Principles to Guide the Future of Paramedicine in Canada

Figures & data

Table 1. Demographic characteristics of key-informants (n = 35)

Demographic category		Frequency
Sex	Female	10
	Male	25
Geographic Area	Alberta	6
	British Columbia	4
	Manitoba	3
	New Brunswick	2
	Newfoundland & Labrador	1
	Nova Scotia	3
	Ontario	5
	Prince Edward Island	2
	Quebec	2
	Saskatchewan	2
	Yukon	2
	Multiple Provinces	1
	National	1
	International	1
Stakeholder Organizations	Base hospital	1
	Educational institution	5
	Family health team	1
	Federal government	1
	Health care institution	1
	Municipal EMS	2
	Municipality	1
	Non-profit organization	1
	Private organization	2
	National professional organization	1
	Provincial government	2
	Provincial health authority	7
	Provincial health organization	2
	Provincial/territorial EMS	7
	Public organization	1
	Regional health authority	1
	Regulatory organization	2
	Worker cooperative	1
Stakeholder Groups	CQI/Standards	2
	Directors/chiefs	8
	Educator	3
	Frontline	2
	Management	9
	Medical director	5
	Professional association	1
	Regulator	3
	Researcher	6
	Primary care physician	1
Practitioner Level	Advanced care paramedic	12
	Critical care paramedic	4
	Emergency medical technician	3
	International paramedic	1
	Nurse	2
	Primary care paramedic	3
	Physician	6
	Other	1
	None	3
Clinically Active	Yes	18
	No	8
	No but licensed	2
	Not applicable	3
	Unknown	4

Many aligned with more than one category.

Table 2. Six cross cutting features that were described as enabling factors to achieve principles guiding the future of paramedicine in Canada, with their descriptions

Cross cutting enabling factors	Description
Shift Professional Culture and Identity:	Refers to the need for internal conceptual shifts related to what paramedicine is (e.g., identity, purpose, core business) and how it should be enacted (e.g., emphasis on health care over public safety, broader social accountabilities, diminishing para-military roots, elevating professional autonomy, openness to innovation).
Enhance Knowledge:	Refers to the need to advance the depth and breadth of knowledge in the system from entry to practice to leadership, as a means to achieve many future desired states. Advancing knowledge, skills, competencies, and expertise through higher education across domains such as clinical care, social sciences, humanities, leadership, economics, quality, research, technologies, and logistics, were believed to enable bridges to the future goals of paramedicine.
Promote Shared Understanding of Paramedicine:	Refers to broad awareness campaigns to educate partners (e.g., the public, academic institutions, related health professions, health leaders, and government) as to the expanded roles and services offered by paramedicine. There was consensus among participants that historical conceptualizations of paramedicine (e.g., resuscitation and transport focused), contributes to a misunderstanding among the public and policy makers, and further impedes growth.
Integrate Data Environments:	Refers to the structuring of rich data environments across jurisdictions, that serve broad and yet to be defined quality measurement, research activities, and advances. This includes working on data sharing internally and externally, and the linking of databases with relevant partners.
Leverage Advancing Technology	Refers to the use and integration of advanced existing and emerging technologies (e.g., artificial intelligence) in all aspects of the professionto ensure principles are realized.
Advance Policy, Regulation, Legislation:	Government and current administrative and stakeholder structures were identified as barriers to proposed future states. Participants described the need for paramedic involvement in advocacy and decision-making, and to have organized groups work specifically on identifying necessary changes and how they can be achieved, and aligning these efforts across the country.

Figure 1. The future of paramedicine in Canada: Proposed guiding principles and their enabling factors. The figure represents the emphasis on health care, and the equal but unique individual contributions of each principle, coming together to inform what paramedicine is in Canada. Enabling factors supporting the principles are represented in the outer ring and are not aligned with any particular principle or group of principles.

Table 3. Proposed principles derived from identified themes and definitions to guide the future of paramedicine in Canada

Patients & Their Communities First

Patients are recognized as full partners in their health care experience, leveraging their unique relationships with their communities. Services are aligned to meet combined individual and community needs, and are designed to be accessible, equitable, compassionately delivered, safe, and effective. Working within a whole person framework, encounters with patients are relationship oriented, culturally sensitive, and attuned to the interconnectedness of patients, and their communities. Patients and communities are well-informed as to the value and expertise that paramedics provide. Patient-professional partnerships contribute to the profession’s planning, evaluation, and growth.

Health care Along a Health and Social Continuum

Paramedicine is organized with the infrastructure, knowledge and skills to identify and attend to the health and social needs of patients using a broad range of health and social systems, and strategies. Paramedicine is a point-of-entry into health and social care systems, and works with patients and system partners to determine the most appropriate treatment and care pathways that are accountable to both health and social needs.

Integrated Health care Framework

Paramedicine is a health care profession integrated within and complementary to health care services, shaped by collaborative partnerships with other health professions, patients and communities, government, regulators, industry, education, and evidence-informed institutions. Integrated health care frameworks shape overall structure, practice, and evaluation. Paramedicine leverages accessibility, technology, sustainable funding, and capacity to provide and support care across sectors, in diverse environments, settings, and geography.

Social Responsiveness

Paramedicine takes an accountable and leadership role in social issues, which includes identifying, designing, implementing, and evaluating initiatives to address gaps in structure or services for at-risk communities, social change and unmet needs. This leverages the unique access to, and frequent contact paramedicine has with the community, adds accountability, and provides additional support to health care, and social services. The profession advocates on behalf of patients, communities, and itself, with a particular focus on those traditionally underserved, to contribute to addressing social injustices, and health inequities in society.

Professional Autonomy

Paramedicine is a self-determined profession guided by its own governance, regulation, evidence generation and improvement processes, which are accountable and transparent. The profession demonstrates self-advancement through its leadership and advocacy initiatives, and engages in formal representation and participation in relevant organizational, educational, health care, scientific, government, and professional bodies.

Healthy Professionals

The safety and overall wellness of those enacting paramedicine is an integrated and prioritized mandate. This is reflected in the profession’s determined search for, and solutions to, behaviors, stressors, cultural features, and other threats to safety and wellness. Decision-making related to the profession is made within a wellness framework, monitored, and systems are held accountable to and evaluated based on the health of their professionals.

Quality based Framework

Improvements at all levels – patient care, services, operations and systems, education – are measured using evidence-informed and meaningful indicators of quality. Evidence-informed performance measurement is integrated into the profession’s culture. Measures of quality reflect the priorities of the profession and system, align with leading quality frameworks, and drive future decisions..

Intelligent Access to and Distribution of Services

Paramedicine exists within a network of services informed by patient preference and need. Services are distributed and allocated to meet patient needs while making efficient use of resources, and using advanced technologies and data to determine the services required. Pathways are structured and used to best meet the needs of patients, communities, and health care systems.

Continuous Learning Environment

Paramedicine is growth-oriented, continuously learning, and adapting. The profession promotes knowledge generation, and leverages advanced technologies, data environments, research, education, and broadening specialty clinical pathways, encouraging ongoing system progress. Professional and organizational culture is structured to encourage respectful debate, discussion, and discourse that leads to the generation of new ideas and insights. Formal mechanisms allow new ideas to be implemented, refined, and evaluated.

Evidence-Informed Practice & Systems

Knowledge production and use are inherent and integrated features, used to transform paramedicine practice. Sufficient resources and infrastructure create a vibrant research community, with support from inter-sectoral partners, to develop a unique body of knowledge led by the profession. Data environments are organized and shared, including with scholarly communities, to promote discoveries that guide the direction of the profession.