The study relates to the diverse Queensland community which contributes to the service provided by the Queensland Ambulance Service (QAS). The QAS motive of improving the health and well being of all Queenslanders has remained stable since 1892, despite changes in organisational structure and the actions employed by paramedics in achieving motive. The QAS is primarily focused on the pre-hospital facets of health care and in this study the changing nature of paramedic actions are juxtaposed with the longevity of QAS motive. The research deals with QAS vocational training coupled with technological innovation and evolving community expectation in meeting the demands of contemporary clinical paramedic practice. The thesis focus is on the contemporary work practices of QAS paramedics, why dominant practices prevail above the plethora of alternatives thus pointing the way to future development of the service. The theoretical framework of the study takes account of Queensland's geographical and sociological diversity, coupled with the heterogenous nature of paramedic practice. Cultural Historical Activity Theory (CHAT) informs a study into a broad range of mediating influences, unified into an account of current QAS motive, culture and clinical interventions. The CHAT approach provides ongoing potential to inform QAS policy and optimise the clinical performance of rural paramedics. The empirical framework, congruent with paramedic practice, contains elements of both scientific practice and deductive reasoning. These elements lend themselves to the descriptive nature of qualitative research methods to facilitate the application of scientific principles while visualising the multi-faceted human health experience as experienced by paramedics. Research tools including literature review, interview and questionnaire facilitate a study of specific areas of paramedic practice. The research reveals paramedics as diverse and complex individuals with professional practices unique to the individual, yet remaining within the acceptable parameters of QAS convention on most occasions. The study identifies and interprets a number of workplace contradictions in terms of the meanings that paramedics attribute to them and the consequences of these tensions for paramedic practice. The study concludes that paramedic practices are a consequence of complexities within an activity system which belie the simplicity of direct relationships between QAS education, directives and practice. Findings relate to paramedic dissatisfaction with several restrictions imposed on their clinical practice - explicit restrictions as prescribed in the QAS Clinical Practices Manual 2001 to which QAS paramedic are required to adhere. Paramedic perceptions of identified contradictions are inductively and numerically analysed leading to data synthesis and a narrative summary of findings. Identified contradictions embedded in work practices of QAS paramedics have been argued to provide the impetus for either positive or negative development within the system. The summary of findings visualises the collective paramedic experience and thus speak to recommendations aimed at the amelioration of identified systemic contradictions. Recommendations include reviewing the clinical practice profile of paramedics in remote rural areas, review of clinical accreditation levels, the retaining of clinical placements in preliminary training and the provision of more comprehensive information technology support for paramedics. In this study, recommendations are portrayed in a positive light as signals of opportunities for both expansive paramedic learning and for organisational expansion through policy initiatives embracing the contemporary demands on the QAS and its operational paramedics.