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A description of a unique paramedic role in a Canadian emergency department

02 June 2019
Volume 9 · Issue 2

Abstract

Background:

Paramedics are known for their role in prehospital emergency medical services. In response to healthcare system overcrowding, and increased demands on emergency departments, roles for paramedics have emerged in hospitals.

Aims:

The authors describe a well established paramedic role in the emergency department of a busy regional referral centre, highlighting the successes and challenges of the programme.

Methods:

In this phenomenological study, six paramedics employed at the Charles V. Keating Emergency and Trauma Centre were interviewed. Interviews were analysed using thematic content analysis.

Findings:

Paramedics at the centre are involved in resuscitation, trauma, critical care transport, airway management, and procedural sedation. Performing procedural sedation is an important part of the role and is perhaps where paramedics have had their greatest impact within the department.

Conclusions:

The diverse scope of practice paramedics maintain at this centre allows them to work where the need is highest within the department, ultimately improving department flow.

Emergency departments (EDs) are facing significant and continuous demands on their resources. Affected factors include hospital overcrowding and boarding of inpatients in the ED, increased patient census and acuity, and deficiencies in primary and secondary care availability—all of which are compounded further by a shortage of trained emergency care providers. To meet these demands, numerous strategies have been instituted, from moving boarded patients to alternative hospital space and deflecting patients away from the ED, to the use of mid-level providers with different and specific skills in new and evolving roles. This employment of ‘mid-level care providers’, also called ‘advanced care providers’, is becoming increasingly common (Klauer, 2013; Campbell et al, 2014). The term mid-level provider typically includes nurse practitioners, physician assistants, and paramedics. These health professionals work alongside ED physicians and nurses.

Paramedics are health professionals traditionally known for their work in prehospital care, including the management and transport of acutely ill or injured patients. However, they are being increasingly used in non-traditional settings in countries such as the UK, the United States, and Canada (Oglesby, 2007; Campbell et al, 2008a; 2012; Morrison, 2013; College of Paramedics, 2017a). In these atypical settings, the scope of their practice varies, as does their level of training.

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