Paramedicine is undergoing a rapid change on a steep trajectory in a short time. Indeed, there is still a widely held view that paramedicine and ambulance services are two of the same thing, but the reality is starkly different. Whilst much attention is focused on the front-line of paramedicine through the lens of emergency ambulance services, there is a paucity of any real insight into the upper echelons in the corridors of power and influence of and within the profession and associated linked ecologies. Professionalisation has been at the forefront of the profession's agenda for many years - developing organically, with no apparent clear or directed strategy. Indeed, whilst paramedicine demonstrates many of the classic hallmarks of a profession as seen in classic sociology of professions literature (McCann, 2022, Leicht and Fennell, 2001, Muzio et al., 2019), this development has not been in congruence with all parts of the sum. Paramedics in the UK are represented by, and regulated by UK-wide bodies – but work in increasingly stratified areas: 3 national, ten regional ambulance services in four public healthcare bodies reporting to four different governments – let alone outside the ambulance sector. With the profession no longer limited to its historical organisational home how can, and more importantly, does the profession have a strategy (Hambrick and Fredrickson, 2005) and who “owns” it? To date, research into the paramedic profession has almost exclusively focused on the operational frontline clinicians (McCann, 2022). This study aims to ask the following key research questions, at a senior/strategic level. Given the focus on strategic and system level thinking in the wider NHS at this time, this work is critical to add to this area of importance. • How is the paramedic profession pursuing a professionalisation strategy? • What are the roles and implications for different constituents in this process? • How can we understand the boundaries of the profession's claimed “scope/territory”? • How can we evaluate the possible success/failures of the strategy?
This research aims to assess the impact of Community First Responder (CFR) involvement on the outcomes of Out-of-Hospital Cardiac Arrest (OHCA) cases within the North East Ambulance Service (NEAS) region. The study will focus on the Return of Spontaneous Circulation (ROSC) rate, alongside secondary outcomes such as bystander interventions and clinical management metrics, comparing CFR-attended and non-CFR-attended cases. It will also examine the specific impact of the Newcastle University First Responder Scheme on OHCA outcomes. The project will analyse routinely collected OHCA data from 2019 to 2024, using a retrospective cohort design. The primary aim is to investigate whether CFR involvement leads to improved ROSC rates and other clinical outcomes. A secondary focus will be on exploring the effectiveness of the Newcastle University CFR scheme within the NEAS region. Building on a 2023 analysis of urban and rural OHCA outcomes, this study will expand the dataset to five years of data. This broader scope will allow for a more detailed exploration of CFR impact, specifically whether CFR intervention is linked to improved ROSC at hospital. The study will use anonymised data from NEAS’s OHCA audit database, including key variables such as CFR dispatch status, bystander CPR, and ROSC rates. Statistical analyses using SPSS will compare outcomes between CFR and non-CFR cases, adjusting for confounders like demographics and response times. The findings will add to the evidence base on the role of CFRs in OHCA care, providing insights into their effectiveness in improving clinical outcomes. These results will inform future initiatives involving CFRs. The research will be disseminated through peer-reviewed publications to the British Paramedic Journal, conference presentations, and internal reports to NEAS and other CFR schemes. This research has received funding from the College of Paramedics small research grant.
The study aims to obtain a comprehensive view of the EDI landscape within prehospital critical care by exploring a diverse range of clinician perspectives. This includes those currently working within critical care roles and those from the broader prehospital workforce who may aspire to or have previously sought critical care positions. By capturing positive and challenging experiences in accessing and progressing within critical care roles, this study seeks to identify actionable insights that will benefit all levels of the prehospital clinical workforce. The study is in the form of an anonymous online questionnaire. It is a collaboration between AAKSS and SECamb.
This qualitative study is exploring stakeholder perspectives with experience of paramedics working in primary care, on the education and training required to work effectively as a paramedic in primary care settings, establishing whether paramedics have the appropriate education, training, and skills and whether this model is sustainable.
Background and rationales: Recognising that someone has deteriorating health can be a trigger for a change in their care plan, and potentially for advance care planning and introducing palliative care. While there are tools that can provide an objective measure of someone’s health status (for example scales designed to measure functional status), changes in a patient’s general appearance may be the first sign that their health is deteriorating. For example, people with white skin may look ‘grey’ or ‘sallow’ as their illness advances. For people with advanced and life-limiting illness, these subtle cues can be a trigger for health care professionals to discuss goals of care, the risks and benefits of further treatment, or to refer to specialist palliative care teams. We know that people from minoritised ethnic groups are less likely to access specialist palliative care and more likely to have frequent Emergency Department visits towards the end of life, though the reasons for this are not clear. We also know that identification of a diverse range of skin signs (such as rashes, pressure damage) can be challenging among people of colour. If health professionals are less able to identify deteriorating health among people of colour, this could lead to higher rates of Emergency Department attendance near the end of life, or delay in referral to palliative care. Whether and how skin colour influences how health professionals make judgements about people’s health in advancing illness is unclear, but is a potential source of racial bias. Research Questions: 1/ What are the skin changes that are used by health and care professionals as an indication that someone with advanced illnesses is deteriorating? 2/ How confident and competent are health and care professionals in identifying these skin changes in people of colour? Method: Two workstreams will occur in parallel. WS1: A rapid review will be undertaken to identify published evidence on (i) changes in skin and appearance that may indicate that someone with advanced illness is deteriorating, (ii) whether these changes are as readily identifiable among people of colour, and (iii) health and care professionals’ confidence in identifying these changes. Using guidance on literature searching for rapid reviews from the Cochrane Rapid Reviews Methods Group, we will perform focused searches on MEDLINE and Embase databases via OVID and utilise citation searching of known relevant references to supplement. Based on scoping searches, we anticipate that the rapid review will identify relatively little evidence. Therefore, in WS2 we will draw on health and care professionals’ experiential knowledge. WS2 Expert consultations will be held with health and care professionals to explore their experience in using skin and appearance changes to identify deterioration in health for people with advanced illnesses. At least two expert consultations will be held online, each lasting 90-120 minutes, and each including 6-10 health and care professionals who regularly care for people with advanced illness. Professional groups will include GPs, geriatricians, community nurses, care home professionals and specialist palliative care professionals. One expert consultation will be for professionals who practice in the UK, selecting those who practice in areas with high levels of ethnic diversity. Another will be for professionals who practice outside the UK in countries where the majority of the population are people of colour. A facilitated conversation will explore professionals’ experience in identifying deteriorating health in people who have advanced illness, their confidence to identify these changes, and whether there are differences for people of colour. Findings from the rapid review will be used to guide questions. PPI: We will convene a group of patients and public members who represent diverse ethnicities to guide the research, meeting with them regularly to discuss the research questions and emerging findings. As part of WS2 we will invite PPI members to observe (with their cameras off) the expert consultations and feed back their reflections about the discussions to the research team, to guide interpretation. In the expert consultations, we will aim to explore: 1/ health and the professionals’ experience in identifying changes in skin that may indicate that someone with an advanced illness is deteriorating; 2/ whether these changes are as readily identifiable among people of colour; and 3/ health and care professionals’ confidence and competence in identifying these changes among people of all skin tones Eligibility of taking part in the online expert consultation includes all of the following (for UK-based professionals): 1/ Health and care professionals who regularly care for adults with advanced illnesses 2/ GPs, geriatricians, community nurses, care home professionals, paramedics, or specialist palliative care professionals 3/ practice in the UK and in areas with high levels of ethnic diversity The online expert consultation meeting will last 90 minutes and involve 6-10 health and care professionals who regularly care for adults with advanced illnesses. We are planning to hold the consultation for health and care professionals based in the UK on Thursday, 13 February 2025, 11.00-12.30 (GMT) on Microsoft Teams.
West Midlands Ambulance Service crews are taking blood and saliva samples at first point of contact with suspected stroke patients. These are then tested in University of Birmingham facilities to see if we can identify stroke biomarkers in these ultra-early samples.
Whilst research on MECC implementation and evaluation is fairly established in other areas of healthcare, there is limited existing evidence specific to the ambulance service setting, despite paramedics being in a unique position where they engage with a wide range of the population, some of whom may not routinely be seen by other healthcare professionals. Without clear evidence on how MECC has been implemented and how staff utilise this framework on a day-to-day basis, it is hard to evaluate or further improve its use. The study will be conducted in at least three UK NHS Ambulance Trusts, focus groups will seek to explore the content of MECC conversations discussed by participants, as well as the perceived barriers and facilitators of paramedics having MECC conversations.
Each year in Northern Ireland, there are approximately 1,400 out-of-hospital cardiac arrests (OHCA). With an increasing incidence of up to one third of OHCA, pulseless electrical activity (PEA) continues to present a challenge for paramedics, due to inadequate diagnostic capabilities, coupled with a lack of clinical guidelines to inform decision-making. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provide the only nationally accepted guideline for decision-making in PEA, which acknowledges the lack of supporting literature regarding termination of resuscitation for PEA in OHCA. Rapid transport to hospital and contacting senior clinical advice are key factors in JRCALC’s guidance, which is adopted by Northern Ireland Ambulance Service (NIAS) due to lack of a locally agreed decision tool. Subsequently, issues arise from failure to consider circumstances in which there is a lack of senior support, and transport is infeasible, which mirrors challenges faced by paramedics in Northern Ireland (NI). There is conflicting literature on the relationship between intra-arrest transport and survival rates, with one study concluding statistically significant higher survival rates with rapid intra-arrest transport, whilst another reports opposing statistically significant results of continued on scene resuscitation. Protracted transport times in NI, due to geographical and logistical constraints, in conjunction with the conflicting literature and absence of local PEA guidance, reinforces the difficultly faced by paramedics in deciding to terminate resuscitation. In NIAS, access to critical care clinical support is only available during the hours of 7am – 12am, depending on the availability of critical care paramedics, therefore, paramedics must rely on clinical judgement and shared decision-making to inform their rationale for termination of resuscitation of PEA. Despite the notable complexity of decision making in PEA, only one study exists exploring senior paramedic decision making when terminating PEA in OHCA in the United Kingdom. To date, no literature exists in relation to paramedic decision-making for PEA in NI, indicating the need for a study to understand how paramedics decide to terminate resuscitation in these circumstances. The proposed research question intends to develop evidence in this area for paramedics in NI. Paramedics working for the Northern Ireland Ambulance Service will be contacted to voluntarily complete a survey consisting of quantitative and qualitative questions relating to decision-making for termination of resuscitation of pulseless electrical activity in adult out-of-hospital cardiac arrest. Quantitative data will be analysed using descriptive statistics to provide a summary of the participants, without making statistical inferences. Qualitative data will be analysed using reflexive thematic analysis and displayed in themes. The study will be written up and submitted to the University of Hertfordshire as part of a Master's degree in Advanced Paramedic Practice.
Ambulance clinicians often encounter challenging situations involving patient deaths and serious accidents, requiring them to provide bereavement care to affected families. However, research indicates that many ambulance clinicians feel unprepared for this role, citing a lack of formal training in breaking bad news (BBN) and managing bereavement. This can lead to significant emotional strain, impacting their mental health, professional performance, and personal lives. Existing coping strategies and training protocols, such as SPIKES and GRIE_VING, have shown some promise but are not widely known or implemented in pre-hospital care. This study aims to address these challenges by exploring the perspectives and practices of ambulance clinicians in the North East Ambulance Service (NEAS) regarding bereavement care. The research seeks to understand how clinicians perceive their role in supporting families and to identify potential improvements in bereavement care delivery, both for the families and for the clinicians themselves. The study employs a mixed-methods approach. It will begin with a quantitative survey of NEAS clinicians to gather insights into their current bereavement care practices. This will be followed by focus group discussions to explore their experiences in greater depth. Participants will include frontline NEAS ambulance clinicians who have encountered bereavement care situations in the past five years. Findings from this research will provide valuable insights into the realities of bereavement care in pre-hospital settings and help to inform evidence-based strategies for training and support. Ultimately, the goal is to enhance bereavement care for families and better equip ambulance clinicians for this critical aspect of their role.
This is a sequential mixed methods, pre and post questionnaire study. Student paramedics from UK based universities will be asked to complete a quantitative questionnaire getting them to self rate their levels of reflection and well-being. They will then be given a digital tool (WRAPT tool) which is an online model of reflection to use whilst on their ambulance placement for a minimum of 4 weeks. After using this tool for a minimum of 4 times, for a minimum of 4 weeks they will then be given the same questionnaire getting them to self rate their levels of reflection and well-being and to rate the usability of the WRAPT tool. This will evaluate if there has been a change in the participants well-being, self insight, and self-reflective abilities after using the WRAPT tool. Based on the results of the questionnaires an interview guide will be created. A sample of participants who completed both questionnaires will be invited to discuss the strengths and weaknesses of the tool, as well as their overall experience.
Every year in England, there are around 8 million calls to the ambulance service. Only around 1 in 10 of these will be a serious emergency. The rest might have a health need that requires a different level of care - such as from a GP, pharmacist, or nurse. Some may even be patients that paramedics can treat and leave at home. It is hard for ambulance staff to work out what the exact care need of the complex patient is. There are lots of reasons for this, such as limited access to that patient's health data and a lack of available technology. In this study, we want to know what ambulance people think about the use of technology in these patients. The new knowledge from this study will help us understand why ambulance services are not using them to identify the care needs. We will ask lots of different types of ambulance people. These might be paramedics who respond in an ambulance. They could also be people who make the decisions on what technology goes on an ambulance. The way we will be asking all these people is through an interview. This lets us ask lots of questions to everyone, making sure we get all their views and beliefs. We can then look at all the answers and find what they all agree and disagree on about the topic. The way we have designed the study allows us to take the sample and generalise it to all UK ambulance services. This means the results will lead to a new way of thinking about how to bring this technology to the clinicians who need it, and to the patients who could benefit from it. Once we can work out the answers to these questions, we can start to create new care plans and help these patients in a meaningful way.
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.