The Definition of Paramedicine: An International Delphi Study

Figures & data

Table 1 Importance of Defining Professional Terms in Healthcare

Advantages of Clarity of Terms in Healthcare
Assist the development of a strong evidence base
Inform agenda for future research
Enable international comparisons and benchmarking
Assist with articulation of role to patients, colleagues, other healthcare professionals, the public, other key stakeholders
Inform curricula development
Inform healthcare policy development
Provide clarity on concepts guiding contemporary paramedic practice
Protection of professional title
International work/Humanitarian aid work (professional titles of responders may assist in the rapid organisation of roles)

Note: Data from^16,18,20,21.

Figure 1 Delphi process and participation

Table 2 Existing Paramedicine Definitions: Identified Domains and Attributes

Domain	Specific Attributes	Median (IQR)	Mode	% Mode
About the paramedics	Paramedicine is a specialized allied health profession	10 (8.25–10)	10	59%
	Paramedicine is underpinned by autonomous practice	8 (7.25–9)	8	22%
	Paramedicine requires medical oversight	4.5 (1–8)	0	9%
	A paramedic has complex knowledge and skills	9 (8–9.75)	9	26%
	A paramedic understands pathophysiology and pharmacology	8 (6–9)	10	24%
The focus and aim of paramedicine	Paramedicine focuses on enhancing survival, controlling morbidity, and preventing disability	8 (6.25–10)	10	28%
	Paramedicine focuses on providing advanced emergency medical care	8 (6–9)	10	22%
	Paramedicine focuses on attaining and maintaining optimal health and quality of life	7 (6–9)	7	13%
	Paramedicine focuses on patient-centred care	9 (8–10)	10	43%
	Paramedics treat individuals, families, communities and patients accessing the emergency medical system	9 (7.25–10)	10	35%
The clinical work of paramedicine	Paramedics deliver emergency, lifesaving care to patients with life-threatening conditions	9 (8–10)	10	48%
	Paramedics deliver emergency, critical care, to patients that are seriously ill or injured	9 (8–10)	10	39%
	Paramedics deliver emergency and non-emergency medical care	10 (8–10)	10	54%
	Paramedics deliver general emergency care including assessment, treatment and referrals	9 (8–10)	10	33%
	Paramedics deliver specialized thorough assessments, pathology testing, interpretation, and appropriate medical care	8 (7–9.75)	10	26%
	Paramedics deliver care that contribute to the treatment of chronic conditions and community health monitoring	8 (6–9)	10	24%
	Paramedics work in clinical and non-clinical roles (such as education, leadership and research)	9 (8–10)	10	41%
Where and when paramedics work	Paramedics respond to unscheduled, episodic events, at any time	9 (7.25–10)	10	43%
	Paramedics respond to both scheduled and unscheduled events, at any time	9 (7–10)	10	41%
	Paramedics provide timely provision of appropriate interventions	9 (8–10)	10	33%
	Paramedics work within a variety of environments, predominantly outside hospitals	9 (8–10)	9	30%
	Paramedics work in a pre-hospital context	8 (4–10)	10	30%
	Paramedics work on scene and during transport to hospital	9 (5.25–10)	10	39%
	Paramedics work across a range of settings including emergency, primary and urgent care	9 (8–10)	10	39%
Paramedicine and transportation	Paramedics provide prompt transport to hospital	7 (5–9)	10	24%
	Paramedics transport patients to an appropriate health facility	8 (7–9.75)	10	26%
	Paramedics provide ongoing care if required or arrange alternative options	9 (7.25–10)	10	33%
	Paramedics work in an ambulance transporting patients to the hospital	5 (1.25–9)	10	24%
The role of paramedicine within the healthcare system	Paramedicine is an essential and intricate part of the healthcare system	10 (9–10)	10	65%
	Paramedicine coordinates the responses of multiple emergency agencies	8 (5–10)	10	28%
	Paramedicine is an integrated medical health care delivery system	8.5 (7–10)	10	37%
	Paramedicine is a branch of medicine	8 (5–10)	10	33%
	Paramedicine is fully integrated with the rest of the health care system	8 (6–10)	10	28%

Table 3 Attributes Identified from Questionnaire 2 as Important to Include in the Definition of Paramedicine

Attributes	Include (n)	Include (%)	Exclude (n)	Exclude (%)
Paramedicine is a specialized allied health profession	31	74%	3	7%
Paramedicine is an essential and intricate part of the healthcare system	30	71%	0	0%
Paramedics work across a range of settings including emergency, primary and urgent care	26	62%	1	2%
Paramedics work in clinical and non-clinical roles (such as education, leadership and research)	25	60%	2	5%
A paramedic has complex knowledge and skills	23	55%	4	10%
Paramedicine focuses on patient-centred care	19	45%	1	2%
Paramedics deliver emergency and non-emergency medical care	17	40%	3	7%
Paramedics deliver emergency, life-saving care to patients with life-threatening conditions	15	36%	10	24%
Paramedics deliver general emergency care including assessment, treatment and referrals	15	36%	7	17%
Paramedics treat individuals, families, communities and patients accessing the emergency medical system	15	36%	3	7%
Paramedics deliver emergency, critical care, to patients that are seriously ill or injured	14	33%	7	17%
Paramedics work within a variety of environments, predominantly outside hospitals	10	24%	4	10%
Paramedics respond to both scheduled and unscheduled events, at any time	9	21%	5	12%
Paramedics respond to unscheduled, episodic events, at any time	8	19%	9	21%
Paramedics provide ongoing care if required or arrange alternative options	6	14%	4	10%
Paramedics provide timely provision of appropriate interventions	4	10%	6	14%
Paramedics work on scene and during transport to hospital	2	5%	22	52%

Table 4 Proposed Definitions of Paramedicine as Rated in Questionnaire 3

Definition	Median (IQR)	Mode
Paramedicine is a specialized allied health profession, which works across a range of settings, including emergency, primary and urgent care, as well as non-clinical roles such as education, leadership and research. Paramedics work autonomously and possess complex knowledge and skills, and a broad scope of practice that is an integral part of the healthcare system.	9 (8–10)	10
Paramedicine is an essential, specialized and integral part of the healthcare system and spans across emergent, primary and urgent care, working both in the out-of-hospital and in-hospital settings. Paramedics work interdisciplinary in both clinical and non-clinical roles and possess complex knowledge and skills, sufficient to practice autonomously.	7 (5–8)	8
Paramedicine is an allied health profession providing community-based emergency healthcare. Paramedics possess a wide range of knowledge, skills and scope of practice to provide optimal health outcomes to their patients. They work in both clinical and non-clinical roles and across a range of primary healthcare settings.	4.5 (3–7)	3

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