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.
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.
When faced with children paramedics (and other healthcare professionals) may have to estimate weight which can be used as a basis for administering drugs. Many estimation techniques rely on the patient’s chronological age however this has been shown to be unreliable (Black et al., 2002; Marlow et al., 2011; Charlton, Capsey and Moat, 2020), and in some cases a patient’s age may be unknown. Other techniques include parental estimation (Krieser et al., 2007) and measuring systems based on height and size (e.g. Braselow tape). Anecdotally paramedics may use a child’s clothing size to estimate age, and thus weight, when this is unknown. It is expected that the findings of this study will be used to improve the safe and effective treatment of children treated by paramedics by informing methods to estimate weight. This study will use a combination of face-to-face and online questionnaires to compare parental estimation, age-based formulae, and clothing size based formulae to establish their accuracy. The reference standard will be that 70% of estimations are within 10% of the actual weight, and 95% are within 20% (Wells et al., 2017).
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.
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.
The demand for mental health support in England has risen sharply in recent years, exceeding the capacity of available services. Approximately 1.2 million people are currently on NHS community mental health waiting lists, placing increased strain on paramedics, who now spend an estimated 1.8 million hours annually responding to mental health-related calls. As frontline responders, paramedics play a critical role in providing urgent care to individuals experiencing mental health difficulties. However, existing research highlights that paramedics tend to feel frustration, uncertainty, and lack of confidence when managing patients with mental health presentations. Despite this, there is currently no standardised mental health education or training requirement for paramedics in England, and limited research has explored the specific knowledge gaps that hinder their ability to provide effective care. This study aims to identify and assess the knowledge gaps and educational needs of paramedics regarding mental health care. Findings will inform the development of targeted educational initiatives, equipping paramedics with the necessary skills to improve patient outcomes and bridge gaps in pre-hospital mental health care.
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.
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.
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.
This project is in partial fulfilment of a PhD that is exploring the relationship and impact of ethnic diversity and diversity training on cultural competence in frontline ambulance service staff. The first study in this PhD was a review of WRES data from all ten ambulance services in England, in order to gain an understanding of workforce equality. The second study was a scoping review of factors impacting cultural competence in healthcare personnel. This was conducted as the third study (this project) aims to survey frontline ambulance service staff diversity demographics, life experiences, training and cultural competence. However, to understand the relationship between these factors and cultural competence, the other factors impacting cultural competence need to be known and accounted for. The fourth and final study in this PhD (also part of this project), aims to explore frontline service staffs’ acquisition of cultural competence, and their experiences and perspectives of cultural competence, its associated diversity training and importance on professional practice.
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
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.