Physiotherapists working in emergency departments (ED) across the country are not typical entry-level practitioners.

Tina Vickery APAM from Macquarie University recently published a study, ‘Demographics and scope of Australian emergency department physiotherapists’, alongside co-authors Dr Lindsey Brett and Professor Taryn Jones, which found that most physiotherapists entering the ED setting have significant prior experience.

Around 70 per cent of those in the study reported having more than five years in the profession before moving into an ED role.

Tina says the study results highlighted the depth of knowledge and level of confidence of ED physiotherapists in Australia, which likely serves them well in the challenging ED environment.

The study surveyed 94 physiotherapists in EDs across Australia, revealing an average professional experience of 17 years, markedly higher than the national average.

This wealth of experience enables physiotherapists to work effectively in high-pressure situations where patient presentations can vary widely, from musculoskeletal injuries to mobility challenges and paediatric care.

Their ability to work autonomously—76.9 per cent of respondents identified as primary contact clinicians—further demonstrates their readiness to take on diverse and demanding case loads.

‘The results showed that physiotherapists who go into ED have quite a lot of prior experience,’ Tina says.

‘Considering the average career span of physiotherapists as clinicians, ED is really attracting experienced healthcare workers.

‘An important finding of the study was that the vast majority indicated that they planned on staying at least another five years—with the average intention to stay at 11.4 years.

'EDs attract experienced clinicians who intend to stay.’

Broad and expanding scope

Physiotherapists in the ED perform a wide variety of tasks and work to the top of their scope.

From conducting mobility assessments to managing acute care cases and performing joint relocations, the role has expanded significantly.

‘They’re not narrow-scoped advanced practitioners,’ Tina says.

‘They’re very broad and deep in their knowledge, expertise and skill set.’

Localised training and supervision have enabled some physiotherapists to take on responsibilities traditionally handled by medical practitioners.

More than half (57 per cent) of the study’s respondents reported interdependently ordering or interpreting imaging such as X-rays and a small percentage was involved in medication administration or prescription—a testament to their advanced capabilities.

Extended scope practices not only increase the efficiency of EDs but also enhance patient care.

Participants from Tina’s study called for an extension of scope to allow physiotherapists to directly refer patients to orthopaedic surgeons and for expedited access to Medicare-funded MRIs.

These practices have the potential to streamline treatment pathways, reduce delays and improve continuity of care, all of which is critical in emergency settings.

Meeting the demand

While the skills and contributions of ED physiotherapists are clear, Tina’s research highlights areas for improvement, particularly in aligning service provision with patient demand.

Physiotherapy coverage often mirrors standard business hours, despite EDs operating around the clock.

‘From about 4pm onwards we see a sharp drop-off in when physiotherapists are present in ED, whereas patient presentations remain high into the evening,’ Tina says.

The study found that physiotherapy coverage is highest during weekday mornings and afternoons, with limited coverage during evenings and on weekends—times when patient volumes remain high.

This misalignment, the study noted, not only limits the potential impact of physiotherapy services but also places additional strain on other healthcare professionals.

Expanding physiotherapy hours to complement ED activity could significantly enhance patient outcomes and reduce bottlenecks, Tina noted.

She suggested that addressing the gap could be a key area for development, emphasising the need for flexibility and adaptability in service models.

Pathway to success

Despite their significant contributions, there is no nationally standardised framework for training or credentialing ED physiotherapists in Australia.

This lack of standardisation can lead to variability in practice and in recognition from state to state.

Tina advocates for a clear pathway, noting that ‘one of the themes that came through strongly was the provision of a standardised pathway for their training.’

Such a framework would outline essential skills, competencies and professional activities for ED physiotherapists, ensuring consistency and enhancing the profession’s credibility.

Tina highlighted the need for collaboration among professional bodies to implement this pathway.

Additionally, many participants in the study expressed interest in further professional development, with nearly half reporting engagement in advanced training or postgraduate studies.

This enthusiasm underscores the profession’s commitment to growth and its potential for broader contributions to emergency care, Tina says.

‘I don’t think it is outside the realm of possibility for us to create a standardised training pathway or credentialing program.

'We have the structures in place to do that.

'We’ve got the Australian College of Physiotherapists, the APA, the Australasian College for Emergency Medicine and Ahpra and we know we can do it for other specialised cohorts of physios, so why not for ED?’ she says.

Leading with learning

Beyond their clinical duties, ED physiotherapists play a vital role in interdisciplinary education and collaboration.

Many respondents indicated their involvement in training junior medical officers, supporting nurse practitioners and enhancing the skills of other healthcare professionals.

This collaborative approach not only improves patient care but also fosters a more cohesive and efficient ED team, Tina says.

‘Respondents identified the ability to provide more training for up-and-coming physios who wanted to practise in an ED but also to really maximise their ability to provide training, education and skill development across all the professions that they work with in ED.

'This encompasses things like supporting training of junior medical officers and doctors in training, better supporting nurse practitioners and further developing their own skills in terms of wound management.

'Some physios were doing fracture reductions collaboratively with doctors; others were doing them independently,’ Tina says.

The study also highlighted the potential for physiotherapists to contribute to research and policy development, advocating for their role as change agents within the healthcare system.

By demonstrating the economic and clinical benefits of physiotherapy in the ED, practitioners can help shape policies that support sustainable and effective care models, Tina says.

The presence of physiotherapists in the ED is no longer a novelty but an essential component of modern emergency care.

The ability of ED physiotherapists to adapt to diverse and unpredictable situations, combined with their advanced skills and collaborative mindset, positions them as invaluable assets to the healthcare system.

However, realising their full potential, Tina says, requires investment in training and research, better alignment of service provision with demand and greater recognition of their achievements.

‘ED physiotherapists make a much broader difference than we potentially thought,’ Tina explains.

‘They’re really committed to their role and want to see it grow.’

She says that by addressing the challenges and supporting the role of ED physiotherapy, Australia can enhance its emergency care services, ensuring that patients receive timely, beneficial and holistic care when they need it the most.

Key findings

The findings of ‘Demographics and scope of Australian emergency department physiotherapists’ highlight the diverse and evolving capabilities of ED physiotherapists in managing complex, high-demand environments.

Specifically, they demonstrate that:

• 76.9 per cent of surveyed physiotherapists operated as primary contact clinicians— demonstrating significant autonomy in assessing and managing patients
• 100 per cent performed mobility assessments, while 89.9 per cent provided care for paediatric patients— underscoring their versatility
• 86.2 per cent worked in EDs with seven-day-per-week physiotherapy service models, although weekend and evening coverage gaps were noted
• only 10.1 per cent of participants were located in districts classified as outer regional or remote—highlighting rural service inequities
• over half could independently order and interpret adult and paediatric X-rays, with some authorised to perform procedures like joint relocations under supervision
• 53.8 per cent had undertaken further university-level training beyond their entry degree—emphasising a commitment to professional development
• most positions were funded through physiotherapy departments, with a primary focus on clearing triage lists and preventing hospital admissions.

To read the full study, click here.