Original Research

Perspectives from the frontline of two North American community paramedicine programs: an observational, ethnographic study

AUTHORS

Angela C Martin1 PhD Candidate, GDipN (Emerg), BN, Dip.ParaSci (Amb), Dip.Mgt Cert IV Training & Assessment., Regional Team Leader/Paramedic *

Peter O'Meara2 PhD, MPP, BHA, Professor of Rural and Regional Paramedicine School, Graduate Research Co-ordinator

AFFILIATIONS

1, 2 LaTrobe Rural Health School, LaTrobe University, PO Box 199, Bendigo, Vic. 3552, Australia

ACCEPTED: 1 November 2018


early abstract:

Introduction: Community paramedicine is one emerging model filling gaps in rural healthcare delivery.  It can expand the reach of primary care and public health service provision in under-serviced rural communities through proactive engagement of paramedics in preventative care and chronic disease management.  This study addressed key research priorities identified at the 2012 “National Agenda for Community Paramedicine Research” conference. The motivations, job satisfaction and challenges from the perspectives of community paramedics and their managers pioneering two independent programs in rural North America were identified.

Methods: An observational ethnographic approach was used to acquire qualitative data from participants, through informal discussions, semi-structured interviews, focus groups and direct observation of practice. During field trips over two summers, researchers purposively recruited participants from Ontario, Canada and Colorado, United States. These sites were selected, on the basis of uncomplicated facilitation of ethics and institutional approval, the diversity of the programs and willingness of service managers to welcome researchers. Thematic analysis techniques were adopted for transcribing, de-identifying and coding data that allowed identification of common themes.

Results: This study highlighted that the innovative nature of the community paramedic role can leave practitioners feeling misunderstood and unsupported by their peers. Three themes emerged: the motivators driving participation; the transitional challenges facing practitioners; and the characteristics of paramedics engaged in these roles. A major motivator is the growing utilisation of ambulances for non-emergency calls and the associated need to develop strategies to combat this phenomenon. This has prompted paramedic service managers to engage stakeholders to explore ways they could be more proactive in health promotion and hospital avoidance.  Community paramedicine programs are fostering collaborative partnerships between disciplines; while the positive outcomes for patients and health cost savings are tangible motivators for paramedic services and funders.  Paramedics were motivated by a genuine desire to make a difference and attracted to the innovative nature of a role delivering preventative care options for patients. Transitional challenges included lack of self-regulation, navigating untraditional roles and managing role boundary tensions between disciplines. Community paramedics in this study were largely self-selected, genuinely interested in the concept and proactively engaged in the grass-root development of these programs. These paramedics were comfortable integrating and operating within multi-disciplinary teams. 

Conclusions: Improved education and communication from paramedic service management with staff and external stakeholders might improve transitional processes and better support a culture of inclusivity for community paramedicine programs. Experienced and highly motivated paramedics with excellent communication and interpersonal skills should be considered for community paramedic roles.  Practitioners who are proactive about community paramedicine and self-nominate for positions transition more easily into the role: they tend to see “the bigger picture”, have broader insight into public health issues and the benefits of integrative healthcare.   They are more likely to achieve higher job satisfaction, remain in the role longer, and contribute to better long-term program outcomes. Paramedic services and policy makers can use these findings to incentivise career pathways in community paramedicine and understand those changes that might better support this innovative model.