IntroductionThis study reports on a subset of findings from a recent doctoral study by the first author, which explored the lived experience of being a paramedic preceptor to novice paramedics in their first year of on-road practice.MethodsA qualitative methodology underpinned by Gadamerian hermeneutics was chosen for this study. Semi-structured interviews were undertaken with a purposive sample of 11 paramedic preceptors from an Australian government-funded ambulance service. Interviews were audio-recorded and data analysis proceeded from the interview transcripts.ResultsAnalysis revealed the paramedic preceptor to be a complex, multidimensional role that is operationalised within four key domains: coach, role model, socialiser and protector. Expectedly, a core function of being a paramedic preceptor is that of coach, supporting and scaffolding novices as they learn to apply theoretical knowledge in practice. Preceptors also appear to play an integral role in the professional socialisation of new employees, and are an important role model of professional behaviours and an empathetic healthcare provider. The paramedic preceptors in this study also viewed their role as a critical advocate for patient safety in the clinical practice environment. Advocacy and protection by the preceptor extended to the novice too, safeguarding their physical and emotional wellbeing during the learning process.ConclusionTo our knowledge, this is the first study to specifically explore paramedic preceptorship from the perspective of preceptors in an Australian context. Therefore it provides an important contribution to understanding how paramedic preceptors operationalise this educative role in the clinical practice environment.

Background Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. Methods A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). Results Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was ‘good to very good’. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload ‘had lessened’ while 36.4-40% of emergency nurses and physicians stated that their workload had ‘considerably increased’. Common concerns raised included disease transmission to family, public complacency, and PPE availability. Conclusions Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.

Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability.

A cultural shift in ambulance services has improved the experience of universityeducated paramedics going on-road for the first time in New South Wales. In the "bad old days", graduate paramedics reported routine rites of initiation, including barbed humour and contempt for skills gained in a university setting. Those educated in the on-road vocational system believed universities did not provide a tough enough environment for future paramedics. In this study, data were drawn from two projects involving university-educated paramedics who graduated between 1996 and 2011 and whose novice on-road experiences were several years apart. Comparative retrospective analysis of data provided evidence of a change in attitude towards New South Wales graduates, with an increase in support and inclusion. Novices with greater confidence in their own capacity was evidence of an attitudinal shift. Engaged on-road preceptors who won the respect of the novice was evidence of an increase in support. Inclusion had been a painful issue for both early cohorts of graduates and industry. Failure to fit is associated with attrition. Early in their on-road practice, recent novices reported a sense of belonging. The authors suggest that the shift in attitude could be attributed, first, to a critical mass of graduates on-road, including increasing numbers with postgraduate qualifications, and secondly, the stated preference of ambulance services in Australia to employ graduates.

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