BackgroundExpanded roles for paramedics, commonly termed community paramedicine, are becoming increasingly common. Paramedics working in community paramedicine roles represent a distinct departure away from the traditional emergency paradigm of paramedic services. Despite this, little research has addressed how community paramedics are perceived by their clients.MethodsThis study took an interpretivist qualitative approach to examine participants’ perceptions of paramedics providing a community paramedicine program, named the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). Both participant observation and semi-structured interviews conducted with program participants were used to gain insight into the on-the-ground experiences of the program. Thematic analysis was employed to analyze all data.ResultsThree themes emerged: i) Caring and trusting relationships; ii) paramedics as health advocates; iii) the added value of EMS skills. Paramedics were perceived by residents as having dual identities: first in a novel role as health advocates and secondly in a traditional role as emergency experts despite lacking contextual features associated with emergency response.ConclusionsFrom this exploratory, qualitative study we present an emerging framework in which to conceptualize paramedic roles in community paramedicine settings. Future research should address the saliency of these roles in different contexts and how these roles relate to paramedic practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1687-9) contains supplementary material, which is available to authorized users.

The development of competency frameworks in healthcare professions is characterised by potentially inadequate descriptions of practice, variable developmental approaches, and inconsistent reporting and evaluating of outcomes. This may be in part due to limited existing guidance, which neglects broader contexts, lacks organising frameworks, and fails to provide guidance on selection of methods. To address such concerns, this paper first outlines a 'systems thinking' conceptual framework by which to conceptualise and describe clinical practice when developing competency frameworks. This is achieved through combining Ecological Systems Theory and complexity thinking to identify, and explore the contexts and components of clinical practice. The 'systems thinking' conceptual framework is then integrated into a six-step model for developing competency frameworks that synthesises and organises existing advice. The six steps include (1) identify practicalities (e.g. purpose, scope, detail, timeline), (2) identify influencing contexts and factors using 'systems thinking', (3) use aligned mixed-methods, (4) translate data into competency frameworks, (5) report processes and outcomes, and (6) plan to evaluate, update and maintain the competency framework. The model provides a logical organising structure of principles to guide assumptions and commitments when developing competency frameworks. Additionally, the model affords the flexibility required when exploring professional practice across varying contexts, and suggests employing mixed methodological approaches that are aligned with purpose and scope. The model acknowledges changing and complex contexts, considers existing guidance, and adds a unique and complementary means to conceptualise and improve the competency framework development process.

ObjectivesPatient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.MethodsWe performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.ResultsA total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.ConclusionAlthough community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.

Objectives: As an aging population continues to place strain on the health care system, many older adults are living with unmet social and medical needs. In response, Emergency Medical Services (EMS) have initiated programs that encourage paramedics to refer patients in need to community based support services. This qualitative study explores frontline paramedic experiences with referral programs to identify opportunities and challenges in their practice. Methods: This study used an intepretivist qualitative study design involving interviews of frontline paramedics employed in a region where referral programs were in place. Interviews were semi-structured and one-on-one. Data were transcribed verbatim and analyzed using inductive open coding throughout, then grouped to identify themes. Data collection and analysis were conducted simultaneously and flexibly until saturation. Results: Twenty-three interviews were conducted representing 6 regions. When participating with referral programs the data revealed that frontline paramedics appear to experience (a) role confusion, (b) an inadequate knowledge base, (c) inadequate feedback, (d) undefined accountability, and (e) strong patient advocacy. Conclusions: In a strained health care system, EMS and paramedics have an opportunity to better serve patients by initiating referrals for patients they encounter with unmet social and medical needs. However, referral programs face a number of challenges that, if left poorly addressed, may threaten the success of such programs. Résultats : il y a eu 23 entrevues, concernant 6 régions. D'après les données recueillies sur les ambulanciers paramédicaux de première ligne, qui participaient aux programmes d'aiguillage des patients, il semblait y avoir : a) une confusion de rôle; b) une base insuffisante de connaissances; c) un manque de rétroaction; d) une obligation de répondre de ses actes non définie; (e) une forte empathie pour les patients. Conclusions : Dans un système de soins de santé soumis à de fortes pressions, les SMU et les ambulanciers paramédicaux ont la possibilité de mieux rendre service aux patients qu'ils rencontrent en dirigeant ceux qui ont des besoins médicaux et sociaux non satisfaits vers les ressources appropriées. Toutefois, ces programmes connaissent un certain nombre de problèmes qui, s'ils sont négligés, risquent de nuire à leur réussite.