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Most UK ambulance services undertake remote assessments of 999 calls with nurses and paramedics to manage demand and reduce inappropriate hospital admissions. However, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they offer.

The retrospective descriptive study analysed data collected at Welsh Ambulance Services University NHS Trust (WAST) from prioritisation, triage, and audit tools between the 17th May 2022 to 8th November 2022. A total of 21,076 cases and 728 audits were included for review.

There was little difference in the type and frequency of the presenting complaints assessed, and clinical outcomes reached in percentage terms. Whilst paramedics had more highly compliant call audits and fewer non-compliant call audits, there was, again, little difference in percentage terms between the two, indicating positive levels of safety across the two professional groups.

There continues to be a substantial difference between UK paramedics to those in the Middle East, the United States, and some African nations, which may limit the applicability of findings. This study also looked at a six-month window from only one UK service using one type of prioritisation and triage tool. Future research could explore longer periods from multiple services using various tools. It is important to note that this study did not link outcome data with primary, secondary or tertiary care settings. Thus, it is impossible to determine if the level of care aligned closely with the final diagnosis.

The practical implications of this work include better workforce planning for agencies who have perhaps only employed one type of clinician or a reaffirmation to those who have employed both. The authors suggest that the training and education of both sets of clinicians could remain general in nature, with no overt requirement for specificity based on professional registration alone. Commissioners and stakeholders in the wider health economy should consider ensuring equitable access to alternative pathways for patients assessed by both nurses and paramedics.

It has been posited that UK nurses and paramedics are, by virtue of their consistency in education, skill set, licensure, and general experience, both able to achieve safe and effective remote outcomes in 999 settings. This study provides evidence to support that hypothesis. These results say more about the two professions' ability to work together rather than just the professions themselves. The multidisciplinary team approach is well-established in acute care settings, and is broadly considered to improve communication, coordination decision making, adherence to up-to-date treatment recommendations, and be positive for shared learning and development for younger colleagues.

Most UK services use a mix of nurses and paramedics; however, little is known about the differences in the types of cases managed by the two professions comparatively, their clinical outcomes, and the quality and safety they each offer. The most recent studies of this nature were published in 2003 and 2004 and looked only at low-acuity 999 calls when remote assessment was not even an established role for UK paramedics. This study updates the literature, identifies areas for future research, and applies to the international setting for the most part.

Paramedics are responsible for managing emergencies, caring for patients and performing life-saving procedures under heavy workloads, which can have a significant negative effect on their emotional eating and food addiction (FA) behaviors. Thus, this cross-sectional study aims to shed light on the relationship between emotional eating tendencies and FA in paramedics by considering their food preferences, sex, and body mass index (BMI) factors.

The questionnaire consisted of Yale Food Addiction Scale and Emotional Eating Questionnaire (EEQ), as well as sex, age, weight, height and number of snacks and main meals collected face-to-face from the 196 paramedics.

The FA prevalence was 14.9%, and more than half of the paramedics were emotional eaters. The total score of the EEQ was significantly higher in the FA diagnosed group than in the group FA not diagnosed (p < 0.001). The food preferences of the paramedics were found to differ significantly depending on whether they were diagnosed with FA or emotional eating. Being a food addict or emotional eater significantly increases the odds of consuming chocolate-wafer, pie-cake, chips, pastries, pasta and fries (p < 0.05), and participants with FA diagnosis and emotional eaters were more likely to prefer these foods than those with nondiagnosis and nonemotional eaters (p < 0.05).

Findings highlighted the connection between FA and the emotional eating behavior of paramedics, indicating that they attempt to compensate for their emotional ups and downs through eating. The job-related stress and emotional eating behaviors of paramedics may increase their BMI and susceptibility to FA.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

In this chapter we describe how paramedics deal with verbal and physical violence to expand on the available knowledge on this subject and relate it to their work-specific context. Our research consists of interviews in two large Dutch cities. We adopt a dramaturgical framework to discuss our findings. Paramedics initially ignore verbal abuse because they value the well-being of the patient above their own emotional needs. Furthermore, they utilize dramaturgical strategies – which entail emphasizing specific hallmarks of their work, such as compassion and professionalism – so that bystanders feel that the patient is in good hands. Not all of the paramedics interviewed proved capable of applying these strategies, resulting in more frequent exposure to physical violence for those paramedics. We conclude that managing emotions through impression-management, particularly one's own emotions and the emotions of bystanders, is crucial. Our recommendation is to further investigate the knowledge and skills present amongst paramedics in a larger qualitative follow-up study, and to repeat the study among other public professionals so that they may reap the benefits and (more) physical violence can be prevented in the future. Few studies exist that allow paramedics to describe their own experiences with violence on the job. In this chapter we let the paramedics do the talking.

Since 2018, Australian paramedics have been regulated under the National Registration and Accreditation Scheme (NRAS) for health practitioners. Established professions have been regulated in Australia for some time, so there is limited knowledge of their entry to regulation. However, as paramedicine has not been previously centrally regulated, this provides a unique case study to explore the transition to regulated practice.

Australian paramedics undertook two surveys: pre- and post-introduction of registration. The first survey was in the month leading up to the commencement of registration (N = 419), and the second survey took place 31 months after registration (N = 407). This paper presents the results of statistical analyses of the post-registration survey including comparisons to the pre-registration survey.

Although support for regulation has increased over time, there remains strong dissent consistent with 2018 levels. After 31 months of regulation, respondents reported increasing knowledge of the scheme and greater ease of navigation. The impacts of regulation are more nuanced and less polarised than in the first survey. Identity is again canvassed, and results suggest a shift from employment status and qualifications as key elements of identity to a community of practice and registration.

Paramedics' experiences and understanding of the rationale for registration are developing. Further support is needed to assist with the emerging professional identity and behaviours. Regulation is one of many occupational factors influencing professional identity and professionalism. Exploring the experience of regulation potentially assists regulators in better supporting practitioners and helps better understand professional evolution.

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.

A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.

Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.

In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

The purpose of this paper is to assess the extent of empathy in paramedic students across seven Australian universities.

A cross‐sectional study was carried out using a paper‐based questionnaire employing a convenience sample of first, second, and third year undergraduate paramedic students. Student empathy levels were measured using a standardised self‐reporting instrument: the Jefferson Scale of Physician Empathy‐Health Profession Students (JSPE‐HPS).

A total of 783 students participated in the study, of which 57 per cent were females. The overall JSPE‐HPS mean score was 106.74 (SD=14.8). Females had greater mean empathy scores than males 108.69 v 103.58 (p=0.042). First year undergraduate paramedic mean empathy levels were the lowest, 106.29 (SD=15.40) with second year's the highest at 107.17 (SD=14.90).

The overall findings provide a framework for educators to begin constructing guidelines focusing on the need to incorporate, promote and instil empathy into paramedic students in order to better prepare them for future out‐of‐hospital healthcare practice.

Paramedics increasingly attend to mental health-related emergencies; however, there has been little evaluation of the mental health training for paramedics. This study aims to analyze the fit between paramedicine pedagogy, patient needs and the conditions for paramedics’ skill development.

Data were collected in a single, qualitative, critical ethnographic case study of pre-hospital mental health and psychosocial care in paramedicine in Ontario, Canada. Transcripts from interviews (n = 46), observation (n ∼ 90h) and document analysis were thematically analyzed using a constant comparative method. The study is theoretically grounded in a feminist political economy framework.

Tensions are explored in relation to the pedagogy of paramedicine and the conditions of work faced by paramedics. The paper presents challenges and insufficiencies with existing training, the ways in which certain work and training are valued and prioritized, increased emergency care and training needs and the limitations of training to improving care.

Recommendations include more comprehensive didactic training, including the social determinants of health; scenario training; practicum placements in mental health or social services; collaboration with mental health and social services to further develop relevant curriculum and potential inclusion of service users.

This paper addresses the lack of mental health pedagogy in Ontario and internationally and the need for further training pre-certification and while in the workforce. It presents promising practices to ameliorate mental health training and education for paramedics.

The purpose of this research is to explore the interaction between organizational policies and daily work practices of paramedics and firefighters within two emergency response organizations.

Data were collected in a case study consisting of interviews, focus groups, and observations. The theoretical grounding for this research is framed by learning in practice through legitimate peripheral participation.

Analysis of the data found that paramedics and firefighters value learning in their daily work above initial qualification training. They learn in practice through increasing collaboration with others, and in the broader context of legitimate peripheral participation. Organizational policies can help in guiding their decision making processes, but learning in practice and relying on experience is most helpful in their daily work.

The notion of situated learning is insufficient to explain the dramatic performance of emergent, creative, and autonomous actions often required of individual emergency personnel in crisis situations.

This study adds to the current literature on communities of practice and legitimate peripheral participation. It applies learning theory to emergency response organizations to demonstrate the need to focus on practice and understandings in workplaces. The research also offers a greater understanding of the unique job of emergency response personnel who must often make instantaneous decisions in critical situations and must therefore understand their practice to ensure positive outcomes.

Violence against paramedics is a complex – but underreported – problem. Extant research suggests organizational culture may play a role in sustaining cultural norms that downplay the significance and limit reporting. The purpose of this paper is to qualitatively explore paramedics’ experience with violence, with particular emphasis on understanding how organizational culture contributes to under-reporting.

The authors surveyed paramedics from a single, large, urban service in Ontario, Canada, asking participants to describe their experiences with violence, including whether – and why or why not – the incidents were reported. Within a constructivist epistemology, we used inductive thematic analysis with successive rounds of coding to identify and then define features of organizational culture that limit reporting.

A total of 196 (33% of eligible) paramedics completed the survey. Fully 98% of participants disclosed having experienced some form of violence; however, only a minority (40%) reported the incidents to management, or the police (21%). The authors defined a framework within which a lack of support from management, and consequences for offenders, implicitly positions the ability of paramedics to “brush off” violent encounters as an expected professional competency. Disclosing emotional or psychological distress in response to violent encounters invited questions as to whether the individual is personally suited to paramedic work.

While the extant research has indicated that underreporting is a problem, the findings shed light on why – a critical first step in addressing what has been described as a serious public health problem.