The prehospital community-volunteer model has a place in rural Australia

Abstract

Objectives Australian ambulance services rely on the community-volunteer model of prehospital care in many rural areas. The aim of this study was to conceptually describe the model as it operates in rural settings. Methods Soft Systems Methodology (SSM) was used to describe and critically appraise an abstract prehospital community-volunteer model within the context of rural Australia. The philosophical starting point was that local prehospital services should be self-reliant and autonomous. SSM was used to structure the elements of prehospital systems and the relationships between them into metaphors and pictures for analysis. Results The major characteristic of the prehospital community-volunteer model is the relatively uncomplicated processes used to deliver services. Key elements are a knowledgeable and empowered community, a dispatch system with local knowledge, adequate physical resources to meet community expectations, a volunteer-based staffing system, and direct communication with local health professionals. Culturally, the community-volunteer model has a very strong rural character, with opportunity for health professional, emergency worker and local community member involvement. This may be as a volunteer ambulance officer or as a participant in the local governance of the service. Conclusions The prehospital community-volunteer model is a strong and resilient model in communities where the relationship between the ambulance service and the community is based on a socially constructed framework. Advanced technology, rules, systems, procedures and policies are unable to sustain a community-volunteer ambulance service. In contrast to other models, it is held together through stories of the past, rituals and myths. Prehospital community-volunteer models will continue to be important providers of prehospital services in rural Australia. Successful community-volunteer ambulance services need to be integrated into a local urgent care system.