British Paramedic Journal

An investigation in to the experiences of those Paramedics rotating in primary care from South Western Ambulance Service: A qualitative study.

Georgina Lambert — Sun, 30 Nov 2025 00:00:00 +0000

Introduction

The Additional Roles Reimbursement Scheme (ARRS) expands roles, including Paramedics and funding into the existing workforce in primary care. This has been laid out in the five-year General Practice (GP) contract reform framework (NHS, 2019a) with the goal of transforming and evolving how primary care is delivered (NHS, 2019b).

Paramedics are rotating from the ambulance service into primary care, to help tackle workforce shortages. This aim of this qualitative study is to investigate the experience of those Paramedics rotating into primary care from the ambulance service.

Methods

This qualitative study utilises convenience sampling of Paramedics who rotate into primary care within one ambulance service. 8 semi-structured interviews took place, conducted by GL (Georgina Lambert).

Results

Key themes were established of Supervision, Education and Workforce planning. Day to day supervision was often seen, however, more formal supervision, such as having a designated mentor and completing the First Contact Practitioner (FCP) portfolio was inconsistent. There were clear core skill educational gap between those ambulance Paramedics and those that work in primary care. Workforce model and how this affects the wider system was discussed, including retention, decision making and referrals.

Discussion

Inconsistent supervision in primary care for those FCP roles appears to be across disciplines, with physiotherapists acknowledging the same short comings. There is a need for a more structured support, with access to a mentor/supervision with any FCP role. There is a need for a training needs analysis and educational days, to support core skills gap within the training period in primary care. Due to the positive workforce planning, it is seen that rotations in primary care retain staff and have some clear system benefits. To further this, an expansion of the rotations with possible other areas within the NHS should be considered.

Safety and Compliance among Newly Qualified Paramedics in a Prehospital Clinical Trial of an Investigational Medicinal Product: A Post-Hoc analysis of the PACKMaN Randomised Controlled Trial

Sun, 30 Nov 2025 00:00:00 +0000

Abstract (296/300 words)

Background

Prehospital research has unique challenges. Ambulance clinicians are required to enrol patients in emergency situations, often remote from the research team at time of recruitment. With Newly Qualified Paramedics (NQPs) representing a significant and growing proportion of ambulance service staff, it is important to establish if they can safely and effectively recruit patients to clinical trials.

Methods

Adverse Events (AEs) and Serious Adverse Events (SAEs) experienced by patients recruited to the PACKMaN trial, and Non-Compliance Events (NCs) committed by paramedics during the trial were retrospectively analysed. We compared recruitment, incidence and type of AEs as well as incidence of SAEs and protocol NCs dichotomised by paramedic experience.

Results

Of the total 458 patients, 259 (56.6%) and 199 (43.4%) were recruited by experienced paramedics and NQPs respectively. Incidence of protocol-defined AEs was similar regardless of paramedic experience: experienced paramedics reported 128/259 (49.8%) and NQPs reported 91/199 (45.7%) OR 0.86 95% CI [0.60 to 1.25]. SAEs had a slight but not statistically significant increase in the NQP group: experienced paramedic 4/259 (1.5%), NQP 8/199 (4.0%) OR 2.67 95% CI [0.79 to 9.00]. NC was similar amongst both groups, experienced 3/259 (1.2%), NQP 6/199 (3.0%), OR 2.65 95% CI [0.66 to 10.74].

Conclusion

In a double-blind Randomised Controlled Trial of an Investigational Medicinal Product (CTIMP), there was no statistical difference in the incidence of safety events or non-compliance among NQPs and experienced paramedics. NQPs made an important contribution to recruitment of patients to this study, improving the generalisability of our findings. Serious adverse events and protocol non-compliances were rare, and patients received analgesics safely. There was no correlation between experience and likelihood of adverse event occurring. There were no safety concerns identified arising from NQP participation. Our findings demonstrate that NQP’s can safely recruit patients to clinical trials.

Emergency Medical Dispatchers’ experiences using MPDS Protocol 24 for maternity telephone triage: a questionnaire study

Joanna Shaw, Ayoola Ariyibi, Justin Kearney, Rachael T Fothergill — Sun, 30 Nov 2025 00:00:00 +0000

Objectives: This study explored emergency medical dispatchers’ experiences of using the Medical Priority Dispatch System (MPDS) Protocol 24 (P24) to gain insights into its usability and appropriateness for triaging maternity calls.

Methods: A semi-structured cross-sectional survey was administered to EMDs in a large UK urban ambulance service. EMDs were invited to anonymously complete the questionnaire over a six-week period; a total of 89 EMDs responded. Six key themes were explored.

Results: Participants felt confident in their knowledge of maternal emergencies, but desired further training (89.9%). When a part of the baby was visible (87.6%) and known complications with current pregnancy (85.4%) were the clinical factors mostly associated with maternal emergencies already well accounted for by P24. The patient being alone (47.2%) or in a public place (42.7%) was seen as an increased risk. However, in general, participants were less likely to associate these non-clinical factors with maternity emergencies.

Specific questions were reported to be challenging to elicit a clear answer from callers, particularly those around the presence of known high-risk complications (44.9%), contractions (60.7%), miscarriage (51.7%) or complications with a newborn (52.8%). P24 instructions could do more to assist with difficult calls (68.5%) and with calls related to miscarriage (49.4%) or termination (29.2%). Participants felt the acuity level associated with certain calls could be refined, such as those related to uncomplicated births (25.8%), first trimester serious haemorrhage (18.0%) and abdominal pain <5weeks with no tissue or foetus (7.9%).

Conclusions: Overall, participants felt maternity emergencies were mostly identified well but that improvements could be made to both the P24 questions and instructions, and further training would improve user experience. Future research should assess the diagnostic accuracy of P24 and determine, if necessary, which questions could be refined to improve the effectiveness of EMDs triage of maternity emergencies.

'Just in Case' medicines use by ambulance paramedics Responding to End-of-Life Care In the Community: protocol for a multi-methods study (RELIEF)

Sun, 30 Nov 2025 00:00:00 +0000

Introduction
At the end of life, anticipatory or 'Just In Case' (JIC) medicines may help manage patients’ symptoms. Sometimes, emergency ambulances attend patients for whom JIC medications have not been prescribed. In Wales, UK, a Welsh Ambulance Services University NHS Trust (WAST) JIC intervention was launched in May 2020, in response to Covid-19, to enable ambulance paramedics to administer JIC medications to patients for whom they had not previously been prescribed. The ambulance JIC intervention is an ongoing feature of WAST prehospital care but has received limited evaluation. This study will explore the rationale, usage, costs and views of stakeholders of the WAST JIC medicines intervention.

Methods & Analysis
We employ a multi-method observational study design incorporating quantitative and qualitative aspects informed by implementation science. Within four work packages, we will (1) prepare a detailed description of the JIC medicines intervention introduced in Wales, UK, and its rationale; (2) interview paramedics and doctors that have provided the intervention, and, paid carers and informal carers who were present during the care episode, and hold a focus group with paramedics who have not administered the intervention; (3) analyse routine ambulance records to describe use of the intervention over a 24 month period; (4) undertake cost analysis to estimate costs and savings associated with the intervention. We will use descriptive statistics to analyse quantitative data and a framework approach for analysis of qualitative data.

Conclusion

This study, which focuses on the voices of patient advocates and practitioners, has the potential to shape future provision of this and similar services in WAST and other care providers.

Hanging Cases Attended by North East Ambulance Service 2020 to 2024: A Service Evaluation

Gary Shaw, Lee Thompson, Graham McClelland — Sun, 30 Nov 2025 00:00:00 +0000

Introduction: Suicide rates in England and Wales remain consistently high with a recorded 10.7 deaths per 100,000 people. The North East region has had the highest suicide rate in 7 of the 10 most recent years, with a recorded 12.8 deaths per 100,000 people.

The most common method of suicide continues to be hanging, which accounts for 60% of deaths. This article will compare the latest findings regarding hangings within the North East of England attended by Emergency Medical Services (EMS), to previous work within this area.

Methods: A retrospective service evaluation taken from the North East Ambulance Service (NEAS) comprehensive pre-hospital trauma audit database. Patients, including children (defined as a patient under the age of 18 years), were subdivided into three specific groups:

Out-of-hospital cardiac arrest (OHCA) due to hanging, strangulation and suffocation
Attempted hanging, strangulation and suffocation (non-OHCA)
Threatened hanging, strangulation and suffocation

Key findings within this service evaluation will be compared to a previous evaluation in NEAS. The previous evaluation ran from 01/12/2018 to 31/11/2020 and recorded 604 cases.

Results: This study reports on hanging cases between 01/12/2020 to 29/02/2024 and includes 2,001 cases. The number of cases per day doubled from 0.8 in the previous evaluation to 1.6 per day. The data also showed rises within the female population in both the non-OHCA and threatened categories. There was found to be a rise in patients who had made a previous suicide attempt by hanging. Two thirds of cases were found to be from the most deprived postcodes.

Conclusion: The number of hanging cases within the North East region continues to rise when compared to a previous service evaluation. The data suggests that a socio-economic link may account for the high numbers of hangings being recorded in the most deprived areas of the North East.

The self reported opinions of ambulance personnel using a feedback system in the Emergency Department.

Karen Chivers, Omar Touma, Victoire Vidart, Simon Bell — Sun, 30 Nov 2025 00:00:00 +0000

Ambulance clinicians manage a wide range of complex and often challenging clinical presentations. Despite spending significant time with patients during the pre-hospital phase, they rarely receive meaningful feedback on the diagnosis, progress, or outcome from the hospital. This lack of structured feedback represents a missed opportunity for learning and emotional closure. To address this gap, Hospital X introduced a formal feedback service for ambulance clinicians. This service evaluation aims to explore the effectiveness and impact of the feedback service, particularly on clinical practice and staff wellbeing.

An electronic questionnaire was distributed to all previous users of the feedback service. Ambulance personnel attending the hospital were also invited to participate. The questionnaire included 12 quantitative and qualitative items designed to explore users’ experience. Quantitative data were analysed descriptively, while qualitative responses underwent thematic analysis by all authors to identify key themes of the service’s impact.

101 questionnaires were completed and included in the analysis. Satisfaction with the service was very high: 98% of respondents reported being satisfied. 91% indicated that the feedback received was likely to influence their clinical practice, and 68% reported positive impact on mental wellbeing.

Four domains of improved clinical care were identified by thematic analysis:

Diagnostic insight and knowledge development
Clinical decision-making
Confidence and professional growth
Continued learning and reflection

Feedback was perceived to have a positive emotional and mental effect, providing clinicians with closure, peace of mind, reassurance, and reducing uncertainty.

A structured and robust feedback service for ambulance clinicians does significantly enhance clinical practice, support wellbeing and improve patient care. It fosters confidence in diagnostic and decision-making skills, reduces anxiety and uncertainty, and encourages self-reflection and professional growth. We recommend that feedback services be implemented at facilities where pre-hospital teams interface with hospital care providers.

The international Paramedic PhD registry. An overview of paramedic doctorates.

Greg Whitley — Sun, 30 Nov 2025 00:00:00 +0000

Introduction

The paramedic profession is developing at speed internationally. To stabilise this growth, the profession must produce, maintain, and enhance its own evidence base. This requires doctoral level training and development of paramedics in the production of robust science. The aim of this article is to provide an overview of paramedics across the globe who have completed or are studying for a doctoral level qualification in the field of paramedicine.

Paramedic PhD Registry

The Paramedic PhD registry – an English language open access voluntary submission platform established in November 2017, was used as the primary source of data to inform this article. The registry relied on voluntary submission of doctoral level qualification details from the field of paramedicine, including doctorate title, details, institution, primary supervisor, and date range. The registry was publicly available and received no funding or sponsorship. Paramedics, along with other clinical and non-clinical researchers, were able to submit their doctorate details to the registry at any time. Since inception to February 2025, 305 doctorates were registered on Paramedic PhD. Of these, 268 were from self-identified paramedics. These paramedics were spread across the United Kingdom (n=80), Australia (n=75), the United States (n=27), Saudi Arabia (n=21), Canada (n=17), and South Africa (n=13), along with 18 other countries. The earliest doctoral qualification completed by a paramedic was 2002. Paramedics undertook the Doctor of Philosophy (n=224), Professional Doctorate (n=32) and the Doctor of Education (n=12) route, with 115 registered as complete. The most popular categories were education (n=55), professional development (n=39) and cardiac arrest (n=21).

Conclusion

As more paramedics focus their career on research and pursue doctoral level qualifications, the volume and quality of evidence will continue to rise, improving outcomes for patients and staff across the globe.

How are incidental findings identified and managed in urgent and emergency care? A rapid scoping review

William Mulrooney — Sun, 30 Nov 2025 00:00:00 +0000

Introduction
Incidental findings are unexpected abnormal findings during routine care. Urgent and Emergency Care (UEC) professionals in emergency departments, ambulances, and urgent treatment centres, are presented with an opportunity to act and potentially reduce long-term disease burden for the patient and the healthcare system. This review aims to investigate the current state of primary evidence about how incidental findings are identified and managed in UEC.

Methods
Only two databases (MEDLINE Complete and CINAHL Complete) were searched due to resource constraints. Two reviewers completed abstract screening, reference and citation searching, and full-text screening. Included articles underwent data extraction and critical appraisal, before being synthesised descriptively in a narrative format.

Results
245 results were identified through search, with 10 included for full-text screening. An additional 418 articles were identified through reference and citation searching, of which 38 were included for full-text screening. 18 articles were included after screening, with an additional 2 added from another source. Articles explored incidental findings in the form of elevated blood pressure, atrial fibrillation, late returning laboratory results, and abnormal findings on sonography.

Discussion
There appears a moderate prevalence of incidental findings amongst patients presenting to emergency departments and urgent care centre. Only 17.4% of patients with elevated blood pressure are referred for follow-up, but 40.6% will be diagnosed hypertensive. New onset atrial fibrillation is seen in 2.7% of patients not transported by the ambulance service. 47-68% of those with incidental findings on sonography are referred to follow-up. Patient demographics and ownership of findings appear to be influential factors in rate of referral. Additionally, time constraints and education appear to be barriers to referral.

Recommendations
Further research is required to understand sociodemographic characteristics and how they influence the decision to act on incidental findings, especially amongst young men with elevated blood pressure. Responsibility for managing incidental findings needs assigning to a specific professional group, team, or role. Mechanisms for managing incidental findings should have a low burden of effort and time, and should make the requested actions very clear to the receiving professional. There appears to be untapped knowledge of incidental finding management in the field of radiography. Incidental findings in ambulance practice are minimally explored and appear to be revealing contrasting results to colleagues in other settings.