Paramedic Roles Research Articles

Progressing as a trainee ACP

In this instalment of Paramedic Roles, Abbie-Louise Frake sheds some light on her current role as a trainee advanced clinical practitioner, reflecting on where she has been and where she is headed

Getting to grips with neurosciences intensive care

In this month's instalment of Paramedic Roles, Oliver Saddler shares his journey towards becoming a trainee advanced critical care practitioner in neurosciences intensive care, and walks us through a day in his work life

Development of physical employment standards of specialist paramedic roles in the National Ambulance Resilience Unit (Naru)

AimTo develop evidence-based role-specific physical employment standards and tests for National Ambulance Resilience Unit (NARU) specialist paramedics. MethodsSixty-two (53 men, 9 women) paramedics performed an array of (1) realistic reconstructions of critical job-tasks (criterion job performance); (2) simplified, easily-replicable simulations of those reconstructions and; (3) fitness tests that are portable and/or practicable to administer with limited resources or specialist equipment. Pearson's correlations and ordinary least products regression were used to assess relationships between tasks and tests. Performance on reconstructions, subject-matter expert and participant ratings were combined to derive minimum acceptable job performance levels, which were used to determine cut-scores on appropriate correlated simulations and tests. ResultsThe majority of performance times were highly correlated with their respective simulations (range of r: 0.73–0.90), with the exception of those replicating water rescue (r range: 0.28–0.47). Regression compatibility intervals provided three cut-scores for each job-task on an appropriate simulation and fitness test. ConclusionThis study provides a varied and easily-implementable physical capability assessment for NARU personnel, empirically linked to job performance, with flexible options depending on organisational requirements.

Teaching in the British Army

In this instalment of Paramedic Roles, Sgt Ty Jewell shares some insight into his role as a paramedic in the British Army and how things operate, reflecting on his own contributions and passion for teaching

Non-medical prescribing for paramedics in primary care

As paramedic roles continue to grow and diversity, the number of paramedics working in primary care is on the rise. Knowledge of non-medical prescribing specifically for paramedics in these settings is necessary, as are new frameworks for medicines management beyond the ambulance services and for general practice in particuar. This instalment in the Prescribing Paramedic series discusses prescribing in primary care settings including some of the more practical aspects of relevance to paramedics.

Flying to new heights as an advanced flight paramedic

In the fourth instalment of Paramedic Roles, Jared Bishop reflects on his journey in Canadian paramedicine that brought him to his current role as an advanced care paramedic (flight) in Northern Saskatchewan

What is an expedition medic?

In the third instalment of Paramedic Roles, Jakki Owens reflects on the multidisciplinary nature of expedition medicine, and details areas that can be the most far-ranging from a paramedic's natural environment.

A day as a prison paramedic

In this second instalment of Paramedic Roles, Rachel Hodgett shares what a day in the life of a prison paramedic looks like, alongside what led her there, and the job's unique challenges and rewards.

Life as a locum

Most health professionals are likely to weigh up the pros and cons of becoming a locum at some point in their careers. The prospect of being able to choose where and when you do or do not work is often a big pull. In this first instalment of the JPP Paramedic Roles column, Suki Kaur, who has been a paramedic since 2013, explores why she decided to become a locum emergency care practitioner 3 years ago.

A Taxonomy of Australian and New Zealand Paramedic Clinical Roles

Introduction This article aims to summarise and categorise the current types of frontline paramedics in Australia and New Zealand, their relative scopes of practice, their qualifications and training, and the titles used in each jurisdictional ambulance service. Methods Each of the 10 jurisdictional ambulance services were contacted and their current clinical roles discussed with a manager or senior paramedic between June and October 2020. Information was summarised in tables and text. Results Minimum qualifications for paramedics range from a diploma to an undergraduate degree, with graduate programs ranging from six to 18 months’ duration. Additional minimum qualifications for Extended Care Paramedics range from no minimum qualifications to a nursing degree. Additional minimum qualifications for Intensive Care Paramedics range from no minimum qualifications to a postgraduate diploma. Additional minimum qualifications for Retrievalists range from no minimum qualifications to a master degree. Helicopter emergency medical services (HEMS) teams range from primarily physician-led in four services to autonomous paramedics in five services. Armed offender paramedics exist in four services; urban search and rescue paramedics exist in five services; wilderness paramedics exist in five services; CBRNE paramedics exist in three services; mental health paramedics exist in three services. Special Operations variously refers to HEMS, USAR, CBRNE or armed offender. Critical Care variously refers to Intensive Care, HEMS in a physician-led team and autonomous HEMS. Advanced life support refers to paramedics and intensive care. Rescue Paramedic refers to road crash extrication or wilderness paramedics. Flight Paramedic refers to Paramedics or Intensive Care Paramedics, either HEMS or fixed wing. Conclusion The jurisdictional ambulance services are heterogenous in the structure, qualifications, training and terminology for their frontline paramedic roles. Due to this lack of consistency, roles for paramedics in Australasia are currently largely incomparable between services, rendering shared titles inoperable from intranational and international perspectives.

A Rapid Review of Pandemic Studies in Paramedicine

Introduction The spread of COVID-19 has challenged the paramedic community's ability to provide health care, maintain personal safety, and implement evidence informed decisions and programs. The study objective was to examine the published literature related to paramedicine and pandemics. Methods A rapid review of research derived from an existing broad database of literature generated between 2006 and 2019 was used. We conducted a targeted secondary search of this database to identify studies of pandemics in paramedicine contexts and included three levels of screening. We used content analysis to identify broad themes and subthemes, and provide summaries and descriptions of each. Results From 54,638 citations, our search identified 24 citations representing eight countries. The most common method of enquiry was cross-sectional survey (n=10). Five broad themes (and 15 subthemes) were identified: general planning and preparedness (impact to paramedic service operations, roles and responsibilities, communication centre preparedness, paramedic service preparedness, training); workforce (availability of personal protective equipment, safety of family, perception of risk, trust in the organisation); ethics (duty, resource allocation); (triage (needless exposure to infection, transmission of disease); and vaccination (vaccination information, organisational readiness). Conclusion The evidence base describes the importance of pandemic planning and preparedness for emergency medical services and integrating these activities into broader public health and healthcare system plans. Although this rapid review provides a foundation to support response plans and research, it is considered ‘just in time’ for the evolving pandemic, and further work understanding research in paramedicine and pandemics is recommended.

A job task analysis to describe the physical demands of specialist paramedic roles in the National Ambulance Resilience Unit (NARU).

The National Ambulance Resilience Unit (NARU) works on behalf of each National Health Service (NHS) Ambulance Trust in England to strengthen national resilience and improve patient outcome in challenging pre-hospital scenarios. To conduct a Job Task Analysis and describe the physical demands of NARU roles. A focus group was conducted to describe the physically demanding tasks performed by NARU personnel. Subsequently, the physical demands of the identified tasks were measured in 34 NARU personnel (29 male and 5 female). Eleven criterion tasks were identified; Swift Water Rescue (SWR), Re-board Inflatable Boat (RBIB), Set up Decontamination Tent (SDT), Clinical Decontamination (CD), Movement in Gas Tight Suits (MGTS), Marauding Terrorist Fire Arms (MTFA), Over Ground Rescue (OGR), Unload Incidence Response Unit Vehicle (UIRUV), Above Ground Rescue (AGR), Over Rubble Rescue (ORR) and Subterranean Rescue (SR). The greatest cardiovascular strain was measured during SWR, MGTS, and MTFA. The most thermally challenging tasks were the MTFA, CD, SR and OGR. The greatest muscular strength requirements were during MTFA and OGR. All five components of fitness (aerobic endurance, anaerobic endurance, muscular strength, muscular endurance and mobility) were required for successful completion of the physically demanding tasks performed by NARU personnel.

Rural paramedics’ capacity for utilising a salutogenic approach to healthcare delivery: a literature review

Introduction Australia has had a long-standing challenge in meeting rural and remote healthcare needs. Recently, new expanded paramedic roles have proven successful in addressing healthcare gaps, however, further research is needed to establish cost-effectiveness, sustainability and training. Equally, many established rural paramedics highlight primary healthcare as fundamental to their role. This study explores combining paramedics’ existing assessment scope and unique access to patients in their living environments with the introduction of a tool to measure sense of coherence, general resistance resources and social determinants of health to build patient resiliency to improve outcomes of current and future health events. Through utilising a salutogenic approach which addresses patient wellness and capacity for utilising health resources and knowledge, paramedics can provide a more holistic and patient-centred approach to care and care planning augmenting their existing clinical scope. Methods As this study aimed to establish the feasibility of paramedics undertaking a salutogenic approach to healthcare delivery, seven questions were developed focussing on areas identified as necessary components of feasibility within the paramedic paradigm. A systematic overview of literature was conducted to identify the connection between the salutogenic theory and the provision of pre-hospital care. ResultsFifty-four articles outlined the factors associated with rural living and the aspects that impact on the potential for paramedics in rural communities to undertake a salutogenic approach to healthcare delivery. Additionally, two pieces of grey literature were identified as pertinent to the research. Conclusion It is reasonable to assume that it is a feasible option for rural paramedics to utilise their current skills and unique access to patients in rural and remote settings in a salutogenic approach to healthcare delivery by undertaking assessments of patients’ sense of coherence, general resistance resources and social determinants of health.

Perspectives from the frontline of two North American community paramedicine programs: an observational, ethnographic study.

Community paramedicine is one emerging model filling gaps in rural healthcare delivery. It can expand the reach of primary care and public health service provision in underserviced rural communities through proactive engagement of paramedics in preventative care and chronic disease management. This study addressed key research priorities identified at the National Agenda for Community Paramedicine Research conference in Atlanta, USA in 2012. The motivations, job satisfaction and challenges from the perspectives of community paramedics and their managers pioneering two independent programs in rural North America were identified. An observational ethnographic approach was used to acquire qualitative data from participants, through informal discussions, semi-structured interviews, focus groups and direct observation of practice. During field trips over two summers, researchers purposively recruited participants from Ontario, Canada and Colorado, USA. These sites were selected on the basis of uncomplicated facilitation of ethics and institutional approval, the diversity of the programs and willingness of service managers to welcome researchers. Thematic analysis techniques were adopted for transcribing, de-identifying and coding data that allowed identification of common themes. This study highlighted that the innovative nature of the community paramedic role can leave practitioners feeling misunderstood and unsupported by their peers. Three themes emerged: the motivators driving participation, the transitional challenges facing practitioners and the characteristics of paramedics engaged in these roles. A major motivator is the growing use of ambulances for non-emergency calls and the associated need to develop strategies to combat this phenomenon. This has prompted paramedic service managers to engage stakeholders to explore ways they could be more proactive in health promotion and hospital avoidance. Community paramedicine programs are fostering collaborative partnerships between disciplines, while the positive outcomes for patients and health cost savings are tangible motivators for paramedic services and funders. Paramedics were motivated by a genuine desire to make a difference and attracted to the innovative nature of a role delivering preventative care options for patients. Transitional challenges included lack of self-regulation, navigating untraditional roles and managing role boundary tensions between disciplines. Community paramedics in this study were largely self-selected, genuinely interested in the concept and proactively engaged in the grassroots development of these programs. These paramedics were comfortable integrating and operating within multidisciplinary teams. Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs. Experienced and highly motivated paramedics with excellent communication and interpersonal skills should be considered for community paramedic roles. Practitioners who are proactive about community paramedicine and self-nominate for positions transition more easily into the role: they tend to see the 'bigger picture', have broader insight into public health issues and the benefits of integrative health care. They are more likely to achieve higher job satisfaction, remain in the role longer, and contribute to better long-term program outcomes. Paramedic services and policymakers can use these findings to incentivize career pathways in community paramedicine and understand those changes that might better support this innovative model.

Nursing, health informatics, and paramedic roles in prehospital management of overdose cases: Opioids and beyond

Nursing, health informatics, and paramedic roles in prehospital management of overdose cases: Opioids and beyond

Frontier and remote paramedicine practitioner models.

For the past 50 years paramedic services and paramedic roles in high-income nations have evolved in response to changes in community needs and expectations. The aim of this article is to review paramedic models of service delivery, with an emphasis on models that have the potential to improve the health and wellbeing of frontier and remote populations. Paramedic models of relevance to rural and frontier settings were identified from searches of CINHAL and Medline, while key paramedic-specific journals were individualy searched in the event that they were not indexed. Search terms were ambulance, paramedic and EMS. These were then combined with model* and rural, remote and frontier. These findings were then synthesised. During the 1950s and 1960s the volunteer transport model, based on the values of community informed self-determination, developed to meet local needs for transport to local hospitals and medical services. Somewhat later, the technological model, characterised by professionally staffed and managed paramedic systems providing prehospital using advanced technology and technically skilled staff, became the dominant model in metropolitan and regional settings. Paramedic practitioner models are now emerging that are part of integrated prehospital systems. These provide a range of services to prevent injury and illness, respond to emergencies and facilitate recovery, and contribute to efforts to produce a healthy community. Implementation of paramedic practitioner models in frontier and remote settings raises challenging policy and practice issues, including changes in scopes of practice, design of education programs, self-regulation of paramedics, and reimbursement.

Self-regulation and medical direction

PurposeThe purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.Design/methodology/approachA case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.FindingsParticipants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.Originality/valueIn North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

Effects of Clinical Placements on Paramedic Students’ Learning Outcomes

Background: Clinical placements are of major importance in students’ learning processes through creating supportive environments and fostering independence into paramedic professional roles. The study aimed to explore whether clinical experiences in out-of-hospital emergency services affected students’ learning outcomes and satisfaction.
 Methods: A retrospective study was carried out using preceptors’ evaluations (n=160) and students’ feedback forms (n=21). Descriptive and non-parametric inferential statistics were used to analyse quantitative items, and open-ended questions were analysed using content analysis.
 Results: Findings showed that more than 70% of students were satisfied with the quality of preceptors and the fieldwork atmosphere. Preceptors reported that students’ clinical skills across all categories improved significantly in the last two weeks of training. Qualitative data indicated that students displayed appropriate behaviour and professional socialisation and were keen to learn, and demonstrated competence in paramedicskills.
 Conclusion: A supportive atmosphere and positive student–preceptor relationships are key attributes for clinical placements if students are to accomplish learning outcomes in out-ofhospital environments.

PP21 Can paramedics correctly recognise cardiac arrhythmias and does recency of training have an impact?

BackgroundParamedics increasingly utilise alternative care pathways and direct referrals to reduce Emergency Department admissions. The National Institute of Clinical Effectiveness (NICE) Transient Loss of Consciousness (TLoC) guidelines are one such...

Educating Paramedics for the Future: A Holistic Approach

The education and training of paramedics largely remains focused on an emergency medicine dominated curricula with limited attempts made to expand paramedic education to include primary care and public health topics that might better address the contemporary needs of practicing paramedics. In developed countries, paramedic roles and scopes of practice are changing in response to aging populations and the attendant prevalence of chronic conditions, advances in technology, changes in community expectations and broader health system challenges. The emergence of paramedic practitioner roles in a number of countries illustrates the impact of these social, technological and economic factors, and how paramedics are being integrated into the health systems of their respective countries. Countries such as the United Kingdom, Australia and New Zealand, have moved toward near-mandatory higher education models for paramedics. While three-year Baccalaureate degrees generally provide the scope and flexibility to introduce a wider range of studies in primary care and public health, they face the challenge of adding these topics to an already crowded curriculum. In countries without widespread access to Baccalaureate degrees in paramedicine the challenge of broadening the education of paramedics would appear to be near impossible within the constraints of relatively short entry-level programs. This paper describes how an Australian university is responding to this challenge through the development of a four-year Bachelor of Paramedic Practice with (Clinical) Honours program. The paramedic program was initially encompassed within a suite of allied health courses in 2009 and provided students with the qualification of Bachelor of Health Science / Master of Paramedic Practice. Shortly after its inception, the course was reviewed against the future needs of students, industry and the community. Practice trends and the educational requirements of future entry-level paramedics were critically examined in Australia and internationally through literature reviews, conference attendances, direct feedback from the field, and overseas visits. As a result, the program was modified, and after further review, a new four-year paramedic program will be offered to commencing students in 2018. The structure of the program will provide opportunities for students to gain skills and knowledge beyond that delivered in traditional paramedicine programs, including knowledge specific to primary health care and extended community paramedicine. These components of the program will allow for enhanced and flexible roles within communities and professional settings, and are responsive to calls for a holistic model of education to meet future paramedic role demands.