Words by Ali Rengers
Although paramedicine is a key part of healthcare systems around the world, it lacks a universal definition. A recent study undertaken by Brett Williams, Bronwyn Beovich and Alexander Olaussen aimed to develop a universal definition of paramedicine in order to unify this continually advancing and maturing field.
Paramedicine has developed from emergency patient transport to independent out of hospital treatment utilising evidence-based practice and a unique collection of knowledge. Over a few decades Paramedicine has progressed rapidly, however, lack of well defined, uniform and universal paramedic standards and the use of different terms for out of hospital healthcare (EMT, EMS, paramedic) disunify the paramedic profession globally.
International differences due to different scope of practice and education requirements to be an out of hospital healthcare provider inhibits global collaboration and knowledge sharing. A lack of a universal definition for paramedicine causes lack of educational curriculum uniformity, limiting qualification transferability between countries. Current research shows that the attempts to define paramedicine are not on a global scale and centre around characteristics, role, regulation and professional standards.
Williams et al., aimed to utilise the Delphi methodology to develop the definition for paramedicine. The Delphi method involves a group of topic specific experts (in this case paramedicine leaders and advocates around the globe) answering, typically, between two to four questionnaires until consensus is reached. The degree of consensus between the group’s answered is assessed at the end of each round of questioning, and subsequent questions are refined using the previous round’s feedback. This study method has been used to develop definitions for other health fields including obstetrics and gynaecology, neurology and palliative care.
To begin the study, a literature search was undertaken to identify paramedicine related attributes and existing definitions. Six common attribute themes were established and became the basis of the Delphi study questionnaires. Questionnaire One asked which attributes the participants believed should be included in the definition of paramedicine while Questionnaire Two asked participants to include or exclude the top-ranking attributes unveiled in Questionnaire One. From these results, three definitions were generated and asked for evaluation in Questionnaire Three, with Questionnaire Four presenting the participants with the proposed definition of paramedicine and asking if it encapsulated paramedicine. Finally, the proposed definition was circulated to worldwide paramedicine industry groups for input and endorsement.
Following this process, the final definition of paramedicine was established as:
“… a domain of practice and health profession that specialises across a range of settings including, but not limited to, emergency and primary care. Paramedics work in a variety of clinical settings such as emergency medical services, ambulance services, hospitals and clinics as well as non-clinical roles such as education, leadership, public health and research. Paramedics possess complex knowledge and skills, a broad scope of practice and are an essential part of the healthcare system. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable or dynamic settings.”
As a novice paramedic, I understand that the paramedic profession is continually evolving. Until this point in time in Australia, the fledgling paramedic profession lacked a clear-cut definition with which to underpin the different approaches to patient care implemented across states and territories. With the changing from a certificate-based qualification to the new degree requirements for practice, a definition of paramedicine paves the way for consistent understanding of a paramedic’s role and expected traits and qualities. The definition further solidifies and legitimises paramedicine’s place within the healthcare system, encouraging current and future paramedics to contribute to their profession’s sparce research and publication fields. Finally, this definition encourages the move toward world-wide paramedic profession portability and education equivalency so that paramedics may more easily transfer their role, skills and knowledge to practice internationally
Overall, the results of the questionnaires determined that Paramedicine is an intricate and essential part of the healthcare system, with paramedics functioning in various settings with an extensive range of skills and roles. Although the attributes included in the definition of paramedicine are not unique in their own right, the amalgamation of these attributes is distinctive of paramedicine. The definition provides clarity to out-of-hospital healthcare providers, other disciplines, policy makers, the public and the media. As the paramedicine discipline continues to develop and grow globally, a revision of this developed definition would be advised.