Analysis of Interventions Afforded to Out-of-Hospital Cardiac Arrest (OHCA) Patients in Rural NSW: Is There a Case for Upskilling Rural Paramedics?

Abstract

It is hypothesised that in rural NSW, patients have reduced access to lifesaving Out-of-Hospital Cardiac Arrest (OHCA) interventions due to limited availability of Intensive Care Paramedics (ICPs) with advanced skills. This study comprised two components: a narrative review exploring how an Expanded Scope of Practice (ESOP) for rural paramedics may align rural healthcare needs with practice, and a retrospective Electronic Medical Record (EMR) audit quantifying rural–metropolitan differences in OHCA care.

The narrative review analysed literature from 2015–2023, focusing on paramedic scope of practice within rural contexts. Internationally, rural challenges such as restricted healthcare services are being addressed through ESOP models. Rural paramedics are adaptable to new skillsets, and ESOP implementation positively impacts rural services, clinicians and patients.

The EMR audit included OHCA cases attended by NSW Ambulance from 2015–2020. Rural vs metropolitan disparities were examined in terms of ROSC and administration rates of adrenaline (paediatric), amiodarone and intraosseous (IO) cannulation. In paediatric OHCA, no relationship was observed between geography and adrenaline administration (metropolitan 62%, rural/remote 61%) or ROSC (10% vs 15%). In adults, significant differences existed in adrenaline administration and ROSC after adrenaline. Amiodarone administration declined with increasing rurality, but ROSC did not differ. IO attempts were lower in rural/remote areas (2.5% vs 1.4%), including second-line IO use (1.4% vs 0.3%). Reduced odds of adrenaline and amiodarone administration in rural and remote areas persisted in regression analysis.

Overall, inequities exist in delivery of amiodarone and IO access in rural NSW OHCA care, likely reflecting workforce maldistribution. Expanding rural paramedic scope of practice may improve equity and patient outcomes, with further research needed in paediatric access and broader rural contexts.