The CARPA Standard Treatment Manual (STM) is one of CARPA's main activities.

It has an established role as:

• a population health approach to primary care in remote and Indigenous Central Australia
• a resource for most appropriate clinical practice
• a guide for practitioner training programs a tool for standardising practice across the range of service providers
• a tool for updating 'best practice'
• a checklist and reassurance for experienced remote practitioners.

The concept is that the manual will be constantly reviewed, and this process relies on feedback to the STM editorial committee.

The artwork on the cover is by Aboriginal artist Tjamtitjinpa Nolan. It tells the story of some women who are ill due to the loss of their 'souls' (kurrunpa). They are being healed by Ngangkaris (traditional healers) who are restoring their 'souls'.

Remote primary health care practice has evolved in recent decades, and so too have the demands and expectations of those providing and receiving clinical services. There is a greater recognition of the public health aspects of clinical management, more proactive health care and a strong expectation of evidence based practice. The STM has also evolved, partly in response to these changes and partly as a leader and agent of change.

Many practitioners arrive in Central and Northern Australia without any specific training relevant to remote practice. The STM helps them to cope with a range of health, social and work conditions that for many are a great shock. The STM has a very strong reputation among its users, and further afield, as an outstanding tool to support evidence based practice. An evaluation of the 3rd edition in 2001 found that it was being used in every remote health centre in the Northern Territory. There is also strong support and use of the STM in other states of Australia.

The style of the STM continues with the following principles:

• One manual for Aboriginal health workers, nurses and doctors
• Simple language, without critical compromise in the content
• Brief, easy-to-read cookbook style
• Focus on what will make a difference to clinical practice and health outcomes
• A process of producing a manual by the users for the users

With more than 100 topics, and a number of expanded sections, the CARPA STM does not stand alone, and does not claim to be comprehensive. It covers conditions that:

• are common in remote practice
• have different presentations and management issues to those in 'mainstream' practice
• are dangerous or are frightening to practitioners
• have important public health considerations
• need coordinated, standardised care

The focus is on what to do, with detail on how to do it found as references to the CRANAPlus Clinical Procedures Manual for Remote and Rural Practice. Women's health issues are dealt with separately in the Women's Business Manual, which covers obstetrics, gynaecology, well women's screening, menopause, infertility and contraception.  More detailed medications information can be found in the Medicines book for Aboriginal health workers.  Together these resources, along with the Reference Book to the 5th edition, make up the suite of Remote Primary Health Care Manuals.

It remains crucial to safe practice for any practitioner who is unsure of what they are dealing with to talk to someone more experienced or skilled. Thankfully this is easier to do now in the days of telephone and internet rather than radio.

The STM should be used in conjunction with:

• The Reference Book for the CARPA STM
• The Women's Business Manual (Congress Alukura)
• The Public Health Bush Books (Northern Territory Department of Health and Community Services - now Northern Territory Department of Health and Families)
• The Clinical Procedures Manual for remote and rural practice (CRANAplus)
• Local Centre for Disease Control Guidelines (where relevant)
• The Australian Immunisation Handbook
• The Australian Medicines Handbook or the Medicines Book for Aboriginal Health Workers

The Process of making the manual

Feedback on the previous editions has been collected since their publication. This was augmented by an initial Territory-wide evaluation undertaken in 2001. The most significant change at this time was the equal and active involvement of both Central Australia and the Top End in all aspects of the manual's development, making it truly a manual for both regions.

Recognition of a particular need to expand and develop the mental health topics in previous editions came out of the expressed needs of remote practitioners. These protocols were developed in a related research project carried out by the Centre for Remote Health. In recent years the importance and management of preventable chronic diseases has been given greater emphasis. 

The manual is written and developed by the users: remote practitioners, for the users. It results from a process of reviewing all existing protocols and then developing new ones in conjunction with recognised Australian authorities, current evidence, expert advice and practice wisdom on specific topics. This represents best practice for the common presenting problems in remote areas of Australia. The latest edition, the 5th edition follows the success of the first, second, third and fourth editions. It is fully revised as a result of extensive evaluation and supersedes previous editions. 

In this edition the task for authors included revision of the current protocol, preparing a detailed reference document describing the background and rationale for the revised or newly developed protocols, which is to be published as a separate companion book (the CARPA Manual Reference Book). Combined with the push for a stronger evidence base for the content of the protocols, this led to more of the primary authors being specialists than has previously been the case. To maintain the philosophy of the STM being written 'by the users for the users', great efforts were made to ensure that each topic was reviewed by both technical experts and a number of remote practitioners (users). The practicality and acceptability of the protocols was kept at the forefront in the editing process. This extensive review and editing process means that the final authorship of each topic cannot be attributed to a particular person.

Sponsorship
The vast bulk of the time and effort required to produce the STM is donated by the hundreds of contributors. These people, from all over Australia, donate their time and expertise in recognition of the valuable contribution the STM makes to rural and remote practice in Central and Northern Australia. Funding for coordination, editing and initial printing came from the Australian Government Department of Health and Ageing. Additional in-kind support was also given by the Central Australian Aboriginal Congress, the Centre for Remote Health and the Northern Territory Department of Health and Families .

The users of the STM
The STM is intended for use by trained health professionals including Aboriginal health workers, nurses and doctors. It is not intended as a layperson's manual. It is primarily intended to be used in remote Indigenous communities, rural and urban Aboriginal health services and for non-Indigenous people living in these communities. We have continued to try to make the manual as easy to use for everyone in remote areas with illustrations and simple English where possible.