A survey of front-line paramedics examining the professional relationship between paramedics and physician medical oversight

Foerster, Christopher R.; Tavares, Walter; Virkkunen, Ilkka; Kämäräinen, Antti

doi:10.1017/cem.2017.36

Cited by 4 publications

(14 citation statements)

References 9 publications

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“…(Participant 2) Up to half of the participants saw little need or prospect of changing from medical direction, even when they were criticising this model for being ineffective and sometimes punitive. These views are consistent with similar findings in a Canadian study of the professional relationships between paramedics and medical directors, where respondents identified an association between medical direction and a punitive culture that discouraged paramedic critical thinking (Foerster et al, 2018). Although the National Association of EMS Physicians offers training and certification for medical directors, this is not universal throughout North America, and any licensed physician can fill the role in a number of states and provinces (Bass et al, 2015;National Association of Emergency Medical Service Physicians, 2016).…”

Section: Independent Practice Facilitators and Barrierssupporting

confidence: 80%

“…One Canadian conference paper used rhetorical genre theory to challenge medical direction on the grounds that it is a form of continuing medical dominance over the work of paramedics (Fitzgerald, 2014). More recently, a survey of front-line paramedics in Ontario, Canada found mixed perceptions about medical direction in their unique "base hospital" system (Foerster et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Self-regulation and medical direction

O’Meara

Wingrove

McKeage³

2018

IJHG

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Purpose 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. Design/methodology/approach 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. Findings 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. Originality/value 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.

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Section: Independent Practice Facilitators and Barrierssupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Self-regulation and medical direction

O’Meara

Wingrove

McKeage³

2018

IJHG

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“…Three citations were excluded as they did not explore paramedic or physician perceptions of receiving or delivering teleconsultations, while one was excluded as a quantitative examination. This left two unique citations for inclusion in the review (22,23).…”

Section: Study Inclusionmentioning

confidence: 99%

“…184 primary care paramedics (PCPs) and 58 advanced care paramedics (ACPs) working in non-specialist roles receiving physician-delivered teleconsultations were also included (23). Both studies were conducted with paramedic staff working in the out-of-hospital environment (22,23).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Using a combination of descriptive statistics and inductive thematic analysis, Foerster et al (23) examined the relationship between paramedics and physician-delivered teleconsultations from the perspective of paramedics. Almost half of respondents felt physicians providing teleconsultations understood the unique challenges of the out-of-hospital environment, compared with 23% who felt physicians did not understand these challenges (23).…”

Section: Paramedics Receiving Physician-delivered Teleconsultationsmentioning

confidence: 99%

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Paramedic-Delivered Teleconsultations: A Scoping Review

Armour

Helmer

2021

Australasian Journal of Paramedicine

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Introduction Progression in the field of paramedicine has resulted in the development of novel roles within the profession, including the role of advanced paramedics providing teleconsultations for frontline paramedics. Little is known about the experience of paramedics providing or receiving teleconsultations. This scoping review aimed to investigate paramedic perceptions of physician and paramedic-delivered teleconsultations. Methods A scoping review of MEDLINE, CINAHL and EBM Reviews as well as paramedic-specific journals and the grey literature was conducted. Articles were included if they examined advanced paramedics, paramedics, emergency ambulance crew or emergency medical technicians receiving teleconsultations, or physicians and advanced paramedics providing teleconsultations. Results A total of 7461 unique citations were identified. Two citations were ultimately included in the review. One study examined the delivery of teleconsultations by advanced paramedics and one by physicians, both from the perspective of paramedics. Paramedics delivering teleconsultations generally considered the experience to be positive, while those receiving paramedic-delivered teleconsultations felt the level of advice was appropriate and assisted in expanding their own knowledge base. Paramedics receiving physician-delivered teleconsultations reported variable understanding of the unique challenges of out-of-hospital care and tension in the relationship between paramedics and physicians. Conclusion Little literature was identified examining the perceptions of paramedics delivering or receiving physician-delivered or paramedic-delivered teleconsultations. Given the continuing expansion of teleconsultation programs for out-of-hospital staff, this represents a significantly understudied area.

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Prehospital Providers’ Perspectives about Online Medical Direction in Emergency End-of-Life Decision-Making

Waldrop

McGinley

et al. 2021

Prehospital Emergency Care

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A survey of front-line paramedics examining the professional relationship between paramedics and physician medical oversight

Cited by 4 publications

References 9 publications

Self-regulation and medical direction

Self-regulation and medical direction

Paramedic-Delivered Teleconsultations: A Scoping Review

Prehospital Providers’ Perspectives about Online Medical Direction in Emergency End-of-Life Decision-Making

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