Setting basic standards in a developing ambulance service: a qualitative description of the impact of the intermediate ambulance care course on prehospital care practice in Penang, Malaysia

Abstract

The Intermediate Ambulance Care (IAC) course is a thirty-week training program run in Penang Malaysia which was adapted from the South Australian Certificate IV in Ambulance Practice. The adaption of this program was designed and implemented to improve the clinical education of ambulance practitioners in Penang. However, the IAC is not the only course available within Penang or wider Malaysia, which seeks to improve the standard of care within the EMS. The question that remains unresolved is: what has been the impact upon the development of prehospital care as an occupation? The prehospital care environment in Penang, Malaysia is a complex mix of government and non-government agencies, with variable training standards that lack consistency. Despite its central place in the public health system of many countries, there is little research or other literature available to inform the development of prehospital care education within developing countries. Even within developed systems, such as Australia, there is little evidence available to suggest how a program of education may assist prehospital care professional development. This research considers the impact of the IAC on the development of prehospital care practice and how the course might have contributed to the development of an emerging profession. The questions in this research centre on what the IAC has achieved within the rapidly changing emergency medical system (EMS) in Penang as well as considering the perceptions of leading professions, such as the medical profession. The study examined the IAC in light of the attributes of a profession as suggested by Greenwood (1984). A focused ethnography, triangulated with field notes and observational data, was conducted in order to describe the impact and subsequent professional development. Focused ethnography was selected as the most appropriate methodology as the subject matter of this study was the constructed reality of professionalism and the subjective way in which a professional development course might contribute. As such semi-structured interviews were the most appropriate method for the collection of the primary data. A total of eleven interviews were conducted and thematically analysed through the process described by Braun and Clarke (2006). The four themes that were identified were: Quality of training and quality of care go hand in hand; how standardisation is managed in Penang; the IAC one course that is assisting the development of a profession; and the management of change. The themes described the way in which the IAC contributed to the development of a distinct profession. Whilst pre-hospital care, as a profession, is yet to establish itself in Malaysia, in countries where it has there have been significant improvements in delivering public health outcomes. This study sought to describe the impact of the IAC within the complex mix of service and education available, rather than in isolation. As such the study offers an insight into what can be achieved with a developing country’s EMS by offering professional education and development.