Global Emergency Medical Registry

08/14/2025

USE OF ADVANCED PARAMEDICS IN HOSPITAL CRITICAL CARE AREAS – Michael Christie
https://www.gemr.org/blog/30/use-of-advanced-paramedics-in-hospital-critical-care-areas/

The use of advanced paramedics (APs) in hospital critical care areas is an evolving aspect of healthcare delivery, enhancing the capacity and effectiveness of medical response in high-acuity environments. Their expanded roles have been increasingly recognized as necessary due to various challenges facing emergency services, particularly the escalating demand for timely patient care and the pressures on medical institutions to optimize patient outcomes. Advanced paramedics’ involvement in critical care not only addresses the immediate medical needs of patients but also alleviates some of the burdens from emergency departments (EDs), enabling a more streamlined healthcare system.

A significant aspect of advanced paramedics' impact on critical care settings is their ability to undertake more complex medical interventions. Australian MICA (Mobile Intensive Care Ambulance) paramedics, for example, are trained in critical care protocols similar to those of hospital-based teams, allowing them to manage severe injuries effectively while on-site or during patient transport (Vopelius‐Feldt et al., 2013). They can administer advanced airway management, including life-saving procedures like intubation and chest tube thoracostomy, both of which have shown efficacy comparable to hospital settings in terms of complication rates (Vopelius‐Feldt & Benger, 2014). This capability empowers APs to provide pre-hospital critical care that can stabilize patients before they reach a hospital, potentially increasing survival rates from critical conditions such as cardiac arrests (Vopelius‐Feldt et al., 2015).

Moreover, the integration of advanced paramedics within rural and urban healthcare frameworks significantly diversifies their skill sets, allowing them to engage in both acute care and preventative health. Studies indicate that advanced paramedics can operate under standardized protocols to treat, stabilize, and refer patients without the immediate need for a physician’s oversight, which is particularly beneficial in rural settings where physician access may be limited (Feerick et al., 2022; , Power et al., 2019). This adaptability reflects an increasing recognition of their role in bridging the gap between emergency response and ongoing patient management, contributing to a reduction in hospital overcrowding by managing cases directly at the community level (Barry et al., 2022).

The application of curriculum enhancements for paramedics has also led to this role expansion. Current training programs have begun to include competencies in critical decision-making processes and interdisciplinary collaboration with other healthcare professionals (Campbell et al., 2012). Advanced paramedics employed in hospital settings often liaise directly with emergency nurses, ensuring smoother transitions of care for patients classified as low acuity. In fact, the use of APs to handle these less complex cases has demonstrated a reduction in the length of hospital stays, directly improving patient flow and operational efficiency within emergency departments (Campbell et al., 2012).

As the healthcare landscape continues to shift, there remains an imperative to understand the nuances of AP integration into hospital systems. Concerns have been raised regarding the long-term sustainability of relying on advanced paramedics to alleviate workforce strains within emergency services, particularly amidst the stresses associated with high-pressure environments in the healthcare sector (Stenner et al., 2021). Burnout and job dissatisfaction are notable issues that can affect paramedics, contributing to workforce turnover that complicates the goal of establishing consistently high-level care Power et al., 2019). Thus, while advanced paramedics bring invaluable skills to critical care, there is a need for systemic support to address the underlying challenges of recruitment and retention in this field.

The development of triage and treatment protocols, such as the "treat and discharge" framework in Ireland, underscores the potential of advanced paramedics to redefine patient management pathways. These protocols empower them to operate autonomously in various clinical scenarios, improving efficiency without compromising the quality of care provided to patients (Feerick et al., 2022; , Power et al., 2019). This paradigm shift aligns with international trends recognizing the effective functioning of APs in emergency medical services, where their training equips them with specialized knowledge applicable across diverse medical scenarios (Campbell et al., 2012).

Further empirical evidence pertaining to advanced paramedics’ roles in critical care indicates that they significantly enhance patient access to necessary medical interventions. They find themselves at the forefront of managing patients with complex health profiles who might typically overwhelm emergency departments. The practical involvement of APs ensures that interventions can be initiated promptly, where traditional hierarchies might result in delays (Campbell, 2017). Evidence also suggests that advanced paramedics possess a sophisticated understanding of geriatric assessments, preparing them to effectively address the unique needs of older patients (Goldstein et al., 2015).

Challenges faced by APs are manifold, including the pressing need for ongoing training to maintain high standards of practice. Given the broad scope of skills they must master, advanced paramedics require continuous professional development opportunities that reflect evolving healthcare practices (Jensen et al., 2013; , Brown, 2017). This aspect integrates the need for additional support systems within hospitals where these paramedics function, ensuring they can fulfill their roles competently and confidently.

In conclusion, the integration of advanced paramedics into hospital critical care areas represents a pivotal evolution in healthcare delivery, responding to the needs of an increasingly complex patient population. Their ability to leverage advanced skills effectively not only enhances patient outcomes in acute scenarios but also contributes to the overall efficiency of healthcare systems. As healthcare continues to evolve, embracing the role of advanced paramedics within critical care will be fundamental for improving service delivery and addressing the ongoing challenges facing emergency medical services.

REFERENCES:
Barry, T., Batt, A., Agarwal, G., Booker, M., Casey, M., & McCombe, G. (2022). Potential for paramedic roles in irish general practice: a qualitative study of stakeholder’s perspectives. HRB Open Research, 5, 40.
https://doi.org/10.12688/hrbopenres.13545.2
Brown, P. (2017). A day in the life of a paramedic advanced clinical practitioner in primary care. Journal of Paramedic Practice, 9(9), 378-386.
https://doi.org/10.12968/jpar.2017.9.9.378
Campbell, C. (2017). Ecmo transport: the role of critical care paramedics. Qatar Medical Journal, 2017(1).
https://doi.org/10.5339/qmj.2017.swacelso.53
Campbell, S., Janes, S., MacKinley, R., Froese, P., Harris, S., Etsell, G., … & Urquhart, D. (2012). Patient management in the emergency department by advanced care paramedics. Healthcare Management Forum, 25(1), 26-31.
https://doi.org/10.1016/j.hcmf.2011.12.001
Feerick, F., Connor, C., Hayes, P., & Kelly, D. (2022). Introducing advanced paramedics into the rural general practice team in ireland – general practitioners attitudes. BMC Primary Care, 23(1).
https://doi.org/10.1186/s12875-022-01740-9
Goldstein, J., McVey, J., & Ackroyd‐Stolarz, S. (2015). The role of emergency medical services in geriatrics: bridging the gap between primary and acute care. Canadian Journal of Emergency Medicine, 18(1), 54-61.
https://doi.org/10.1017/cem.2015.73
Jensen, J., Travers, A., Bardua, D., Dobson, T., Cox, B., McVey, J., … & Carter, A. (2013). Transport outcomes and dispatch determinants in a paramedic long-term care program: a pilot study. Canadian Journal of Emergency Medicine, 15(04), 206-213.
https://doi.org/10.2310/8000.2012.120965
Power, B., Bury, G., & Ryan, J. (2019). Stakeholder opinion on the proposal to introduce ‘treat and referral’ into the irish emergency medical service. BMC Emergency Medicine, 19(1).
https://doi.org/10.1186/s12873-019-0295-5
Stenner, K., Even, S., & Collen, A. (2021). Paramedic independent prescribing: a qualitative study of early adopters in the uk. British Paramedic Journal, 6(1), 30-37.
https://doi.org/10.29045/14784726.2021.6.6.1.30
Vopelius‐Feldt, J. and Benger, J. (2014). Critical care paramedics in england. European Journal of Emergency Medicine, 21(4), 301-304.
https://doi.org/10.1097/mej.0000000000000085
Vopelius‐Feldt, J., Coulter, A., & Benger, J. (2015). The impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest. Resuscitation, 96, 46.
https://doi.org/10.1016/j.resuscitation.2015.09.106
Vopelius‐Feldt, J., Wood, J., & Benger, J. (2013). Critical care paramedics: where is the evidence? a systematic review. Emergency Medicine Journal, 31(12), 1016-1024.
https://doi.org/10.1136/emermed-2013-202721

This ‘day-in-the-life’ article is the author's first-person account of his experiences as a paramedic working in an inner-city GP practice, while training to be an advanced clinical practitioner. The author aims to illustrate the range and complexity of the role of paramedics based in primary ca...

08/07/2025

USE OF ADVANCED PARAMEDICS TO PERFORM SEDATION IN HOSPITAL SETTINGS – Michael Christie
https://www.gemr.org/blog/29/use-of-advanced-paramedics-to-perform-sedation-in-hospital-settings/

The integration of advanced paramedics in hospital settings, particularly for the administration of sedation, marks a significant evolution in emergency medicine and patient care. The traditional roles of paramedics, primarily focused on pre-hospital care, are expanding into the hospital environment, where their skills in advanced procedures, including sedation, are increasingly recognized as essential for enhancing patient outcomes and operational efficiency. This discussion examines the use of advanced paramedics in performing sedation within hospital settings, emphasizing the implications for clinical practice, training, and patient safety.

Advanced care paramedics (ACPs) have demonstrated their capability in conducting procedural sedation across various medical contexts, including emergency departments and specialties such as gastrointestinal endoscopy. A study by Wiemer et al. noted that ACPs successfully administered sedation for emergency gastrointestinal endoscopy, highlighting their ability to manage complex sedation scenarios, including the use of agents like propofol and fentanyl, with critical patient monitoring (Wiemer et al., 2018). The observations from this research indicate that the successful application of sedation protocols by ACPs can help maintain high standards of care while facilitating complex procedures that might otherwise be delayed or require greater resource allocation (Wiemer et al., 2018).

The effective role of ACPs in sedation practices is further underscored by their capacity to handle various agents and manage associated risks. This proficiency is beneficial in routine settings and has proven invaluable during high-stress situations, such as dealing with agitated and violent patients. Scheppke et al. illustrated the successful application of intramuscular ketamine, a dissociative anesthetic, in prehospital settings to safely sedate agitated patients, paving the way for its use in emergency care environments where patient stabilization is paramount (Scheppke et al., 2014). These findings underscore the versatility of ACPs and their training in effectively utilizing ketamine and other sedatives while employing careful airway management strategies.

The evolving practice environment aligns with broader movements in healthcare that emphasize interdisciplinary collaboration. Stenner et al. discussed how enabling independent prescribing for paramedics allows them to engage in independent clinical decision-making, including the management of sedation (Stenner et al., 2021). This autonomy fosters a more dynamic team structure within hospitals, permitting agile decision-making and adapting treatment based on patient responses in real-time, ultimately enhancing care quality and efficiency (Stenner et al., 2021).

Despite these advancements, the introduction of paramedics into patient sedation practices necessitates rigorous training and standardization to address potential risks effectively. Research indicates that while adverse events during sedation administered by non-anesthetists are relatively rare, they can occur, and stratified risk assessments must be integrated into ACP training (Wiemer et al., 2018). Equipped with both the practical and theoretical knowledge related to sedation protocols, ACPs can better monitor patients for adverse effects, thus striking a balance between hastening patient throughput and ensuring stringent safety measures are upheld (Bellolio et al., 2016).

Training for advanced paramedics involves extensive education focused not only on pharmacological aspects but also on managing sedation-related complications. The emergence of community paramedicine models, as articulated by O'Meara et al., reflects a commitment to equipping paramedics with the necessary competencies to engage with complex patient needs within diverse care settings (O’Meara et al., 2015). These models reinforce the understanding that the expanding roles of paramedics in sedation should complement a broader commitment to continuous professional development, ensuring that ACPs are well-prepared to operate within the multifaceted hospital environment (O’Meara et al., 2015).

Moreover, the integration of paramedics in sedation practice must address logistical and operational considerations inherent in a hospital setting. Studies evaluating pretreatment outcomes and patient flow demonstrate that the use of ACPs can significantly reduce delays associated with procedures requiring sedation, ultimately benefiting patient management and resource utilization (Helmer et al., 2020). This capability aligns with ongoing discussions regarding the optimization of healthcare delivery models, particularly given the increasing demands on emergency departments.

Furthermore, the broader implications of ACPs performing sedation extend beyond immediate procedural contexts. The ability of paramedics to perform sedation could help bridge care disparities evident in acute medical settings. As advanced paramedic roles expand, the stakeholder perceptions illustrated by Barry et al. indicate a recognition of the valuable contributions paramedics can make in emergency settings and primary care (Barry et al., 2022). This trend has the potential to alleviate patient load in hospitals, thereby enhancing the overall functioning of the healthcare system.

In summary, the use of advanced paramedics to perform sedation within hospital settings signifies a paradigm shift in both the operational roles of paramedics and the overall structure of care delivery. Such practices are supported by evidence reflecting their competency and efficacy, bolstered by proper training and adherence to safety protocols. Continuous quality improvement efforts and stakeholder engagement are essential as the role of advanced paramedics in sedation evolves, ensuring that patient safety, care quality, and operational efficiency remain the overarching goals of healthcare systems.

REFERENCES:
Barry, T., Batt, A., Agarwal, G., Booker, M., Casey, M., & McCombe, G. (2022). Potential for paramedic roles in irish general practice: a qualitative study of stakeholder’s perspectives. HRB Open Research, 5, 40.
https://doi.org/10.12688/hrbopenres.13545.2
Bellolio, F., Gilani, W., Barrionuevo, P., Murad, M., Erwin, P., Anderson, J., … & Hess, E. (2016). Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta‐analysis. Academic Emergency Medicine, 23(2), 119-134.
https://doi.org/10.1111/acem.12875
Bhatt, M., Johnson, D., Chan, J., Taljaard, M., Barrowman, N., Farion, K., … & Roback, M. (2017). Risk factors for adverse events in emergency department procedural sedation for children. Jama Pediatrics, 171(10), 957.
https://doi.org/10.1001/jamapediatrics.2017.2135
Bongiorno, D., Peters, G., Samuels‐Kalow, M., Goldberg, S., Crowe, R., Misra, A., … & Cash, R. (2025). Racial and ethnic disparities in ems use of restraints and sedation for patients with behavioral health emergencies. Jama Network Open, 8(3), e251281.
https://doi.org/10.1001/jamanetworkopen.2025.1281
Burnett, A., Watters, B., Barringer, K., Griffith, K., & Frascone, R. (2012). Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium. Prehospital Emergency Care, 16(3), 412-414.
https://doi.org/10.3109/10903127.2011.640766
Campbell, S. and Froese, P. (2014). “midlevel providers” in the emergency department: don't forget paramedics!. Canadian Journal of Emergency Medicine, 16(01), 12.
https://doi.org/10.2310/8000.2013.131299
Chiaretti, A., Benini, F., Pierri, F., Vecchiato, K., Ronfani, L., Agosto, C., … & Barbi, E. (2013). Safety and efficacy of propofol administered by paediatricians during procedural sedation in children. Acta Paediatrica, 103(2), 182-187.
https://doi.org/10.1111/apa.12472
Clarke, B., Campbell, S., Froese, P., & Mann, K. (2019). A description of a unique paramedic role in a canadian emergency department. International Paramedic Practice, 9(2), 28-33.
https://doi.org/10.12968/ippr.2019.9.2.28
Cullingham, P. and George, G. (2023). Advanced sedation in oral surgery as an alternative to general anaesthetic: a service evaluation. Oral Surgery, 16(4), 331-335.
https://doi.org/10.1111/ors.12808
Flynn, D., Francis, R., Robalino, S., Lally, J., Snooks, H., Rodgers, H., … & Price, C. (2016). A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC Emergency Medicine, 17(1).
https://doi.org/10.1186/s12873-017-0118-5
Helmer, J., Acker, J., Deakin, J., & Johnston, T. (2020). Canadian paramedic experience with intramuscular ketamine for extreme agitation: a quality improvement initiative. Australasian Journal of Paramedicine, 17, 1-9.
https://doi.org/10.33151/ajp.17.763
O’Meara, P., Stirling, C., Ruest, M., & Martin, A. (2015). Community paramedicine model of care: an observational, ethnographic case study. BMC Health Services Research, 16(1).
https://doi.org/10.1186/s12913-016-1282-0
Pannifex, J., Cetiner, E., Wilkie, T., & Kelly, A. (2013). Design and roll out of standardised approach to paediatric procedural sedation in victorian emergency departments. Emergency Medicine Australasia, 25(6), 597-602.
https://doi.org/10.1111/1742-6723.12144
Park, J., Byun, Y., Lee, J., Lee, J., Ryu, J., & Choi, S. (2020). Safety and efficacy of pediatric sedation protocols for painless diagnostic examination in a pediatric emergency room of a single tertiary hospital..
https://doi.org/10.21203/rs.3.rs-112956/v1
Reibling, E., Green, S., Phan, T., Lopez‐Gusman, E., Fierro, L., Davis, A., … & Futernick, M. (2018). Emergency department procedural sedation practice limitations: a statewide california american college of emergency physicians survey. Academic Emergency Medicine, 26(5), 539-548.
https://doi.org/10.1111/acem.13619
Scheppke, K., Braghiroli, J., Shalaby, M., & Chait, R. (2014). Prehospital use of im ketamine for sedation of violent and agitated patients. Western Journal of Emergency Medicine, 15(7), 736-741.
https://doi.org/10.5811/westjem.2014.9.23229
Stenner, K., Even, S., & Collen, A. (2021). Paramedic independent prescribing: a qualitative study of early adopters in the uk. British Paramedic Journal, 6(1), 30-37.
https://doi.org/10.29045/14784726.2021.6.6.1.30
Turmelle, M., Moscoso, L., Hamlin, K., Daud, Y., & Carlson, D. (2011). Development of a pediatric hospitalist sedation service: training and implementation. Journal of Hospital Medicine, 7(4), 335-339.
https://doi.org/10.1002/jhm.979
Wiemer, H., Butler, M., Froese, P., Lapierre, A., Carriere, C., Etsell, G., … & Campbell, S. (2018). Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy. Canadian Journal of Emergency Medicine, 21(2), 235-242.
https://doi.org/10.1017/cem.2018.372

Objectives This was a systematic review and meta-analysis to evaluate the incidence of adverse events in adults undergoing procedural sedation in the emergency department (ED). Methods Eight elect...

07/31/2025

USE OF PARAMEDICS AS PROCEDURALISTS IN HOSPITAL ENVIRONMENTS – Michael Christie
https://www.gemr.org/blog/28/use-of-paramedics-as-proceduralists-in-hospital-environments/

The employment of paramedics as proceduralists within hospital environments marks a significant shift in healthcare paradigms, driven by increasing demands on emergency services and the evolving role of paramedics in clinical settings. With an expanding skill set that includes advanced care measures traditionally reserved for other medical professionals, paramedics can contribute more effectively to patient management, particularly in acute care scenarios.

Paramedics, who historically focused on pre-hospital care, have increasingly become integral to hospital emergency departments (EDs). Tavares et al. highlight that paramedics must provide safe and effective clinical care, drawing on their knowledge and skills while functioning within specified scopes and standards of practice (Tavares et al., 2016). This shift emphasizes the importance of equipping paramedics with the training necessary to perform procedures that enhance patient care and operational efficiency within hospitals. Enhanced training and clear protocols for paramedics facilitate the safe application of their skills in clinical environments, allowing them to engage in procedural tasks such as airway management and intravenous access (Ebben et al., 2017).

Furthermore, the inclusion of paramedics in procedural roles has been associated with improved patient safety and quality of care. McLelland et al. found that standardized protocols supporting paramedic involvement in acute situations, such as childbirth where rapid decision-making is vital, can augment emergency care effectiveness (McLelland et al., 2013). This recognition of paramedic capabilities aligns with findings from Evans et al., who report on the administration of advanced analgesic techniques, such as fascia iliaca compartment blocks, by paramedics, highlighting their effectiveness in improving pre-hospital pain management (Evans et al., 2019). Such procedural skills not only enhance the immediate care patients receive before reaching the hospital but also streamline the overall healthcare process by reducing treatment delays.

The operational benefits of integrating paramedics as proceduralists also manifest in acute cases such as strokes and myocardial infarctions. Bae et al. demonstrated that EMS prehospital notifications significantly shortened transfer and in-hospital processing times for acute stroke patients, showcasing that well-trained paramedics can play crucial roles in coordinating urgent care prior to hospital arrival (Bae et al., 2010). Furthermore, Lin et al. emphasized that timely communication between paramedics and hospital staff, aided by advanced training in stroke diagnostics, significantly improves treatment speeds post-admission (Lin et al., 2012). This synergy between pre-hospital care and hospital resources enhances overall patient outcomes and increases the efficiency of healthcare delivery systems.

Moreover, the application of telemedicine has evolved to include paramedics as valuable participants in remote consultations, especially in rural settings where immediate access to specialized care can be limited. Research by Bergrath et al. demonstrated the feasibility of teleconsultation by paramedics in acute stroke cases, which not only facilitated better immediate care but also informed subsequent hospital procedures (Bergrath et al., 2012). Such advancements signify an evolving landscape wherein paramedics act not only as transporters but as critical members of the healthcare team, capable of executing essential medical procedures to optimize patient outcomes.

Paramedics’ enhanced roles in hospital environments necessitate ongoing professional development to maintain competency in complex procedures. As outlined by Suryani et al., hospitals must invest in the continuous training and engagement of paramedics to ensure they remain proficient in their expanded scope of practice (Suryani et al., 2022). This commitment to education and professional growth is essential as the medical landscape continues to evolve, demanding that paramedics adapt to both technological advancements and the continually changing needs of patient care.

In closing, the integration of paramedics as proceduralists within hospital environments is substantiated by a growing body of evidence indicating the numerous benefits this model brings to healthcare delivery. Enhanced training and clear procedural protocols empower paramedics to provide critical interventions, ultimately resulting in improved patient care outcomes, reduced emergency department congestion, and increased interdisciplinary collaboration. As the healthcare system adapts to its challenges, the role of paramedics will be fundamental in ensuring not only the efficiency of emergency medical services but also the overall quality of patient care.

REFERENCES:
Bae, H., Kim, D., Yoo, N., Choi, J., Huh, J., Cha, J., … & Kim, J. (2010). Prehospital notification from the emergency medical service reduces the transfer and intra-hospital processing times for acute stroke patients. Journal of Clinical Neurology, 6(3), 138.
https://doi.org/10.3988/jcn.2010.6.3.138
Bergrath, S., Reich, A., Rossaint, R., Rörtgen, D., Ge**er, J., Fischermann, H., … & Skorning, M. (2012). Feasibility of prehospital teleconsultation in acute stroke – a pilot study in clinical routine. Plos One, 7(5), e36796.
https://doi.org/10.1371/journal.pone.0036796
Bolster, J. and Batt, A. (2025). Building bridges and moving upstream: paramedics as policy architects. Paramedicine.
https://doi.org/10.1177/27536386251336008
Clarke, B., Campbell, S., Froese, P., & Mann, K. (2019). A description of a unique paramedic role in a canadian emergency department. International Paramedic Practice, 9(2), 28-33.
https://doi.org/10.12968/ippr.2019.9.2.28
Duffy, I. and Jones, C. (2017). Exploratory study into the views of paramedics on paramedic prescribing.. Journal of Paramedic Practice, 9(7), 296-301.
https://doi.org/10.12968/jpar.2017.9.7.296
Ebben, R., Vloet, L., Speijers, R., Tönjes, N., Loef, J., Pelgrim, T., … & Berben, S. (2017). A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 25(1).
https://doi.org/10.1186/s13049-017-0409-6
Evans, B., Brown, L., Bulger, J., Fegan, G., Ford, S., Guy, K., … & Snooks, H. (2019). Paramedics’ experiences of administering fascia iliaca compartment block to patients in south wales with suspected hip fracture at the scene of injury: results of focus groups. BMJ Open, 9(2), e026073.
https://doi.org/10.1136/bmjopen-2018-026073
Lin, C., Peterson, E., Smith, E., Saver, J., Liang, L., Xian, Y., … & Fonarow, G. (2012). Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke. Circulation Cardiovascular Quality and Outcomes, 5(4), 514-522.
https://doi.org/10.1161/circoutcomes.112.965210
McLelland, G., Morgans, A., & McKenna, L. (2013). Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review. Emergency Medicine Journal, 31(4), 345-350.
https://doi.org/10.1136/emermed-2012-202309
Nudell, N., Becker, T., Waddell, R., O’Meara, P., Leÿenaar, M., & Willits, S. (2025). Professionalization of paramedicine in the united states of america: unlocking the future with the american college of paramedics. Paramedicine.
https://doi.org/10.1177/27536386251348671
Phillips, J. (2024). Paramedic role in emergency mental healthcare. Journal of Paramedic Practice, 16(5), 204-211.
https://doi.org/10.12968/jpar.2024.16.5.204
Shannon, B., Baldry, S., O’Meara, P., Foster, N., Martin, A., Cook, M., … & Miles, A. (2023). The definition of a community paramedic: an international consensus. Paramedicine, 20(1), 4-22.
https://doi.org/10.1177/27536386221148993
Suryani, S., Girsang, E., Ramadhani, S., & Nasution, S. (2022). Analysis of factors affecting the performance paramedic at hospital royal prima medan. International Journal of Health and Pharmaceutical (Ijhp), 2(1), 124-131.
https://doi.org/10.51601/ijhp.v2i1.22
Tavares, W., Bowles, R., & Donelon, B. (2016). Informing a canadian paramedic profile: framing concepts, roles and crosscutting themes. BMC Health Services Research, 16(1).
https://doi.org/10.1186/s12913-016-1739-1
Theodore, R. (2023). Science of life saving through paramedical care: a comprehensive review. International Journal of Medical and Allied Health Sciences, 3(02), 33-38.
https://doi.org/10.54618/ijmahs.2023323
Vuuren, J., Thomas, B., Agarwal, G., MacDermott, S., Kinsman, L., O’Meara, P., … & Spelten, E. (2021). Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Services Research, 21(1).
https://doi.org/10.1186/s12913-020-06037-0