Preamble

As paramedics, we are often called upon to assess and manage patients with chronic or low acuity conditions that do not require immediate emergency-level interventions but still necessitate medical attention. Many of these conditions can be effectively managed in the community by paramedics with a primary healthcare focus thus reducing unnecessary hospital admissions and promoting better long-term outcomes for patients. This case report will focus on differentiating between common chronic and low acuity diseases, utilising pathophysiology, epidemiology, risk factors and signs and symptoms, and integrating diagnostic findings to formulate a working diagnosis.

Task Description

Introduction to the Case

• Provide a brief introduction to a clinical case involving a chronic or low acuity condition relating the body systems in Module 1, Module 2 or Module 4 that you have attended as a paramedic, including the patient's background and the context involved.

Patient’s Initial Presentation and Assessment

• Describe the patient’s initial presentation, including relevant patient history (e.g., previous medical history, family history, lifestyle factors)
• Discuss the clinical assessments performed, focusing on signs and symptoms that align with the suspected chronic or low acuity conditions
• Include any relevant diagnostic findings (e.g., vital signs, blood glucose levels, oxygen saturation, or ECG) that informed your assessment.

Differentiating Chronic and Low Acuity Diseases

• Provide a list of possible differential diagnoses for this patient. For each differential diagnosis, examine its pathophysiology, epidemiology, and risk factors
• Critically evaluate how this patient’s clinical presentation, risk factors, and symptoms support or rule out each differential diagnosis.

Formulation of a Working Diagnosis

• Based on the patient’s history, assessment, and diagnostic findings, present your working diagnosis
• Justify your diagnosis with reference to the pathophysiology and epidemiology of the disease, linking this to the patient’s clinical presentation and risk factors
• Discuss the role of clinical reasoning in forming a working diagnosis and reflect on how this diagnosis could evolve with additional data or as the patient’s condition progresses.

Revised Assessment and Diagnostic Plan

• Propose a revised assessment plan that a paramedic with a primary healthcare focus could undertake for this clinical case
• Consider the role of additional diagnostic tests (e.g., iStat, advanced clinical assessment or referral for imaging) or follow-up assessments to clarify the diagnosis
• Reflect on how these further diagnostic findings could strengthen or refine the current working diagnosis. How would this improve the overall management approach for this patient?

Level of GenAI use allowed:

Level 2: You may use Al for planning, idea development, and research. Your final submission should show how you have developed and refined these ideas.

The case report will be assessed in accordance with the rubric and information provided on the unit’s Moodle site.

The following criteria are key points to be included:

• The written assessment should be presented in an essay format
• The written assessment must address each of the main topic tasks as detailed in the task description
• Avoid superficial points or comments and be clear and concise
• Ensure all guidelines and research are relevant and well-integrated into your argument
• As this is a written assessment, you must include in-text referencing and a reference list.

The required word count is 3000 words (+/-10%)

The case report is worth 40% of your overall unit mark.

You will create a recorded presentation of a clinical case involving a patient with a chronic or low-acuity disease from Module 5, Module 6 or Module 7 that you have managed as a paramedic. This assessment aims to evaluate your ability to integrate diagnostic findings, formulate a working diagnosis, and employ evidence-based approaches in managing primary care conditions.

Your recorded presentation should include the following elements:

Introduction to the Case 

• Provide a concise yet engaging introduction to the case
• Include relevant background details such as patient demographics, pertinent medical history, and presenting complaint.

Patient Presentation and Initial Assessment 

• Describe the patient's initial symptoms and clinical presentation in detail
• Outline a comprehensive patient history, including past medical history, medications, allergies, and relevant lifestyle factors
• Present a thorough physical assessment, including vital signs, general appearance, and focused examination results
• Demonstrate advanced clinical reasoning in your approach to the assessment.

Working Diagnosis with Supporting Evidence 

• Present a logical and well-supported working diagnosis based on the patient's symptoms, history, and assessment
• Justify the diagnosis using clinical guidelines, pathophysiological mechanisms, and diagnostic criteria
• Use evidence and logical deductions to support your diagnostic reasoning.

On-scene and En-route Management 

• Critically evaluate the treatment and interventions provided on scene and during transport
• Discuss the rationale behind your clinical decisions, including symptom management, medication administration, and non-pharmacological interventions
• Evaluate the effectiveness of your management and any challenges encountered.

Revised Assessment Plan and Further Diagnostic Considerations

• Discuss a comprehensive revised approach to the patient's assessment, incorporating additional diagnostic tools or methods suitable for a primary healthcare setting
• Consider point-of-care testing, community-based follow-up, or alternative diagnostic pathways that could improve patient care
• Support your discussion with high-quality evidence and guidelines
• Demonstrate analytical thinking in your approach to further assessment and diagnostics.

Clinical Management Plan with a Primary Healthcare Focus

• Present a new detailed, patient-centered management plan tailored to the patient's chronic or low-acuity condition
• Justify your management decisions with evidence-based guidelines and primary care management protocols
• Highlight non-emergency interventions such as lifestyle modifications, medication adjustments, and referral pathways
• Demonstrate high-level critical analysis of interventions and potential outcomes.

Level of GenAI use allowed:

Level 2: You may use Al for planning, idea development, and research. Your final submission should show how you have developed and refined these ideas.

The presentation will be assessed in accordance with the rubric and information provided on the unit’s Moodle site.

The following criteria are key points to be included:

• The presentation should be in a PowerPoint format. An alternative may be approved after consultation with the Unit Coordinator.  
• Recorded narration is required and you can use the Notes section to detail your thinking
• The presentation must address each of the main topic tasks as detailed in the task description
• Avoid superficial points or comments
• Ensure your presentation is highly engaging, logically structured, and professional
• Use advanced communication techniques and effective visual aids to enhance your presentation. These must be referenced
• Maintain a clear and coherent flow of information throughout the presentation
• Demonstrate critical appraisal and synthesis of research in supporting your clinical decisions
• Ensure all guidelines and research are relevant and well-integrated into your argument
• Maintain flawless spelling, grammar, and professionalism throughout your presentation
• Demonstrate high-level academic communication skills
• In-text referencing must be included on each slide as required. This information can be added to the Notes section of the slide
• A reference list must be included at the end. 

The presentation has no specified length in regards to the number of slides used but the recorded presentation should be approximately twenty-five (25) minutes in length.

This presentation is worth 30% of your overall unit mark.

"Paramedics are uniquely placed to provide frontline 24/7 care for people nearing the end of life, yet the profession is repeatedly overlooked in healthcare funding, workforce planning, and palliative care-related policy…. The most recent data from the Australian Institute of Health Welfare shows that nearly 70% of potentially preventable hospitalisations are for people with life-limiting and chronic conditions." (Palliative Care Australia 2024).

Essay Topic:

"The expansion of paramedic practice into palliative care in Australia risks fragmenting care rather than improving it". Critically argue for or against this statement

Considerations for your argument for or against:

• Continuity of Care vs. Service Fragmentation
  Consider whether adding paramedics to palliative pathways creates more handovers or reduces them through extended care roles. Examine the risk of parallel services that operate without integration into established palliative care teams. What is the impact on patient experience when multiple providers deliver palliative or end of life care across different settings. 
• Communication and Information-Sharing Barriers 
  Consider paramedic access to electronic health records and consequences for consistent palliative care plans.; handover processes, continuing of care and conflicting treatment decisions/ Consider role clarity and how paramedics would obtain necessary patient history information to make team aligned palliative decisions. 
• Interprofessional Role Tension
  Consider traditional role protection, duplication or confusion with paramedics entering nursing and GP territory, effect of blurred boundaries / new paramedic practice on collaborative decision making, will paramedics enhance or disrupt established multidisciplinary teams.
• Clinical Competence and Scope of Practice
  Does current training adequately prepare paramedics (general, extended or advanced practice) to support complex palliative interventions. What sort of training/education would be required for paramedics to ensure risk of unsafe escalation or undertreatment is minimised. Consider role of enhanced training frameworks or credentialling. 
• Health System Integration 
  Are paramedic-led palliative care models properly embedded in policy and funding structures? Impact of ad-hoc or pilot programs without systemic alignment on care pathways. How/do system level governance and guidelines support integrated palliative delivery.
• Patient Centered Outcomes
  Are patient preferences supported by jurisdictional service paramedics providing rapid in-home end-of-life care - does this differ from a community paramedic embedded in a palliative care service? Consider whether paramedic involvement in palliative care symptom management or end-of-life care reduces unwanted hospital admissions vs. clinical delays in required treatment.
• Ethical and Legal Complexity
  Consider potential for ethically inconsistent decisions when paramedics treat without full access to advanced care plans. Conflicts between emergency care default actions such as resuscitation and palliative goals of care. Ethical fragmentation as a result of current legislation and guidelines, is there anything can be done to reduce this?
• System Efficiency and Resource Allocation
  Paramedic involvement may reduce fragmentation by relieving pressure on primary care and hospital / ED services. Introducing another point of care may increase system complexity and service redundancy. Cost-benefit considerations (health economics) in creating new palliative care responders vs. strengthening existing teams.

Level of GenAI use allowed:

Level 2: You may use Al for planning, idea development, and research. Your final submission should show how you have developed and refined these ideas.

Reference

Palliative Care Australia 2024, Paramedics are key to improving access to palliative care, viewed 5 February 2025, https://palliativecare.org.au/mediarelease/paramedics-are-key-to-improving-access-to-palliative-care/

The essay will be assessed in accordance with the rubric and information provided on the unit’s Moodle site.

The following criteria are key points to be included:

• The written assessment should be presented in an essay format

• The written assessment must address each of the main topic tasks as detailed in the task description

• Avoid superficial points or comments and be clear and concise

• As this is a written assessment, you must include in-text referencing and a reference list.

Word Count: 3000 (+/- 10%)

This written assessment is worth 30% of your overall unit mark.