Paramedic Practice Research Articles

Trans-inclusive paramedic practice: Translating cultural safety into everyday transgender-affirming care

Trans-inclusive paramedic practice: Translating cultural safety into everyday transgender-affirming care

Representing contemporary paramedic practice in Canada: Development of the national competency framework for paramedics

Representing contemporary paramedic practice in Canada: Development of the national competency framework for paramedics

Knowledge, Attitudes and Practices of Radiologists and Paramedics Towards Accident and Emergency Preparedness and the Role of Biomedical Engineering in Prehospital Emergencies

Purpose: The purposes of this study were to assess the knowledge, attitude, and practice of radiologists and paramedics regarding accident and emergency preparedness in hospitals in the southern region of the Kingdom of Saudi Arabia and how to improve their role. Materials and methods: This was a descriptive, cross‑sectional online survey that was carried out among radiologists and paramedics in the Kingdom of Saudi Arabia. A self-structured, close-ended questionnaire that was administered that consisted of 19 questions was included. The questionnaire validity and reliability were evaluated for vetting and remarks. The questions were circulated through Google Forms, and it was circulated among the study participants through online mode. The data were collected systematically, and SPSS Statistics version 26.0 was used for data analysis Results: There were 139 responses, (77 specialist's radiology and 62 paramedics) participated in the study through Google Forms. In the study group, 84 (61.4%) were know the main steps for emergency response in major emergencies (p-value 0.000). Among the 19 questions used to assess the KAP, 12 questions were significant with a p-value less than 0.05. More than 72.6% agree the Management must be adequately prepared when emergencies and accidents occur. The respondents’ attitude toward emergency preparedness was generally positiveو Only a minority, that is, 43 (30.9%) of the respondents think it is possible for cooperation between radiologists and paramedics to interpret emergency cases and develop treatment plans in the emergency department. Conclusion: The level of knowledge was satisfactory among the radiologists and paramedics with a neutral level of attitudes, practice and knowledge regarding disaster preparedness. Follow-up research is essential to maximize the preparedness of the accident and emergency department.

Paramedic clinical practice guideline development in Australia and New Zealand: A qualitative descriptive analysis

BackgroundThis collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services. MethodsEmploying a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field. ResultsKey findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation. ConclusionThe study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges.

Vocational and University Paramedicine Education

This paper highlights key research areas within paramedicine education in Australia. Firstly, it discusses the need for a comparative analysis of accreditation standards, focusing on the recent shift towards a pre-employment model and its impact on program content, particularly the balance between theoretical and practical components. Secondly, it addresses the importance of exploring the influence of ethics education on paramedic practice, investigating how a robust ethical foundation acquired during education translates into ethical practices in real-world scenarios. Additionally, it suggests conducting a comparative study of international models to understand different education approaches, emphasising the importance of identifying best practices to enhance paramedic education in Australia. Lastly, it emphasises the significance of assessing the impact of accreditation changes in 2018, specifically the shift in accreditation responsibilities from the Council of Ambulance Authorities to the Paramedicine Board of Australia, aiming to understand its implications on the quality and consistency of paramedicine education across various institutions. Overall, this paper highlight the critical research gaps and areas of investigation essential for advancing paramedicine education and improving the quality of paramedic training in Australia.

Knowledge, attitude and practice of paramedics towards health care waste in Port Harcourt, Nigeria

Knowledge, attitude and practice of paramedics towards health care waste in Port Harcourt, Nigeria

Decision making in prehospital and paramedic practice: part 2

Decision making in prehospital and paramedic practice: part 2

Is the Calgary-Cambridge Model of consultation a suitable communication tool for students and newly qualified paramedics? A qualitative study.

The Calgary-Cambridge Model (C-CM), developed by Kurtz and Silverman in 1996, is a communication tool developed for doctors. Since its publication, it has been adopted by various healthcare professionals; however, no previous research has been identified that evaluates its use in paramedic practice. This study aims to explore the experience of students and newly qualified paramedics (NQPs) applying the C-CM in practice, and establish their experiences and perceptions of its suitability as a communication tool in the pre-hospital environment. This MSc research project, conducted in April-May 2021, applied qualitative methods with thematic analysis to written reflections and semi-structured interview transcripts discussing the implementation of C-CM in paramedic practice. A convenience-quota sample of 11 participants, consisting of third-year paramedic students and recent NQPs, were recruited. This research is reported using Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines. Eleven participants were recruited in total; nine consented to reflective writing analysis and interviews, two consented to writing analysis only. Analysis of the writing samples allowed for a deductive approach to the interview plan. Participants consisted of seven males and four females. All eleven participants (ten British and one Indian) spoke English as a first language. Ages ranged from 18 to 59 years. Career status was 46.2% third-year students and 53.8% NQPs. Four major themes were identified: barriers to implementation of the C-CM in practice; impact of C-CM on paramedic practice; C-CM as a teaching and learning tool in paramedic practice; and adaptation of C-CM for paramedic practice. Participants suggested that implementation of C-CM leads to improved structure and shared decision-making; however, adaptions to make it more paramedic-focused would be welcomed. The diversity of patients and their preferences can make its implementation challenging, and the negative feedback received from experienced ambulance staff was a significant concern to participants.

Towards an understanding of the embedded nature of everyday ethical reasoning in paramedic education and practice

Paramedicine is increasingly complex in affective, behavioural, and cognitive domains of practice. The ability to navigate this complexity is essential for paramedics who are required to simultaneously practice assertively, dynamically, sensitively, and professionally. Although these may seem to be superficially incongruent ways of practising, through insightful and reflexive practice underpinned by appropriate ethical approaches, paramedics can navigate the complexity inherent in paramedic work whether care episodes are routine or extreme. In what follows, we discuss the potential of virtue ethics as a way of navigating complexity in paramedic practice and preparing clinicians for the varied work they manage as paramedics. We do this by first describing some of the issues faced by the modern paramedic, outlining ethical approaches to practice, then working through a vignette showing how a deeper understanding of ethics and utilising a virtue ethics approach may have helped the clinicians navigate a typical ethical dilemma found in practice.

Identifying Features of a System of Practice to Inform a Contemporary Competency Framework for Paramedics in Canada.

Paramedic practice is highly variable, occurs in diverse contexts, and involves the assessment and management of a range of presentations of varying acuity across the lifespan. As a result, attempts to define paramedic practice have been challenging and incomplete. This has led to inaccurate or under-representations of practice that can ultimately affect education, assessment, and the delivery of care. In this study, we outline our efforts to better identify, explore, and represent professional practice when developing a national competency framework for paramedics in Canada. We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice in Canada. This approach makes use of the role and influence of system features at the microsystem, mesosystem, exosystem, macrosystem, supra-macrosystem, and chronosystem levels in ways that can provide new insights. We used methods such as rich pictures, diagramming, and systems mapping to explore relationships between these contexts and features. When we examine the system of practice in paramedicine, multiple layers become evident and within them we start to see details of features that ought to be considered in any future competency development work. Our exploration of the system highlights that paramedic practice considers the person receiving care, caregivers, and paramedics. It involves collaboration within co-located and dispersed teams that are composed of other health and social care professionals, public safety personnel, and others. Practice is enacted across varying geographical, cultural, social, and technical contexts and is subject to multiple levels of policy, regulatory, and legislative influence. Using a systems-thinking approach, we developed a detailed systems map of paramedic practice in Canada. This map can be used to inform the initial stages of a more representative, comprehensive, and contemporary national competency framework for paramedics in Canada.

Decision making in prehospital and paramedic practice: part 1

This first continuing professional development article in this 2-part series on decision-making explores this process in prehospital and paramedic practice and the complex world of how clinicians make decisions in often challenging and time-critical situations in prehospital settings. It gives a brief overview of the neuroanatomy involved in decision-making, problem-solving and critical thinking as well as Bloom's taxonomy and its application to prehospital practice. While it is outside the remit of this paper to incorporate all theories regarding decision-making, it will explore some key concepts and frameworks around it.

Guidelines for peer reviewers

Have you ever considered becoming a peer reviewer? In this issue, we provide the Journal of Paramedic Practice guidelines for peer reviewers. Have a read and contact the editor with your CV if you think you want to join the JPP peer reviewer panel

“This is how I'm going to do it, but this is not how you're going to do it”: the expectation gap between student paramedics and mentors in East and Central Scotland

BackgroundThe role of paramedics has expanded significantly over the past two decades, requiring advanced skills and education to meet the demands of diverse healthcare settings. In 2021, the academic requirements for paramedics were raised to a bachelor’s degree to align with other registered professions. The limited evidence on effective paramedic practice education necessitates a novel or new examination of unique learning methods, emphasising the need to establish effective learning relationships between mentors and learners to enhance professional respect and support achieving learning outcomes. This study aimed to investigate expectations between student paramedics and their mentors, focusing on the learning dynamics within paramedic education.MethodsThis qualitative study used purposive sampling to recruit participants from two distinct cohorts: student paramedics from the University of Stirling and Practice Educator Mentors from the Scottish Ambulance Service. Focus groups were conducted to illuminate comprehensive insights into participants' expectations regarding practice education and their respective roles in the learning process. Codebook thematic analysis was used to assess the alignment of these expectations.ResultsFindings illustrate important challenges within practice placement across learning paradigms and highlight the attitudes surrounding the integration of higher education and expectations of practice placements. These challenges encompass systemic barriers, including the support provided to mentors as they assume increased responsibilities and barriers that deter qualified staff from initially undertaking this role.ConclusionThe study aimed to assess expectations between practice educators and students within the paramedic profession in Scotland. The methodology effectively identified key themes from comprehensive data, marking the first primary research in this field. There are disparities in learning styles, expectation measurement, and attitudes toward higher education during practice placements, which could significantly impact the teaching and assessment processes. The findings suggest increased support for practice educators, educational programs addressing challenges of mentorship, and stronger links between higher education institutes and the Scottish Ambulance Service. Further research is needed to understand the extent of the expectation gap, how expectations evolve, and to develop strategies to address disparities.

A qualitative exploration of ambulance clinician behaviour and decision making to identify factors influencing on-scene times for suspected stroke patients in North East England.

Ambulance clinician assessment of suspected stroke patients aims to provide rapid access to specialist care, however regional and national data show increasing pre-hospital times. This study explored paramedic views about factors contributing to on-scene time (OST) for suspected stroke patients, with a view to identifying opportunities for future interventions, to reduce OST. Views of paramedics from one regional service on factors influencing OST were explored using a qualitative approach. Semi-structured interviews with volunteers were recorded, transcribed and analysed using thematic analysis. Interviews were conducted with 13 paramedics between August and November 2021. Five interlinked themes were identified and described a range of factors influencing OST: 'Initial assessment and sources of information' describes how clinicians make assessments based on initial presentation, influenced by pre-arrival information from ambulance control and family members / bystanders at the scene, and how this influences OST.'Suitability for treatment and interventions' describes how paramedics consider actions such as the face, arms, speech test, cannulation, electrocardiograms and neurological assessments while recognising that pre-hospital interventions for suspected stroke are limited.'The environment' describes the influence of incident setting on OST, including the overall process needed to transport the patient to appropriate care.'Hospital interactions' describes how interactions with hospital staff influenced paramedic actions and OST.'Changing practice' describes the influence of experience and interaction with hospital staff leading to changes in paramedic practice over time. This study provides insight into how UK paramedics spend time on scene with stroke patients. Multiple factors influencing OST were identified which signpost opportunities for interventions designed to reduce OST. Standardising on-scene assessments for stroke patients, refining communication processes between ambulance services and hospital stroke services and increasing availability of stroke continuing professional development for paramedics were all identified as potential targets for improving OST.

Clinical practice guidelines in prehospital pain management for paramedics: a systematic review protocol.

The purpose of this review is to examine prehospital pain management clinical practice guidelines (CPGs) to identify recommendations that can be adopted or adapted into paramedic clinical practice. An additional aim is to consider the methodological quality of these CPGs and the recommendations within them. Quality, evidence-based CPGs support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, the evaluation of pain management CPGs, their quality, and whether their recommendations can be adopted or adapted into practice is required to increase understanding in this area. We will include CPGs for pain management intended for prehospital services in civilian communities. CPGs in English published from 2017, and containing clear recommendations addressing pain of any cause will be considered for inclusion. This review will combine methodologies, including the PICAR framework (population, intervention, comparison, attributes of eligible CPGs, recommendation characteristics) by Johnston et al. , and the JBI umbrella and scoping review methodologies. The search strategy will cover 12 databases, including PubMed, Embase, and specific CPG databases (eg, GIN Library). Additionally, Google Scholar and Google will be searched, and prehospital organizations without regular publications will be contacted. The AGREE II and AGREE-REX tools will be used to assess the methodological rigor and clinical credibility of the CPGs. The characteristics of both CPGs and the recommendations will be extracted and discussed in the review. PROSPERO CRD42022352951.

Exploring the alignment between paramedicine's professional capabilities and competency frameworks for current and evolving scopes of practice: a literature review

BackgroundTo adequately prepare graduates for the dynamic demands of paramedic practice, adopting a contemporary educational approach is essential. This involves collaborating to identify crucial competencies through input from industry stakeholders, experienced practitioners, and discipline-specific experts. Accreditation assumes a central role within this framework, serving as a cornerstone to ensure that paramedicine curricula align with paramedics' diverse and evolving professional roles.MethodsA narrative review of the literature and a directed search of grey literature were performed to identify specific developments in paramedicine competencies and scope of practice and mapped to the professional capabilities published by the Paramedicine Board of Australia. In determining a competency map and accreditation’s role in a competency framework specific to current and evolving paramedic practice, key documents were analysed using a qualitative approach based on content analysis to identify common traits among documents, countries and other professions.ResultsThe review process identified 278 themes that were further allocated to 22 major analytical groupings. These groupings could further be mapped to previously reported cognitive, technical, integrative, context, relationship, affective/moral competencies and habits of mind. At the same time, the highest-rated groupings were key competencies of intellectual skills, safety, accountability, clinical decision-making, professionalism, communications, team-based approach and situational awareness. Two groups were represented in the literature but not in the professional capabilities, namely Health and Social continuum and self-directed practice.ConclusionsThis review highlights the importance of measuring and validating the professional capabilities of Paramedicine Practitioners. The study explores various metrics and competency frameworks used to assess competency, comparing them against national accreditation schemes' professional capability standards. The findings suggest that accreditation frameworks play a crucial role in improving the quality of paramedicine practice, encompassing intellectual skills, safety, accountability, clinical decision-making, professionalism, communication, teamwork, and situational awareness.

Marine Medical Response: Exploring the Training, Role and Scope of Paramedics and Paramedicine

This article delves into the evolution of paramedic practice, particularly in the context of marine medicine, highlighting the emergence of dive paramedics and the augmentation of prehospital care. It emphasises the potential for qualified paramedics to pursue specialised training in marine paramedicine through postgraduate programmes, ultimately broadening their skill set.

Paramedics in advanced practice: role, requirements and impact

Paramedic practice has been rapidly developing over a short space of time, with more paramedics entering the world of advanced practice across a variety of healthcare settings. Although there is a need for further advanced practitioners, due to the global healthcare workforce crisis and ageing population, advanced practitioner paramedics face many barriers to integration into the workforce. This article reviews the factors influencing UK paramedic advanced practice, and explores the attributes required for the role and its impact in healthcare. Although recognised as a vital resource, it is recommended that more research is needed to look at the effectiveness of paramedics as advanced practitioners.

Cultural safety in paramedic practice: experiences of Māori and their whānau who have received acute pre-hospital care for cardiac symptoms from paramedics.

Background Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori.

응급실 임상실습에 참여한 응급구조학과 학생들의 경험에 관한 근거이론 연구

This study examines paramedic students' emergency room clinical practice experiences. For this purpose, the researcher selected nine students at the college in the G area and conducted the study using the grounded theory approach. The researcher con-ducted in-depth interviews using semi-structured questionnaires and analyzed them us-ing grounded theory. Data analysis performed open coding, axis coding, and refining theo-ry proposed by Strauss and Corbin based on grounded theory. To acquire validity and reli-ability, the researcher categorized concepts through continuous questioning, comparative analysis, identifying essential things in the data, and giving meaning to them. As a result of this study, 14 categories, 36 subcategories, and 128 concepts were derived, and the core category was establishing occupational perspective as a paramedic. Causal context and intervening conditions influenced the central phenomenon of establishing an occupa-tional perspective as a paramedic. In addition, actions/interactions showed an incessant desire for academics, exploration of vocational aptitude, and effort to adapt to the emer-gency room. Consequences appeared as a feeling of the importance of clinical practice, perspective on society, growth and development, and the future of a paramedic. This study is meaningful because it seeks to understand the paramedic students' clinical prac-tice experiences and raise social and policy interests.