History and Evolution of Paramedic Practice in Australia In the years back people who lived in remote and rural areas had no means of transportation except for animals which they were relying on when they were traveling. Having a look at Australia’s vast land mass and less population density, it becomes apparent how difficult and sluggish it was to transport a sick or seriously injured person to a medical facility located hundreds of kilometers away with unpredicted road and weather conditions. There was a need to overcome this problem and explore ways to help people with health problems and injuries. In the late 1800s, groups of public-spirited people who were interested in providing first aid for their people and neighborhood established the foundation of today’s ambulance services in Australia, these services were of primary first aid, and the providers had limited understanding and training. St John Ambulance was one of the first-aid providers at that time, and it had a substantial influence on the formation of these groups (Curtis, K. & Ramsden, C. 2016). As there were more people with first-aid qualifications, who were looking to apply and maintain their skills in providing first aid resulted in the creation of St John Ambulance Brigades (Curtis, K. & Ramsden, C. 2016). The main job of the ambulance services in the early days was the transportation of the sick and injured to the nearest medical facility where it was medical doctor’s responsibility to provide medical care and were often assisted by nurses. Government administrations, hospitals, and community-based groups were arranging transportation services alongside St John Ambulance (Curtis, K. & Ramsden, C. 2016). Many of the ambulance services in Australia started to operate in the late 19th century as the population increased and cities expanded. Each territory and state founded ambulance services of its own which over the years changed into nowadays advanced ambulance services that run in the Australian States and Territories. For instance, the first ambulance services started in New South Wales was in 1881 which was formed by the NSW Government Board of Health. The primary goal of the ambulance service was to transport patients with infectious diseases to the hospital. The state did not have organized services up until 1895, and many independent organizations were also providing ambulance services. In 1895 Civil Ambulance and Transport Brigade of New South Wales was founded which later in 1904 integrated with St John Ambulance Brigade and formed Civil Ambulance and Transport Corps (CATC), eventually evolving to Ambulance Services of New South Wales that operates nowadays (Moritz, 2018). Ambulance services in Queensland began in the late 1800s after the accident happened at the Brisbane Showgrounds in 1892. A man sustained a fracture in his leg after falling off his horse. He was taken to hospital in the back of a horse-drawn vehicle “Molly Brown Cab” to the nearest hospital. As a result of the bumpy ride and lack of professional medical assistance, his leg’s simple fracture turned into a compound fracture. As a result, a member of Ambulance Corps of the Queensland Defense Force who was at the scene noticed that patients need extra care while handling and started the first Queensland Ambulance campaign to deliver first aid training (Moritz, 2018). City Ambulance Transport Brigade (CATB) began as Queensland’s first self-governing center with stretcher-bearers to transport patients to hospitals. In 1902 the City Ambulance Transport Brigade expanded their operations to regional areas with multiple autonomous centers, and eventually, the name changed to Queensland Ambulance Transport Brigade (QATB). The brigades were independent throughout Queensland until ambulance legislation amalgamated all the centers and created a single ambulance service under the name of Queensland Ambulance Services (Moritz, 2018). Ambulance services in Victoria begun in 1883 after a public meeting in Melbourne decided to form a branch of St John Ambulance Association. In 1887 St John Ambulance raised enough funds to buy six Ashford litters (it was a stretcher attached to wheels), and by 1910 they had their first motor vehicle. In 1916 St John Ambulance separated their activities, and Victorian Civil Ambulance Services (VCAS) founded, it was dependent only on public donations. In the year 1946, all ambulance vehicles fitted with on way radio transmitters, and a few years later it changed to two-way radios. VCAS played a leading role in the worst disaster hitting Melbourne in 1970 when the Westgate Bridge collapsed. A breakthrough in ambulance services came in 1971 by introducing Mobile Intensive Care Ambulance (MICA) in Victoria (Ambulance Victoria Museum, 2019). In July 2008 all the ambulance services integrated and a single ambulance service under the name of Ambulance Victoria got established (Curtis, K. & Ramsden, C. 2016). Other states and territories also evolved following the same transition from a simple start to well-organized ambulance services. For example, in South Australia private groups such as St John Ambulance Brigade and South Australian Police Force established uncoordinated ambulance services in the state. In 1952, St John Ambulance Brigade became responsible for coordinating the services throughout the state. The modern-day ambulance services under the name of South Australian Ambulance Services (SAAS) is now delivering the services state-wide (Moritz, 2018). Ambulance services in Western Australia were at the beginning provided by fire brigades and police. The first ambulance service commenced in 1903 with a horse-drawn van by the Perth metropolitan fire brigade. A year later ambulance services started to expand to industrial workplaces. As the load of work was rising due to providing ambulance services, fire brigade decreased their involvement in ambulance services. In 1922, St John Ambulance took the formal responsibility of Perth metropolitan ambulance services and remains the provider of Ambulance services till now (Curtis, K. & Ramsden, C. 2016). Australian Capital Territory and Tasmania commenced ambulance services in 1915. Ambulance services in ACT begun as the construction of Australia’s capital started. In 1955 Canberra Ambulance Service established and the name shortly after changed to ACT Ambulance Service. Tasmania did not have coordinated ambulance services, and local boards were acting independently without coordination. St John Ambulance took control of ambulance services in the 1950s, and within two years they covered two-thirds of the state with their services. In 1965, St John Ambulance revoked to supervise ambulance services, and thus Tasmanian Ambulance Service came into existence (Curtis, K. & Ramsden, C. 2016). In studying the evolution and development of ambulance services in Australia, one should not overlook the importance of air ambulance services. To deliver pre-hospital care for patients living in remote regional areas aerial medical service remains the feasible way of delivering such services. Australia’s air ambulance services founder is Reverend John Flynn whose aim was to help people of the outback where a next-door neighbor might be as far as a hundred of kilometers away (Curtis, K & Ramsden, C. 2016), and provide a “mantle of safety” for them (Royal Flying Doctor Service). On the 17th of May 1928, the first flight took place in a leased Qantas plane from Queensland (Royal Flying Doctor Service). The services extended to other states as success became evident. Besides the services provided by the Royal Flying Doctor Service (RFDS) for the regional areas, ambulance services utilize from helicopters for the quick transport of trauma patients to relevant hospitals and for the retrieval of those patient with the need of more intensive and specialized care to tertiary hospitals (Curtis, K & Ramsden, C. 2016). Analyzing the history of ambulance services – as to where it was a simple start and just transporting the patient to the nearest medical facility evolving to the advanced pre-hospital care, it becomes evident that the mode of transport had an essential role in the evolution. Moreover, as advancements happened in the modes of transportation, the scope of practice expanded as well, and it did not remain just simple first aid and transport to the hospital. The scope of practice evolved from bearing a stretcher on shoulders to performing some clinical interventions in a pre-hospital environment. Paramedicine transitioned from occupation to profession (Moritz, 2018).