Paramedicine is a constantly evolving field, with paramedic education programmes needing to be adaptable to keep up with changes in the scope of practice. Regulatory frameworks are crucial in guiding university programmes, providing students with the knowledge, skills, and professional attributes necessary to be safe and competent practitioners. This study aimed to identify variations in regulatory structures, the factors that influence those variations, and how they influence curricula. A descriptive-comparative approach was taken to examine paramedic accreditation processes, curricula, and syllabi across five countries using a modified Brady's model and extending the Comparative Education model. The findings suggest that paramedic services, regulatory authorities, and tertiary institutions must adopt a multilateral approach to recognise paramedicine's evolving scope of practice. All three stakeholders are responsible for aligning regulatory frameworks with industry needs and providing curricula guidance to tertiary institutions. This approach will enable paramedic education programmes to remain relevant and adaptable to changes in the field, ensuring that graduates are safe and competent practitioners. In conclusion, this study highlights the need for a collaborative effort between paramedic services, regulatory authorities, and tertiary institutions to recognise paramedicine's evolving scope of practice. The need for recognition of this evolution in both regulatory frameworks and curricula is a significant concern, and a multilateral approach is required to address this issue. This study provides valuable insights into the factors that influence variations in regulatory structures and their influence on curricula.
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 research seeks to understand the links between the culture in ambulance trusts, management decision making and the support provided to Disabled staff. The study will look at the understanding of the term disability, how it is viewed and what is involved in the decision-making process when a request for support is made.
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.
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.
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 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.
Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive the barriers and facilitators to the use of appropriate care pathways (ACPs) in NI are.
This study will explore how real-time feedback affects ambulance clinicians’ ability to perform ventilations during a simulated cardiac arrest scenario over six months. Ventilations, typically given via a bag-valve-mask (BVM), are a basic life support skill performed by paramedics in emergency situations, but evidence suggests that many clinicians struggle to deliver ventilations according to guidelines. Feedback during training can help improve these skills, but without regular updates or refresher training, the skills may deteriorate over time. The study will involve participants from a single ambulance service, randomly assigned to three groups. All of these groups will participate in a simulation using a resuscitation manikin. The first group will receive feedback on their ventilations at every session, the second will receive feedback only at the first session, and the third will receive no feedback and act as a control. Ventilation rates and volumes will be measured using a Zoll X-series monitor, which provides real-time feedback. The main aim of the study is to compare the quality of ventilations at the six-month mark between the three groups. A secondary focus will be tracking any changes in ventilation quality across the six months, to identify potential skill improvements or fade.
This study addresses the overuse of healthcare interventions in UK primary care, which can harm patients and strain healthcare systems. Overuse includes unnecessary tests, treatments, referrals, or diagnoses that are unlikely to benefit patients but could cause harm, such as side effects, psychological distress, or financial burdens. Healthcare professionals (HCPs) face challenges balancing necessary care with avoiding overuse, often due to factors like diagnostic uncertainty, fear of complaints, time pressures, patient expectations, and rigid clinical guidelines. This research explores HCPs’ experiences and perceptions of ‘not doing’, the intentional decision to avoid unnecessary interventions based on patients’ medical needs, values, and preferences. It also examines the under-researched area of documenting such decisions. Current professional guidelines offer limited direction in the documentation of ‘not doing’, and HCPs are often apprehensive about potential repercussions. This study, grounded in social constructivism, uses 40 semi-structured interviews with HCPs, including GPs, Paramedics and Nurses. Participants are recruited through purposive sampling. An interview guide, co-designed with PPI representatives and GP advisors, uses text-based vignettes to prompt discussion. Interviews conducted via video call are audio recorded, transcribed, and analysed using Reflexive Thematic Analysis (RTA) with NVivo software. This method highlights patterns and variations while ensuring reflexivity and rigour.
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.
The study investigates paramedics’ coping actions for sustainable long-term work performance and burnout prevention. The research focuses on what individuals are doing to cope with their day-to-day stressors and the actions they take that may contribute to recovery and be protective against burnout. The research will involve short interviews to collect the data which should take 30 minutes. The interview will be conducted online (e.g. via Microsoft Teams). During the interview, the participant will be asked a series of questions about their experience of their job as a paramedic. Specifically, we will ask about day-to-day responsibilities, how individuals cope with these and if there are any challenges to applying coping strategies. With permission, the interview will be recorded, but participants can choose to keep their cameras off if they wish. Inclusion criteria: current or former practising paramedics, aged 18 and over, who can give informed consent. Exclusion criteria: Paramedic Students or individuals currently diagnosed with and receiving treatment for mental health disorders, such as burnout, mood and anxiety disorders.