Objectives: This paper examines the Tasmanian portion of a four state study commissioned by the Australian Council of Ambulance Authorities in order to examine the expanded scope of practice for Australian rural paramedics. The objectives of this paper were to describe the expanded role for the rural paramedic on the East Coast of Tasmania and determine what factors facilitate this role. Methods: This study uses qualitative methods. Three sources of data were used for this study: a) semi-structured interviews with key informants; b) direct observation of key processes and events, and c) review of documents describing the paramedic role and required organisational and educational support. The semi-structured interviews included questions relating to the role of the paramedic, involvement with other health disciplines, and interactions within the general community. Findings: The study revealed how paramedics on the East Coast of Tasmania have developed a multidisciplinary and multifaceted approach to health care. Emergency care does not end at the hospital doorstep and involves co-operation between paramedics and hospital staff in ongoing care. Doctors and other health professionals who have previously been involved in after hours call outs, training of volunteer ambulance personnel are now free from these additional and often time-consuming tasks. Paramedics have been welcomed as part of the health care team in the area and have been responsible for development of effective working relationships with hospital staff and doctors, volunteers and community members. An important part of these relationships is the health education provided by paramedics. Conclusion: Emergency response in rural areas is only a small part of paramedic practice. This study has identified elements of rural paramedic practice that highlight the importance of a multidisciplinary and community based response to patient care in rural areas namely community involvement, organisational support, professional support, and appropriate education and training. Much of these are rooted in a footing of informality. The move from informality to a more formal framework will perhaps enable rural paramedic practice to emerge as a discipline in its own right, as an integral part of a rural multidisciplinary health care team.