Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

Abstract

BackgroundParamedicine is a rapidly evolving health profession with increasing responsibilities and contributions to healthcare. This rapid growth has left the profession with unclear professional and clinical boundaries. Existing defining frameworks may no longer align with the practice of paramedicine or expectations of the public. The purpose of this study was to explore the roles paramedics in Canada are to embody and that align with or support the rapid and ongoing evolution of the profession.MethodsWe used a concurrent mixed methods study design involving a focused discourse analysis (i.e., analysis of language used to describe paramedics and paramedicine) of peer reviewed and grey literature (Phase 1) and in-depth one-on-one semi-structured interviews with key informants in Canadian paramedicine (Phase 2). Data from both methods were analyzed simultaneously throughout and after being merged using inductive thematic analysis.ResultsSaturation was reached after 99 national and international grey and peer reviewed publications and 20 in depth interviews with stakeholders representing six provinces, seven different service/agency types, 11 operational roles and seven provider roles. After merging both data sets three framing concepts, six roles and four crosscutting themes emerged that may be significant to both present-day practice and aspirational. Framing concepts, which provide context, include variable contexts or practice, embedded relationships and a health and social continuum. Roles include clinician, health and social advocate, team member, educator, professional and reflective practitioner. Crosscutting themes including patient safety, adaptability, compassion and communication appear to exist in all roles.ConclusionsThe paramedic profession is experiencing a shift that appears to deviate or at least place a tension on traditional views or models of practice. Underlying and evolving notions of practice are resulting in intended or actual clinical and professional boundaries that may require the profession to re-think how it is defined and/or shaped. Until these framing concepts, roles and crosscutting themes are fully understood, tested and operationalized, tensions between guiding frameworks and actual or intended practice may persist.

A Critical Analysis of Debates Around Mental Health Calls in the Prehospital Setting

“…Paramedics provide care in the field, en route to the hospital, and increasingly in community settings. Paramedics’ scope of practice varies by region and level of training 1 , 11 ; it includes both basic (eg, medication administration) and specialized (eg, intubation) interventions, as well as direct transport to facilities for suspected cardiovascular emergencies (eg, myocardial infarctions), among other skills and protocols. 1 Skillsets and structure of paramedic services vary both within and between countries and continue to develop.…”

“…This includes traditional response to acute emergencies, community health care and primary health care roles, as well as addressing more chronic health conditions, prevention, and education. 11 …”

“…Drawing on their experience as they interact with individuals in their everyday circumstances, they can join other practitioners in the critical health tradition by informing the understanding of these circumstances, and shift the conversation toward addressing their root causes. As the role and scope of practice of paramedics continue to evolve, paramedics are moving beyond acute physical health care and have the potential to become increasingly involved in both health and social advocacy as has already begun to occur and continue to shed light on the relationship between social context and health, 11 including mental health. This perspective may aid in working toward problematizing claims about the “mental illness” of individuals living in poverty and other challenging circumstances so as to ensure that their distress is not decontextualized or depoliticized.…”

Development of clinical and inter-personal skills to support people living with dementia

“…The importance of communication cannot be over emphasised as alongside patient safety and compassion was found to be one of the crosscutting themes in all paramedic roles (Tavares, Bowles, & Donelon, 2016). However, in this study paramedic students reported challenges in communicating with people with dementia and understanding their needs.…”

Coworker Influence Upon Individual Internalization of Safety

“…'Teamwork/diplomacy' is not defined in this study, however the term 'teamwork' emerges in other paramedic centred work, and is defined as the paramedic working in chain of patient care. The 'team members' include emergency room nurses, doctors and eventual outpatient services (Tavares, Bowles , & Donelon, 2016), most of whom a paramedic would have very little personal contact with. Post-traumatic stress is a current topic in the paramedic field.…”