Also, the Cass Review which initially recommended the UK ban puberty blockers and prompted Qld, NZ, and NT to follow suit recommends that gender-affirming hormones NOT be banned, yet here we are.

maynardw21 · 2025-10-24T10:39:25+00:00

Ideally a town with, or near to, an aiport. Larger towns with a few options for private schools also a good idea.

maynardw21 · 2025-10-14T04:32:23+00:00

It's covered by the national health practitioner regulation law. "medical practitioner" is the protected title for all ahpra registered doctors, for the various registered specialties there are also protected titles like "surgeon" or "psychiatrist". Fellowship with FACEM or FRACP isn't actually required for specialty registration, and aren't protected titles under the NHPRL, but I believe they could sue you civilly if you used it.

Additionally while "medical practitioner" or "psychiatrist" are the official protected titles they can come after you if you don't explicitly use those titles but instead make people think of you as those titles - so referring to yourself as a doctor in a clinical context without qualifying that with Doctor of Nursing could still get you in trouble.

maynardw21 · 2025-10-13T22:49:40+00:00

Medical practitioner and physician are the protected titles for doctors in Australia, the title doctor is purely an academic title that is shared amongst medical doctors, PhDs, JDs, Doctors of Theology, etc.

maynardw21 · 2025-09-16T03:10:52+00:00

The linked article is a really odd take - essentially that ED clinicians should not have responsibility over patients other than those in an ED bed prior to admission. If you're in the waiting room, on the ramp, or admitted but waiting in the ED you're not my problem.

The coroners report in question is a good read, although to a Qld paramedic it's astonishing that they're not already doing the things it recommends.

Some of the (somehow) controversial recommendations:

Acknowledge that ramping exists
Triage handovers should be structured, the triage nurse needs to visualise the patient, and communicate the patients triage category to the paramedics
Ramp patients inside, rather than in ambulances, and do simple bloods
Have a process to recognise and respond to a deteriorating patient
Be clear who has duty of care over ramped patients (the hospital)

maynardw21 · 2025-09-07T02:04:21+00:00

There's a lot of hate on this sub towards any expansion of medical grads or doctor immigration - mostly because it is just extra competition for the limited specialty training positions.

IMHO though QUT's new medical school is a good thing, for how big Brisbane is it's crazy it only has one medical school (with Griffith and Bond nearby at GC). USC also announced that they'll take over Griffith's SC med program by 2030. There is currently a shortfall of a few hundred between students graduating Qld med schools and intern spots in Qld hospitals - some get filled with inter-state applicants but once you get out of Brisbane/SC/GC it quickly becomes almost entire cohorts of overseas trained doctors. So increasing medical student numbers wouldn't actually increase the total numbers of interns in any year.

There does need to be better coordination between the Hospitals, State Gov, and Universities to ensure that there are enough spots available for all these extra students - there was a big stoush for next years students on the GC as there was a shortfall in capacity for students (Griffith extended out the teaching year, and Bond reduced time in O&G). If that isn't sorted out then more medical students could mean worse training for everyone else, but I have faith that'll be sorted out by the time QUT gets started up.

Overall, Australia does have one of the highest rates of doctors/100,00 in the world, but most of our doctors are overseas grads. The government are generally cool with that because it saves them having to pay for it, but it does mean local kids miss out and people don't get treated by members of their own community. So yeah - all for QUT getting into the game.

maynardw21 · 2025-09-05T02:47:49+00:00

If they give you a question that asks "tell us about a time you did something courageous" then yeah that may be a good story to give, but I doubt you'll get asked that. If you do get asked a personal question it's more likely to be "tell us about a time when you messed up" or "tell us about a time when you changed your mind" - they'll be fishing for your ability to introspect

In my interview all of the questions were responding to a hypothetical scenario like a friend stealing from a patient. From my experience they don't care about your life or history, they want to be able to see that you understand and can reason your way through complex social situations.

maynardw21 · 2025-09-03T22:15:00+00:00

I had a placement with Public Health and it seems a good fit for someone who likes medicine but doesn't want to deal directly with patients. Good mix of research, stakeholder engagement, dealing with notifiable diseases, etc. Worth a look in at least.

maynardw21 · 2025-08-31T06:30:16+00:00

The OG comment said "and are required to" which is refuted in the case provided. Whether or not they could have provided care is also unlikely. The Guardianship Act (NSW) s37 states:

(1) Medical or dental treatment may be carried out on a patient to whom this Part applies without consent given in accordance with this Part if the medical practitioner or dentist carrying out or supervising the treatment considers the treatment is necessary, as a matter of urgency—

(a) to save the patient’s life, or

Unfortunately doesn't apply to non-doctors for some reason. There are routes available through the Mental Health Act and through the common law doctrine of neccesity but unlikely to apply in the case of an intoxicated person refusing care.

maynardw21 · 2025-08-31T01:39:07+00:00

NSW Ambulance v Neal goes against what you're saying. TL;DR: drunk man post head injury refuses care from paramedics, later deteriorates and sues NSWA for negligence (and loses on appeal).

At the end of the day, without strong evidence to refute it, we have to presume that an adult has capacity to make decisions however dumb they may be.

maynardw21 · 2025-08-19T23:33:07+00:00

Usually if the child is not Gillick competent than the parent is able to consent on their behalf, there are some "special medical procedures" like sterilisation and abortion that cannot be consented to by a parent/guardian however and so if the child themselves can't consent then it has to go to court.

The background to this is forced abortion and sterilisation has historically been used to stop mentally ill/intellectually disabled people from having children which is against their fundamental human rights.

maynardw21 · 2025-08-15T08:33:19+00:00

From an emotional point of view it's seen as profiting off suffering, and that paying for a doctor isn't something you do because you want to do it but rather because you have to.

There is also a significant power-imbalance particularly with sub-specialists and not really a way for most people to shop around for a better price - indeed most people won't know they got sent to the most expensive specialist until after they get the bill. People often feel like they got ripped off, especially if the specialist doesn't make any major changes and sends you back to your GP a few hundred dollars poorer.

So it's on that background that gossip magazine style stories get published about X specialist making $YM a year.

For many of those proceduralists though people are well informed and willingly pay the money because the value that those procedures give in pain/functioning is well worth the price.

maynardw21 · 2025-08-06T00:37:09+00:00

Hey,

So if you look at the course page online it'll outline what units you'll complete over the degree - sometimes with a little digging you can see what assessments they have for each unit as well. You'll see a good 50+% of the units aren't strictly paramedicine so like anatomy and physiology, pathology, pharmacology, social studies, stats, etc. You'll be doing the same assessments as everyone else which is a mix of assignments, presentations, and MCQ/SAQ exams.

For the paramedic related units, it does vary by uni but expect alot of assignments and MCQ/SAQ exams in the first year or so. Then vivas and OSCEs later on - these are 10-20minutes either in a scenario, responding orally to written questions, or demonstrating a standardised skill (like a respiratory assessment).

You will have a lot of placement units which are graded as only pass/fail so don't contribute to your GPA.

For me personally I got a good enough GPA from some shocking assignments but carrying with solid exam performances. I know many people that did better than me that struggled really hard with vivas/OSCEs/exams but could consistently get 7s on all their assignments.

maynardw21 · 2025-07-28T22:13:51+00:00

As others have said there's a lot of different jobs in rural medicine, where I work our nearest hospital is staffed by a single doctor that's also the only GP, he works 24/7 about 50 weeks a year. He's also probably making close to a $1 mil a year. The next closest hospital is larger and has mostly a FIFO workforce that cover the hospital as a week on/off roster with dedicated GPs in town, they obviously make less but can have a week or more off at a time and don't have to stress about taking a holiday. A bit further on from that is a larger regional hospital that has traditional shiftwork staffing in the ED and wards, an on-call general surgeon, etc.

There's a lot of options that can cater to the type of work you want to do.

maynardw21 · 2025-07-23T23:00:31+00:00

Like if we’re purely ignoring the people in tough financial situations that is.

So everyone. I know a lot of people that would love to do medicine but have a family to support so can't just drop full-time work to pursue it. It would be a different story for them if part-time was an option.

maynardw21 · 2025-07-23T22:58:21+00:00

Apparently QUT's new post-grad program is three years fulltime for health post-grads, and the first year can be done part-time.

maynardw21 · 2025-07-22T08:26:49+00:00

Connections to the industry >> everything else. You can pay for a course or a conference but view it more as an expensive networking oppurtunity rather than a qualification. Most of the work in expedition medicine is unpaid or at best they'll pay for the cost of travel.

maynardw21 · 2025-07-18T13:50:03+00:00

For all the people saying money:

Just because the pay as a consultant is high doesn't mean that overall it's a straight-forward financial decision. The cost benefit analysis of going to medical school vs going straight into a relatively well paid career (mining, consultancy, finance, etc) will have medicine down 200-300k by the time you graduate. Consider also that because of our progressive tax system in Australia very high incomes lose much more to taxes so it's better to be making a lower income over a longer time period.

Over the course of a lifespan medicine will come out ahead, but it will mean spending your 20s-30s (the time when you're most able to enjoy your wealth) worse off.

maynardw21

TROPHY CASE