Abstract
Purpose In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation. Design/methodology/approach This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications. Findings Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics. Originality/value The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.
Highlights
Quality, safety and professional accountability are central to the operation of all health and medical services (O’Hara et al, 2012; Freeman et al, 2016)
They almost universally have historic roots in the military, voluntary organizations or the emergency services sector that continue to strongly influence paramedicine (Reynolds, 2009). This narrative synthesis examines the quality and safety approaches of paramedic services adopted in the Anglo-American ambulance or emergency medical service (EMS) model that uses paramedics to staff ambulances as a distinct occupational group (Al-Shaqsi, 2010; Timmermanna et al, 2008)
While the strategies designed to maintain the quality and safety of paramedic services and paramedic clinical practice in the Anglo-American model have differing underpinnings, the literature cuts across three inter-related themes
Summary
Safety and professional accountability are central to the operation of all health and medical services (O’Hara et al, 2012; Freeman et al, 2016). This tenet is no less true for paramedic services even though differences in funding sources and regulatory regimes, education and certification requirements separate them from their respective health systems They almost universally have historic roots in the military, voluntary organizations or the emergency services sector that continue to strongly influence paramedicine (Reynolds, 2009). This narrative synthesis examines the quality and safety approaches of paramedic services adopted in the Anglo-American ambulance or emergency medical service (EMS) model that uses paramedics to staff ambulances as a distinct occupational group (Al-Shaqsi, 2010; Timmermanna et al, 2008). The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode
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