ObjectivesThe aim of this study is to identify the types of community paramedicine programs and the training for each.MethodsA systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).ResultsFrom 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.ConclusionCommunity paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.

The development of competency frameworks in healthcare professions is characterised by potentially inadequate descriptions of practice, variable developmental approaches, and inconsistent reporting and evaluating of outcomes. This may be in part due to limited existing guidance, which neglects broader contexts, lacks organising frameworks, and fails to provide guidance on selection of methods. To address such concerns, this paper first outlines a 'systems thinking' conceptual framework by which to conceptualise and describe clinical practice when developing competency frameworks. This is achieved through combining Ecological Systems Theory and complexity thinking to identify, and explore the contexts and components of clinical practice. The 'systems thinking' conceptual framework is then integrated into a six-step model for developing competency frameworks that synthesises and organises existing advice. The six steps include (1) identify practicalities (e.g. purpose, scope, detail, timeline), (2) identify influencing contexts and factors using 'systems thinking', (3) use aligned mixed-methods, (4) translate data into competency frameworks, (5) report processes and outcomes, and (6) plan to evaluate, update and maintain the competency framework. The model provides a logical organising structure of principles to guide assumptions and commitments when developing competency frameworks. Additionally, the model affords the flexibility required when exploring professional practice across varying contexts, and suggests employing mixed methodological approaches that are aligned with purpose and scope. The model acknowledges changing and complex contexts, considers existing guidance, and adds a unique and complementary means to conceptualise and improve the competency framework development process.

Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from

<p>Introduction:  Community paramedicine (CP) establishes an ongoing patient relationship beyond short emergency care episodes. How care planning and case management have been adapted from the isolated incidents of traditional practice is unclear.  The objective of this study is to contribute to paramedic practice by examining broad areas of care planning in CP, identifying gaps in the evidence, clarifying key concepts, and reporting on the types of evidence that address and inform practice.  A qualitative analysis of included literature outlines program capacities and identifies comprehensive models of care that can inform clinical practice in CP.</p><p> </p><p>Methods:  A scoping study was completed that included conducting a systematic search of the literature (in MEDLINE and CINAHL) and selecting relevant studies, followed by data extraction, summarizing, and reporting.  The authors of included studies were contacted to confirm the aspects of care planning that were extracted from their respective studies.  Aspects of care planning were compared between studies and used to generate a comprehensive list of existing practices.</p><p> </p><p>Results:   Ten of 1648 studies met inclusion criteria.  Qualitative analysis identified 22 aspects of care planning along four themes; enrollment (n=3), assessment and management (n=6), intervention and care (n=5), and collaboration (n=8).  No study included all 22 aspects of care planning.  One aspect of care planning was present in all 10 studies; collaboration with primary care providers.</p><p> </p><p>Conclusion:  The aspects of care planning identified through this study provide a framework that can guide service providers in the delivery of care and researchers in defined outcome measures to be assessed.  Future program development should be guided by the finding that all articles included in this study included collaboration with primary care providers.  By summarizing care planning within CP programs, ongoing program development can embrace collaboration with other care providers to help insure that patients receive the appropriate care.</p>