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Week 1 Case Study

The Frequent Caller

The Scenario

It is 14:20 on a Tuesday afternoon when Paramedics Sarah and Liam are dispatched to a Priority 2 call for a 78-year-old female, Margaret, reporting "general unwellness and dizziness." The dispatch notes flag Margaret as a frequent caller—this is the sixth ambulance attendance at her address in eight weeks. Previous presentations have included non-specific complaints: fatigue, mild chest discomfort, "not feeling right," and a fall with no significant injury. Each time, Margaret has been assessed, treated symptomatically, and left at home after declining transport to hospital.

On arrival, Sarah and Liam enter Margaret's ground-floor unit in a public housing block in Ipswich, Queensland. The unit is cluttered, with expired food on the kitchen bench, a strong smell of cigarette smoke, and several overflowing ashtrays. The heating is on despite the warm weather. Margaret is sitting in an armchair in front of a television with the volume turned up very high. She is thin, pale, and wearing the same stained dressing gown noted on the crew's last visit. A Webster pack of medications sits unopened on the table beside her—it is labelled for the previous week. She greets the paramedics warmly and says, "I'm sorry for calling again. I just didn't feel right and I didn't know who else to ring."

Sarah's primary survey reveals: GCS 15, BP 148/92, HR 88 regular, SpO2 95% on room air, BGL 14.2 mmol/L, temp 36.8°C. Margaret has a history of type 2 diabetes, COPD, hypertension, and osteoarthritis. She tells them her GP retired six months ago and she hasn't registered with a new one. She has no family nearby—her daughter lives in Perth and calls once a fortnight. Margaret's neighbour used to check on her, but moved away three months ago. She has not left the house in over two weeks. She says she doesn't use the internet and finds the phone "confusing these days." She becomes tearful and says, "I just get scared being on my own."

Discussion Questions

1 Margaret's immediate clinical needs (elevated BGL, non-compliance with medications, mild hypertension) are relatively straightforward. However, what broader public health issues are evident in this scenario? How does this case illustrate the difference between an individual healthcare approach and a public health approach?
2 Using the WHO definition of health ("a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity"), evaluate Margaret's overall health status. Which dimensions of health are most affected?
3 Margaret is a "frequent caller" to the ambulance service. From a healthcare systems perspective, what does this pattern suggest about gaps in her access to primary healthcare? What levels of the healthcare system have failed her?
4 Describe how a community paramedicine program might benefit Margaret. What types of interventions could a community paramedic provide, and what referral pathways within the Australian healthcare system could be activated (e.g., My Aged Care, GP referral, Allied Health, social services)?
5 Consider the three levels of prevention. Identify one example of primary, secondary, and tertiary prevention that could be applied to Margaret's situation. Which level is most relevant to addressing her current needs?
6 If Sarah and Liam only treat Margaret's symptoms and leave (as has happened five times before), what is the likely outcome? What does this scenario tell us about the limitations of emergency care as a substitute for a functioning primary healthcare system?

Key Concepts Applied

Public Health vs Individual Care

Margaret's repeated presentations reveal systemic failures that cannot be solved by clinical treatment alone—her needs are social, structural, and preventive.

WHO Definition of Health

Margaret has physical illness, social isolation, and psychological distress. She is far from "complete well-being" in any dimension.

Healthcare System Levels

Margaret has lost access to primary care (no GP) and is substituting tertiary/emergency services, an inefficient and ineffective pattern.

Community Paramedicine

An expanded paramedic role focused on preventive care, chronic disease management, and connecting patients to community services.

Levels of Prevention

Primary (health education), secondary (diabetes screening/monitoring), and tertiary (managing COPD complications) prevention all apply here.

Referral Pathways

My Aged Care, GP Access programs, social work, and meals-on-wheels are examples of services Margaret could be connected to by a proactive paramedic crew.

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