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.
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 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.
Scoping review of literature to determine if there is any evidence supporting the PICO question directly and indirectly. Research evidence supporting the intervention of POCUS at a timeline within a patient care episode that would predict or rule in/rule out the need for CT head before clinical signs and symptoms of raised ICP due to mild to moderate TBI manifest.
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).
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.
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 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 last 4 years has seen England’s ambulance services sustain unprecedented pressure from the operational demand generated by the pandemic. Operational demand remains high, with system failures, low morale, toxic cultures and hazardous environments causing significant wellbeing, and retention problems. Ambulance staff are more likely to develop mental health conditions such as PTSD than any other emergency service, with many ambulance staff also suffering from assaults, and burnout. If ambulance service senior leaders were better connected to the needs of their staff, however, bespoke leadership models/qualities/skills could be introduced to counteract some of the challenges identified. At the time of writing, no UK research that explores what frontline ambulance service staff need from senior leaders by way of support could be found. This, therefore, is core the focus of our investigations: to understand perceptions and experiences of leadership among these staff, and the type of leaders they need to support them during challenging times. Semi-structured interviews (online) were utilised to capture data which allows the research question to be answered.
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.
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.