Better integration of health services and redefinition of health workforce roles through expanding and extending traditional scope of clinical practice have been explored nationally and internationally. This paper examines models of expanded and extended scope of paramedic practice for attributes which facilitate such a practice. Objective Results Conclusions Facilitators of expanded and extended scope of paramedic practice: What makes them work? Jakki Germann, David Lim, Leo McNamara, Vivienne Tippett School of Clinical Sciences, Queensland University of Technology Successful models of expanded and extended practice harness the full capacity of the paramedic practitioner, and are supported by enabling infrastructures, specifically: professional development/ education; clinical guidelines and policy frameworks (boundary); access to physical infrastructure; clinical support from senior medical practitioners; and, ability to directly refer to other health services (service integration). The scope of practice is however influenced by individual employers’ capacity, perceived community needs and preference/ priorities. The potential for paramedic practice is equally applicable to urban as well as rural Australia. The Council of Ambulance Authorities’ Professional Competency Standard provides the form and function for building on paramedic practice. Recognition of such paramedic practice provides a structure for professional growth, process for career progression, support workforce retention, improves healthcare and equity of access. Methods The achievement of enhanced knowledge and skills has positioned the paramedic profession as a valuable part of the healthcare team. The Council of Ambulance Authorities’ Professional Competency Standards provides the form and function for supporting expanded and extended paramedic practice. An exploratory multi-case study analysis of Australia (Queensland), New Zealand, Canada (Alberta) and the United Kingdom (London) expanded and extended paramedic practices were analyzed. © Queensland Ambulance Service. Used with permission. MicroMesoMacro RecruitmentAutonomyLocationEducationStakeholder engagement Additional scope of practice Internal Governance Legislation Australia – Queensland: Isolated Practice Area Paramedic (IPAP) (2006)  Expression of interest  Advanced Care Paramedic (or equivalent)  Selection process Somewhat; in accordance with protocols Queensland Health approved most rural and isolated communities only  1 year  GradCert (AQF Level 8)  Combined the Rural and Isolated Practice Endorsed Nursing program developed by the Queensland Health and Australian College of Rural and Remote Medicine chronic disease strategy, using the Primary Clinical Care Manual  At practitioner level  Involvement of the Council of Ambulance Authority in policy formulation  Partnership between Queensland Health, Queensland Ambulance Service, and James Cook University Authorised to practice under IPAP Health assessment of patient in accordance with Health Management Protocol  Supervision of project delivery through Queensland Ambulance Service  Direct contact with on- call Emergency Physicians (Medical Director) Amendment of Health (Drugs and Poisons) Regulation 1996 (QLD) to allow expanded paramedic practice New Zealand: Extended Care Paramedic, Community Care Paramedic UnknownSomewhatUrban  1 month equivalent of classroom and 1 month practicum shadowing an ECP  GradCert and Master (equivalent to AQF 8 and 9) Involvement of Council of Ambulance Authorities and Minister of Health in policy formulation  Wound care  Suturing  Blood sample  Usual quality and safety governance  Direct contact with on- call Emergency Physicians Canada – Alberta: Community Care Paramedic Selection process (interview) Limited2 major urban cities  6 weeks classroom and 4 weeks practicum shadowing Nurse Practitioners in care facility  Advanced diploma (equivalent to AQF Level 6)  Post-hospital discharge organised by discharging physician  Community initiated via Alberta Health Services and municipality, in partnership with Alberta College of Paramedics  Extra prescribing and dispensing rights  Wound care  Suturing  Ability to directly refer to community and prehospital support program/ homecare  Usual quality and safety governance  Direct contact with Medical Director (Medical Control) and patients’ family doctors Professional registration UK – London: Paramedic Practitioner, Community Care Paramedic UnknownHigh degreeUrbanHonour and Master (equivalent to AQF 8 and 9) Via NHS  Extra prescribing and dispensing rights  Specific direct referral  Usual quality and safety governance  Direct contact with control centre for medical direction Health Care Professions Counsel - registration