Background
Methods
Study overview
Phase 1 data source: literature
Category | Terms |
Key Terms for Paramedicine | • EMS* • Emergency medical services* • Paramedic* • Ambulance • Prehospital • Pre-hospital |
Secondary Terms | • Attributes • Capabilities • Competence* • Roles • Performance • Standards • Guidelines • Practice • Scope of practice • Themes • Trends • Change |
Activity | # Articles |
Initial Search (primary inclusion criteria) | 817 |
Initial Full Article Review | 25 |
Expanded Search (secondary inclusion criteria) | 3,174 |
Title/Abstract Review | 132 |
Final Articles for In-depth Analysis and Coding | 94 |
Data extraction and analysis
Phase 2 data source: interviews with stakeholders/Key informants
Overview
Participants
Interview guide
Health Care System | 1. In what way do paramedics contribute to the health care system? 2. In what way should paramedics contribute to the health care system? 3. What role are they holding now? (e.g., in ER, Flu shots) 4. Where do you see similarities when considering paramedics and other health care professionals? 5. Where do you see differences when considering paramedics and other health care professionals? 6. What do you see as deficiencies in practicing paramedics in the health care system? |
Position/Roles | 7. At the entry to practice level, what would you like to see in paramedics? Or put differently, what should paramedics be able to do in order to fulfill some of the role(s) or functions we have been discussing? 8. What are “your” (e.g., stakeholder group, practitioner, public) expectations of a paramedic? a. As they interact with you/your organization? b. As independent professionals? c. As collaborative member of a paramedic team or multi-disciplinary team? |
About the Individual | 9. Think of the best paramedic or paramedics you know. What is it about these individuals that make them great? 10. Paramedics work is varied contexts and with a broad range of patients. What do you think is the difference between those that consistently function well and those that don’t? 11. What are common deficiencies or errors paramedics are guilty off that perhaps should be addressed? 12. What professional attributes do you see as essential for paramedics to maintain, develop or refine expertise over the duration of their careers? 13. What attributes or capabilities are integral in paramedic practice? (prompts: can you think of both clinical (i.e., those that are associated directly with patient interactions) and non-clinical (i.e., those that do are not directly associated with patient interactions) attributes?) 14. Do you have anything else you would like to share with us regarding attributes of paramedics in Canada from your point of view, regardless of level, specialization or position, now and to the year 2020? |
Data collection and management
Data analysis and interpretation
Merging of the data and analysis
Results
Part 1 - initial results from the literature
Peer Reviewed: 77 | ||||
Acker, Johnston, & Lazarsfeld-Jensen | 2014 | Industrial paramedics, out on site but not out of mind. |
Rural and Remote Health
| Australia |
Armitage | 2010 | Role of paramedic mentors in an evolving profession. |
Journal of Paramedic Practice
| UK |
Backe, Kaul, Klubmann, Liebers, Thim, Mabbeck, & Steinberg | 2009 | Assessment of salivary cortisol as stress marker in ambulance service personnel: Comparison between shifts working on mobile intensive care unit and patient transport ambulance. |
International Archives of Occupational and Environmental Health
| Germany |
Ball | 2004 | Setting the scene for the paramedic in primary care: A review of the literature. |
Emergency Medicine Journal
| UK; English language literature |
Brown, Dickison, Misselback, & Levine | 2002 | Longitudinal emergency medical technician attribute and demographic study (LEADS): An interim report. |
Prehospital Emergency Care
| USA |
Brown, Margolis, Levine | 2005 | Peer evaluation of the professional behaviors of emergency medical technicians. |
Prehospital Disaster Medicine
| USA |
Burges Watson, Sanoff, Mackintosh, Saver, Ford, Price,… Murtagh | 2012 | Evidence from the scene: Paramedic perspectives on involvement in out-of-hospital research. |
Annals of Emergency Medicine
| UK, USA |
Campbell & Rasmussen | 2012 | Riding third: Social work in an ambulance. |
Health & Social Work
| Canada |
Campeau | 2008 | Professionalism: Why paramedics require theories of practice. |
Journal of Emergency Primary Health Care
| None Stated |
Campeau | 2011 | The paramedic kairotope theory: Findings. |
Journal of Paramedic Practice | Canada |
Clarke, Bradley, et al. | 2014 | Can paramedics use FRAX (the WHO Fracture Risk Assessment Tool) to help GPs improve future fracture risk in patients who fall? Protocol for a randomised controlled feasibility study. | British Medical Journal Open | UK |
Commission on the Future of Health Care in Canada, & Romanow | 2002 |
Building on values: The future of health care in Canada: Final report.
| Commission on the Future of Health Care in Canada | Canada |
Cooper | 2005 | Contemporary UK paramedical training and education. How do we train? How should we educate? |
Emergency Medicine Journal
| UK |
Cooper & Grant | 2009 | New and emerging roles in out of hospital emergency care: A review of the international literature. |
International Emergency Nursing
| International literature |
Cooper, Barrett, Black, Evans, Real, Williams & Wright | 2004 | The emerging role of the emergency care practitioner. |
Emergency Medicine Journal
| UK |
Cummins, Garavan, Dixon, Landymore, Mulligan & O’Donnell | 2013 | The advanced paramedic clinical activity study (APCAS): An insight into the work of advanced paramedics in the mid-west of Ireland. |
Irish Journal of Medical Science
| Ireland |
Dawson, King & Grantham | 2013 | Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. |
Emergency Medicine Australia
| UK |
Donaghy | 2008 | Higher education for paramedics – Why? |
Journal of Paramedic Practice
| UK |
Donaghy | 2008 | Equipping the student for workplace changes in paramedic education. |
Journal of Paramedic Practice
| UK |
Edwards | 2011 | Paramedic preceptor: Work readiness in graduate paramedics. |
Clinical Teacher
| Australia |
Evans, McGovern, Birch & Newbury-Birch | 2014 | Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedics system? A systematic review of the literature. |
Emergency Medicine Journal
| English Language LIterature |
Everden, Eardley, Lorgelly & Howe | 2003 | Emergency care: Change of pace. |
The Health Service Journal
| UK |
Heardman | 2014 | Treating people with cardiac chest pain: Role of paramedics. |
Emergency Nurse: The Journal of the RCN Accident and Emergency Nursing Association
| UK |
Hodge | 2014 | Developing leadership in the UK’s ambulance service: A review of the consultant paramedic role. |
Journal of Paramedic Practice
| UK |
Hou, Rego & Service | 2013 | Review article: Paramedic education opportunities and challenges in Australia. |
Emergency Medicine Australia
| Australia |
Hubble, Brown, Wilfong, Hertelendy, Benner & Richards | 2010 | A meta-analysis of prehospital airway control techniques part I: Orotracheal and nasotracheal intubation success rates. |
Prehospital Emergency Care
| English Language Literature |
Jackson | 2012 | Senior paramedic role at North West ambulance service. |
Journal of Paramedic Practice
| ?UK |
Jensen, Croskerry & Travers | 2011 | Consensus on paramedic clinical decisions during high-acuity emergency calls: results of a Canadian Delphi study. |
Canadian Journal of Emergency Medicine
| Canada |
Kilner | 2004 | Desirable attributes of ambulance technician, paramedic, and clinical supervisor: Findings from a Delphi study. |
Emergency Medicine Journal
| UK |
Kilner | 2004 | Educating the ambulance technician, paramedic, and clinical supervisor: Using factor analysis to inform the curriculum. |
Emergency Medicine Journal
| UK |
Lammers, Byrwa, Fales, Hale | 2009 | Simulation-based assessment of paramedic pediatric resuscitation skills. |
Prehospital Emergency Care
| USA |
Landman, Lee, Sasson, Van Gelder & Curry | 2012 | Prehospital electronic patient care report systems: Early experiences from emergency medical services agency leaders. |
PloS one
| USA |
Larkin & Fowler | 2002 | Essential ethics for EMS: Cardinal virtues and core principles. |
Emergency Medicine Clinics of North America
| Not declared; USA |
Lazarsfeld-Jensen | 2014 | Telling stories out of school: Experiencing the paramedic’s oral traditions and role dissonance. |
Nurse Education in Practice
| Australia |
Lord, Récoché, O’Connor, Yates & Service | 2012 | Paramedics’ perceptions of their role in palliative care: Analysis of focus group transcripts. |
Journal of Palliative Care
| Australia |
Margolis, Romero, Fernandez, Studnek | 2009 | Strategies of high-performing paramedic educational programs. |
Prehospital Emergency Care
| USA |
Mason, Wardrope, Perrin | 2003 | Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions. |
Emergency Medicine Journal
| UK |
Mason, Coleman, O'Keeffe, Ratcliffe & Nicholl | 2006 | The evolution of the emergency care practitioner role in England: Experiences and impact. |
Emergency Medicine Journal
| UK |
McClelland | 2013 | The research paramedic: A new role. |
Journal of Paramedic Practice
| UK |
McKean | 2013 | The forensic paramedic: An outline of the role and essential criteria for the job. |
Journal of Paramedic Practice
| UK |
Michau, Roberts, Williams & Boyle | 2009 | An investigation of theory-practice gap in undergraduate paramedic education. |
BioMedical Central Medical Education
| Australia |
Mulholland, Barnett & Spencer | 2014 | Interprofessional learning and rural paramedic care. |
Rural & Remote Health
| Australia |
Mulholland, O’Meara, Walker, Stirling & Tourle | 2009 | Multidisciplinary practice in action: The rural paramedic--it’s not only lights and sirens. |
Journal of Emergency Primary Health Care
| English language literature |
O’Meara, Tourle, Stirling, Walker & Pedler | 2012 | Extending the paramedic role in rural Australia: A story of flexibility and innovation. |
Rural and Remote Health
| Australia |
Pearson | 2003 | Emergency medical technician/paramedic’s role in prehospital drug delivery. |
Journal of Pharmacy Technology
| UK |
Petter & Armitage | 2012 | Raising educational standards for the paramedic profession. |
Journal of Paramedic Practice
| UK |
Reeve, Pashen, Mumme, De & Cheffins | 2008 | Expanding the role of paramedics in northern Queensland: An evaluation of population health training. |
The Australian Journal of Rural Health
| Australia |
Roberts & Henderson | 2009 | Paramedic perceptions of their role, education, training and working relationships when attending cases of mental illness. |
Journal of Emergency Primary Health Care
| Australia |
Ruple, Frazer, Hsieh, Bake & Freel | 2005 | The state of EMS education research project: Characteristics of EMS educators. |
Prehospital Emergency Care - Education and Practice
| USA |
Safaei | 2010 | A ride to care – a non-emergency medical transportation service in rural British Columbia. |
Rural and Remote Health
| Canada |
Shields & Flin | 2013 | Paramedics’ non-technical skills: A literature review. |
Emergency Medicine Journal
| UK; English language literature |
Silversides | 2009 | Canada’s ability to respond to a national health crisis hampered by jurisdictional issues, untested emergency plans. |
Canadian Medical Association Journal
| Canada |
Singh, MacDonald, Bronskill & Schull | 2007 | Interfacility transport of acutely-ill patients: Incidence of in-transit critical events. |
American Journal of Respiratory Critical Care Medicine
| USA |
Singh, Ferguson, MacDonald, Stewart & Schull | 2009 | Ventilation practices and critical events during transport of ventilated patients outside of hospital: A retrospective cohort study. |
Prehospital Emergency Care
| Canada |
Smart | 2009 | The role of the paramedic in health promotion. |
Journal of Paramedic Practice
| UK |
Stevens &Alexander | 2005 | The impact of training and experience on EMS providers’ feelings towards pediatric emergencies in a rural state. |
Pediatric Emergency Care
| USA |
Stevens, Jones, Smith, Nelson, Agho, Taylor & Raphael | 2010 | Determinants of paramedic response readiness for CBRNE threats. |
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science
| Australia |
Studnek, Fernandez & Margolis | 2009 | Assessing continued cognitive competence among rural emergency medical technicians. |
Prehospital Emergency Care
| USA |
Tam, Maloney, Gaboury, Verdon, Trickett, Ledu & Poirier | 2009 | Review of endotracheal intubations by Ottawa advanced care paramedics in Canada. |
Prehospital Emergency Care
| Canada |
Tavares & Mausz | 2013 | Assessment of non-clinical attributes in paramedicine using multiple mini-interviews. |
Emergency Medicine Journal
| Canada |
Tohira, Williams, Jacobs, Bremner & Finn | 2013 | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis. |
Emergency Medicine Journal
| UK; English language literature |
Trede | 2012 | Becoming professional in the 21st Century. |
Australasian Journal of Paramedicine
| None stated |
Trojanowski & MacDonald | 2011 | Safe transport of patients with acute coronary syndrome or cardiogenic shock by skilled air medical crews. |
Prehospital Emergency Care
| Canada |
Vilensky & MacDonald | 2011 | Communication errors in dispatch of air medical transport. |
Prehospital Emergency Care
| Canada |
Vopelius-Feldt, Wood & Benger | 2014 | Critical care paramedics: Where is the evidence? A systematic review. |
Emergency Medicine Journal
| UK; International literature |
Wang & Yealy | 2006 | Human patients or simulators for teaching endotracheal intubation: Whom are we fooling? |
Academic Emergency Medicine
| USA |
Wang & Yealy | 2006 | How many attempts are required to accomplish out of hospital endotracheal intubation? |
Academic Emergency Medicine
| USA |
Williams, Onsman & Brown | 2010 | Paramedic education: The significance of graduate attributes. |
Journal of Paramedic Practice
| Australia |
Williams, Onsman & Brown | 2012 | A Rasch and factor analysis of a paramedic graduate attribute scale. |
Evaluation & the Health Professions
| Australia |
Willis, Pointon, O’Meara, McCarthy & Lazarsfeld-Jensen | 2009 | Paramedic education: Developing depth through networks and evidence-based research – Executive summary. |
Australasian Journal of Paramedicine
| Australia |
Woollard | 2006 | The role of the paramedic practitioner in the UK. |
Journal of Emergency Primary Health Care
| UK |
Wyatt | 2003 | Paramedic practice – Knowledge invested in action. |
Journal of Emergency Primary Health Care
| Australia |
Youngquist, Henderson, Gausche-Hill, Goodrich, Poore & Lewis | 2008 | Paramedic self-efficacy and skill retention in pediatric airway management. |
Academic Emergency Medicine
| USA |
Grey Literature: 22 | ||||
Bigham, Brooks, Maher | 2010 |
Patient safety in emergency medical services: Advancing and aligning the culture of patient safety in EMS.
| Canadian Patient Safety Institute | Canada |
Clarke, Harris, & Cowland | 2010 | Ethics and law for the paramedic. | Blaber, A. (2008). Foundations for Paramedic Practice. A theoretical perspective
| UK |
Commission on the Future of Health Care in Canada, & Romanow | 2002 |
Building on values: The future of health care in Canada: Final report.
| Commission on the Future of Health Care in Canada | Canada |
Daly | 2012 | The paramedic in the community: My story. |
Primary Health Care
| UK |
EMS Chiefs of Canada | 2006 |
The future of EMS in Canada: Defining the new road ahead. | EMS Chiefs of Canada | Canada |
Griffiths, Lowes & Henning | 2010 |
Pre-hospital anesthesia handbook.
| UK | |
Huot | 2013 |
Transition support for new graduate paramedics.
| Royal Roads University | Canada |
Institute of Medicine | 2007 |
Emergency medical services at the crossroads. | Institute of Medicine | USA |
Jensen, Blanchard, Bigham, Dainty, Socha, Carter … & Morrison | 2011 |
Canadian National EMS Research Agenda.
| EMS Chiefs of Canada | Canada |
Joint Royal Colleges Ambulance Liaison Committee | 2000 |
The future role of and education of paramedic ambulance service personnel.
| Joint Royal Colleges Ambulance Liaison Committee | UK |
Lazarsfeld-Jensen, Bridges & Loftus | 2011 | Transitions: Command culture and autonomous paramedic practice. |
RIPPLE
| Australia |
Margolis | 2005 |
The role of bachelor’s degree emergency medical services programs in the professionalization of paramedicine. | Doctoral dissertation | USA |
Morton-Cooper & Palmer | 2000 |
Mentoring, preceptorship and clinical supervision: A guide to professional support roles in clinical practice. | Blackwell | UK |
National Registry of Emergency Medical Technicians | 2005 |
2004 National EMS Practice Analysis. | National Registry of Emergency Medical Technicians | USA |
NHS Ambulance Chief Executive Group | 2009 |
Report of the National Steering Group on Clinical Leadership in the Ambulance Service. | NHS Ambulance Chief Executive Group | UK |
O'Meara, Walker, Stirling, Pedler, Tourle, Davis, Jennings, Mulholland & Wray | 2006 | O'Meara, P. Walker, J. Stirling, C. Pedler, D. Tourle, V. Davis, K. Jennings, P. Mulholland, P. Wray, D | Charles Sturt University | Australia |
Page | 2008 | The quest for competence: What does it take to achieve competence in EMS? |
EMS Magazine
| USA |
Page | 2013 | Clinical competence. |
Journal of Emergency Medical Services
| USA |
Slade | 2007 | Occupational competencies for paramedic preceptors. | Master’s thesis | |
Touchstone | 2010 | The importance of professional behavior. |
EMS World
| USA |
Williams | 2012 | Keeping a ‘stiff upper lip’ in paramedic practice: Coping with emotion work. |
Nurse Education Today
| UK |
Williams | 2010 | The individual, organizational, and system obstacles to patient-centric emergency medical services system design. | Master’s thesis | USA |
Part 2 results – interviews with stakeholder/Key informants
Percentage of Females/Males | Females = 25 % (n = 5); Males 75 % (n = 15) |
---|---|
Average Years of Service | 22 (SD = 8) |
Provinces Represented | Nova Scotia (n = 2); New Brunswick (n = 1); Quebec (n = 3), Ontario (n = 7); Alberta (n = 2); British Columbia (n = 3), Federal (n = 2) |
Services/Agency Types Represented (some participants hold multiple roles) | Ground (n = 10), Air (n = 4) and Military (n = 1) Paramedic Services; Educational Institutions (n = 8); Regulators (n = 1); Base Hospital (n = 3); Professional Associations (n = 5) |
Operational Roles (some participants hold multiple roles) | Paramedic (n = 15); Paramedic (non-clinical) Administrator (e.g., chief, deputy chief) (n = 7); Paramedic Field Supervisor (n = 1); Educator (n = 9); Regulator (n = 3); CQI/Standards (n = 3), Paramedic Researcher (n = 4); Patient Advocate (n = 1); Medical Director (n = 3); |
Practice Setting or Stakeholder Background (some participants hold multiple roles) | Land Paramedic Service (n = 12); Air Paramedic Service (n = 5); Rural (n = 2), Specialty (e.g., CBRNE) (n = 2); Military (n = 1), Community Paramedic (n = 2); International Paramedic (n = 3); Dispatch (n = 1); Emergency Department (n = 4); Other (n = 1) |
Practitioner Group (some participants hold multiple roles) | PCP (n = 4); ACP (n = 11); CCP (n = 5); EMD (n = 1); Physician (n = 3); Nurse (n = 1), Other (n = 1) |