Paramedics are repeatedly exposed to traumatic and emotionally charged events, which can result in vicarious trauma (VT)—the enduring psychological impact of engaging empathetically with others’ trauma (McCann & Pearlman, 1990). VT has been linked to disruptions in core beliefs around trust, safety, and control, yet its cumulative impact in paramedicine is often overlooked (Meeker et al., 2025). Alongside trauma exposure, paramedics are required to perform significant emotional labour—the management of feelings to display appropriate emotions in professional contexts (Hochschild, 2012). Research suggests that while emotional suppression is culturally ingrained in ambulance services, its role in exacerbating stress or enabling resilience has been underexplored (Wines et al., 2019; Alavi et al., 2023). Despite growing recognition of mental health risks within the ambulance workforce (Faulkner, 2023), most research has focused on symptom measurement, stress, or burnout, neglecting how paramedics themselves construct meaning from these experiences. Importantly, exposure to trauma can also generate post-traumatic growth (PTG)—positive psychological change arising from adversity (Tedeschi & Calhoun, 2004). Evidence of secondary PTG in paramedics exists (Ogińska-Bulik et al., 2021), yet the relationship between VT, PTG, and professional identity remains largely untheorised. To address these gaps, this project will use a qualitative design, employing semi-structured interviews and reflexive thematic analysis to explore how UK paramedics narrate and make sense of VT and emotional labour, and how these experiences shape identity and potential for growth. By focusing on paramedics’ lived experiences and narratives, the study seeks to inform more compassionate, context-sensitive approaches to supporting wellbeing. This study will recruit 6 to 10 UK-registered paramedics who are currently working in frontline NHS ambulance services and have a minimum of three years’ operational experience. The requirement for a minimum of three years’ frontline experience ensures that participants are likely to have encountered sufficient exposure to vicarious trauma to provide meaningful reflections. Vicarious trauma is a common feature of sustained exposure to distressing incidents in this environment, and all eligible participants will have encountered such experiences. However, those no longer in a frontline ambulance role (e.g., working in primary care or education) will be excluded, as the study aims to explore how vicarious trauma and emotional labour are understood within the ongoing context of frontline emergency care. In line with Braun and Clarke’s guidance for reflexive thematic analysis (RTA), smaller samples are acceptable where data are rich, detailed, and fit for purpose (Smith, 2024; Braun & Clarke, 2013, 2021). For a Masters-level project, 6–15 interviews are typically recommended; however, Braun and Clarke note that data quality, not quantity, is key. Studies using rich, experiential interviews often require fewer participants to develop meaningful themes across the dataset. Furthermore, realist concepts like saturation are not applicable to RTA (Braun & Clarke, 2021), and instead the goal is to ensure sufficient information power (Malterud et al., 2016). Given the scope and time-limited nature of this MSc dissertation, a maximum of 10 participants has been set. This allows for deep engagement with each dataset while ensuring practical feasibility for recruitment, transcription, analysis, and write-up within the project’s timeframe. This is a qualitative study using semi-structured interviews and analysed through reflexive thematic analysis (Braun & Clarke, 2019). An inductive, experiential approach will be adopted, meaning that themes will be developed from participants’ own accounts rather than from pre-determined frameworks. The analysis will explore how UK paramedics make sense of vicarious trauma, emotional labour, professional identity, and post-traumatic growth, situated within their social and organisational context. The researcher is an experienced registered paramedic, and the project will be approached through a researcher-practitioner lens. This dual role will be critically reflected upon using a reflexive journal, acknowledging how professional experience informs, but does not dominate, interpretation of the data. All interviews will be audio-recorded, transcribed verbatim, and manually coded by the researcher. Coding will be conducted iteratively, with meaningful units grouped into codes and then into broader candidate themes through a recursive, reflective process of engagement with the data. Transcripts will adopt an orthographic style that captures not only what was said, but also how it was said—for example, pauses, emphasis, and intonation—where relevant to meaning (Braun & Clarke, 2022). This allows for a richer interpretative analysis and ensures fidelity to participants’ lived experiences. Transcription conventions (e.g., underlining for emphasis, inverted commas for reported speech) will be used consistently and explained in the final report. No statistical analysis or outlier management is required. Transparency, supervision, and ongoing reflexivity will support the credibility and trustworthiness of the findings, with a clear audit trail documenting analytic decisions throughout. The primary material is a semi-structured interview guide, structured around three phases: rapport-building openers, core reflective questions, and ethically framed closing prompts to support debriefing. The format is trauma-informed and flexible, designed to ensure consistency while allowing participants to focus on what matters most to them. Questions cover vicarious trauma, emotional labour, professional identity, and meaning-making, aligning closely with the project’s aims. All prompts are open-ended, emotionally attuned, and sensitively worded to reflect the emotive weight of the topic. Participants will also receive a participant information sheet, consent form, and debrief sheet. Interviews will take place online using secure video conferencing software (e.g., MS Teams or Zoom). They will last approximately 40–60 minutes and will be audio-recorded using the platform’s built-in function, then downloaded and stored on the University’s password-protected OneDrive system. Interviews will follow a semi-structured format, beginning with rapport-building before exploring participants’ experiences of vicarious trauma, emotional labour, identity, and potential growth. Interviews will be conducted by the researcher (Jenny Honour). Participants may choose to take part individually or in dyads (e.g., crewmates) and may withdraw at any time before data analysis begins, without giving a reason. Following the interview, participants will be emailed a debrief sheet and a list of relevant support organisations (e.g., Mind, TASC, Ambulance Staff Charity). Where multiple participants are interviewed together, ground rules for mutual respect and confidentiality will be established at the start. Interviews will be transcribed verbatim by the researcher, and all identifiable details will be pseudonymised during transcription. Transcripts and audio files will be securely stored on OneDrive for a maximum of 5 years, accessible only to the researcher and supervisor. Participants may request to review their transcript prior to analysis. Ethical approval was achieved from the University of Portsmouth on 3rd October 2025
It is a legal requirement for NHS ambulance trusts to collect patient ethnicity data, and improvements are needed as current adherence is poor. This study aims to interview frontline NHS ambulance staff in England, like paramedics or technicians, who complete ambulance call out documentation to explore the perceived barriers in this specific staff group to collecting this information. It is important to understand these barriers because the lack of patient ethnicity data in ambulance call-out documentation makes it difficult to monitor if health inequalities due to ethnicity exist. Health inequalities are unfair and avoidable difference in health, like when it was reported during the covid19 pandemic that black, Asian and minority ethnic groups were at higher risk of infection, severe symptoms, and death. This link was only found due to routine collection of patient ethnicity data. This study will look for volunteers across up to 10 NHS ambulance services in England who work in frontline roles, specifically those who have face-to-face contact with patients calling 999 and complete ambulance call-out documentation as a result. The study will aim to recruit 20 participants between February and July 2025. Participants will be asked to attend a 60- minute interview online using MS Teams.
This study explores how family members experience and perceive bereavement care provided by the ambulance service when a loved one dies in the pre-hospital setting. Bereavement care refers to the support provided to families after the death of a loved one. The study aims to understand what families need during this time and how ambulance services can improve their support. We will invite people who, in the past two years, have lost a family member while receiving care from the ambulance service. This includes cases where the patient died at the scene or shortly after being transported to the hospital. The two-year time frame ensures that experiences reflect current practices, without focusing on care during the COVID-19 pandemic. Participants will be interviewed either in person at a local ambulance service site or online via Microsoft Teams. The interviews will explore family members' experiences and what they felt was helpful or could have been done differently. Each interview will last between 30 and 60 minutes, and all responses will be anonymised to protect participants’ privacy. The results will be analysed to identify themes about what families value and need during this difficult time. This will help the ambulance service improve how it supports grieving families. We will recruit participants through posters in healthcare settings, social media, and partnerships with bereavement charities. Participation is voluntary, and people can withdraw at any point up to 24 hours after the interview. The study aims to highlight family members’ voices to ensure bereavement care is compassionate and meets their needs. Findings will be shared with the ambulance service and published to improve care standards.
art of patient care. Medical documentation prevents the loss of information and contributes towards improved ongoing medical care and can be referred to if there is a complaint regarding patients care, for research purposes and quality assurance. The purpose of this research, therefore, is to develop a framework, which can be used to improve the quality of medical documentation completed by PHECPs. This will require the identification of the information and knowledge gaps that PHECPS have regarding medical documentation and the manner in which they complete medical documentation. Solutions to the identified gaps will be provided by interviewing industry experts and reviewing current literature. The identified solutions will be used to create a clinical framework, which can be implemented to improve the quality of medical documentation recorded by PHECPs. This research will utilise a four-phase sequential explanatory mixed methodology. Phase one- quantitative phase: The PHECPS knowledge and perceptions of medical documentation will be assessed using a questionnaire with a quantitative design. Phase two, quantitative phase - Common problems and trends in medical documentation will be identified and quantitatively analysed on completed PRFs using a previously developed tool. Phase three - qualitative phase: Qualitative, semi structured interviews will be conducted to gain a greater understanding of the points identified in phase one and two of the research. Phase four: Assimilation of the data collected in phases 1,2 and 3 will be used to develop a proposed framework to improve MD. Phase four: A Delphi survey will be used to for additional expert input and consensus on the content and design of the framework
Objective: To explore what factors are associated with ambulance use for non-emergency problems in children. Methods: This study is a systematic mapping review and qualitative synthesis of published journal articles and grey literature. Searches were conducted on the following databases, for articles published between January 1980 and July 2020: MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. A Google Scholar and a Web of Science search were undertaken to identify reports or proceedings not indexed in the above. Book chapters and theses were searched via the OpenSigle, EThOS and DART databases. A literature advisory group, including experts in the field, were contacted for relevant grey literature and unpublished reports. The inclusion criteria incorporated articles published in the English language reporting findings for the reasons behind why there are so many calls to the ambulance service for non-urgent problems in children. Data extraction was divided into two stages: extraction of data to generate a broad systematic literature 'map', and extraction of data from highly relevant papers using qualitative methods to undertake a focused qualitative synthesis. An initial table of themes associated with reasons for non-emergency calls to the ambulance for children formed the 'thematic map' element. The uniting feature running through all of the identified themes was the determination of 'inappropriateness' or 'appropriateness' of an ambulance call out, which was then adopted as the concept of focus for our qualitative synthesis. Results: There were 27 articles used in the systematic mapping review and 17 in the qualitative synthesis stage of the review. Four themes were developed in the systematic mapping stage: socioeconomic status/geographical location, practical reasons, fear of consequences and parental education. Three analytical themes were developed in the qualitative synthesis stage including practicalities and logistics of obtaining care, arbitrary scoring system and retrospection. Conclusions: There is a lack of public and caregiver understanding about the use of ambulances for paediatrics. There are factors that appear specific to choosing ambulance care for children that are not so prominent in adults (fever, reassurance, fear of consequences). Future areas for attention to decrease ambulance activation for paediatric low-acuity reports were highlighted as: identifying strategies for helping caregivers to mitigate perceived risk, increasing availability of primary care, targeted education to particular geographical areas, education to first-time parents with infants and providing alternate means of transportation.
This research study aims to examine the relationship between inhibitory control performance and PTSD symptom severity in a sample of emergency service personnel, specifically paramedics and firefighters. It is hoped that this will contribute to the wider literature examining whether executive functioning difficulties, and inhibitory control difficulties more specifically, reflect a potential cognitive marker of PTSD. Exclusion criteria include neurological conditions/factors known to affect neurological functioning (e.g., ADHD, Epilepsy, neurological conditions associated with brain/head injuries). Interested participants will be provided with a online link to complete the study. Consenting participants will asked to complete the online versions of self-report questionnaires asking about experiences of traumatic events and PTSD symptoms as well as experiences of symptoms of depression. Participants will then proceed to complete an online version of two computerised inhibitory control tasks (the Go/No-Go and Irrelevant Singleton tasks). The study procedure is expected to take approximately one hour to complete and participants will be compensated with a £25 Amazon Voucher.
This will be an online survery to explore and understand the influences on paramedic prescribers' decision-making when prescribing antibiotics for acute cough in primary care settings in the UK. An online questionnaire will be distributed using Jisc Online Surveys. The questionnaire will be completable in 10-15 minutes. It will gather demographic information such as years experience, region of the UK, practice setting, consultation and home visit duration, access to support and supervision. Quantitative data using close-ended questions (e.g. Likert-scale and multiple choice questions) and open-ended questions to allow for greater insight into clinical, non-clinical, organisational influences on antibiotic prescribing for acute cough and views regarding paramedic role in antibiotic stewardship. Recruitment will take place via social media using Facebook groups (e.g. Prescribing Paramedics UK, Advanced Clinical Practitioner Forum, Paramedics In Primary Care, Primary Care Paramedics). Snowball sampling will be encouraged via professional contacts. Participation will be voluntary, unpaid, and withdrawal will be possible at all stages. Quantitative data will be analysed using descriptive statistics. Thematic analysis will be employed to summarise data from open-ended questions. The study will provide insights into paramedic prescribing behaviour. Findings may inform future training, antibiotic stewardship strategies, and policy developments.
To 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. Methods A 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. Results The 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. Conclusions This 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.
The method for training paramedics has changed over the last 20-30 years as the paramedic profession has evolved itself and this has resulted in a situation where there are paramedics operating within this field of clinical practice with varying levels of education. This may not represent a major challenge, however, many of those who were trained under the older style programmes have a desire to top-up for reasons of personal development and career progression. The number of registered paramedics with non-degree level education across the UK is unknown and there is a paucity of research in this area. Additionally, their educational needs and aspirations have not formally been identified. This could prove useful to higher education institutions seeking to develop such programmes, the regulator in terms of the overall education status of the paramedic profession as a whole and employers in relation to the continuous professional development of their workforce.
Part of wider PhD project Aim: To gain a comprehensive picture of current models of pre-registration practice based learning (PrBL) including the types of experiences and supervision being used. Sub-Objectives: • Collate data on current education practice in relation to PrBL • Collate data on PrBL models being used in pre-registration education • Collate data on PrBL supervision methods being used in pre-registration education
Background: Head injury is common in children with approximately 700 000 attendances at emergency departments annually; one-third are conveyed by ambulance. However, 75% of them are discharged with no treatment. Most head-injured children could be managed on scene. Aim: This study aimed to investigate paramedic assessment and management of children with minor head injury. Methods: A web-based survey of paramedics at one trust was carried out, and simple descriptive analysis was completed. Findings: Fifty-nine paramedics took part. Parental anxiety, mechanism of injury, presence of red flags, fear of consequences and safeguarding concerns were the most common reasons that paramedics convey children with head injury to the emergency department. Paramedics employ a variety of non-validated tools to help them assess and manage children with head injury, with the head injury guidance by the National Institute for Health and Care Excellence most used. A lack of confidence in wound closure was a key barrier to managing patients on scene, along with a perceived inability to manage children in general, limited GP availability, a lack of training in paediatrics and risk avoidance. Conclusions: Several factors inhibit the ability of paramedics to manage children with minor head injury on scene, leading to avoidable hospital conveyance. Three-quarters of paramedics said they would benefit from a clinical decision tool to support them in the assessment and management of children with minor head injury.
A multicentre, explanatory sequential mixed methods study. Phase 1 consists of an online survey and phase 2 involves semi-structured interviews with key stakeholders from UK NHS ambulance services in order to explore the perceptions and views of ambulance service staff on research culture and capacity building.