British Paramedic Journal

Missed Opportunities of Feedback for Emergency Ambulance Staff: A Mixed-Methods Diary Study

Caitlin Wilson, Luke Budworth, Gillian Janes, Rebecca Lawton, Jonathan Benn — Sun, 01 Jun 2025 00:00:00 +0100

Background: Providing feedback to emergency ambulance staff on performance or patient outcomes may improve care quality and professional development. Current feedback provision in ambulance services is limited and staff desire more feedback; however, we do not know what feedback would be most useful. This study aimed to determine the quality of feedback received by emergency ambulance staff, describe self-directed learning activities performed after receiving feedback (e.g. “reflected on what exactly I did right/wrong”) and identify situations where ambulance staff desired enhanced feedback.

Methods: An observational mixed-methods study was used. Emergency ambulance staff delivering face-to-face patient care in the United Kingdom’s National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they desired feedback but had not received it. Free-text qualitative responses were categorised using content analysis before being included in the quantitative analyses. Quantitative data were analysed using descriptive and inferential statistics.

Results: 299 participants completed baseline surveys and 100 submitted 374 feedback desired diary entries. Ambulance staff expressed a statistically significant preference for patient outcome feedback (77.8% [95% CI 74.0, 82.1]), provided by non-ambulance healthcare professionals (70.7% [66.2, 75.3]) and delivered electronically (54.0% [48.9, 59.4]). Feedback was particularly desired for cases involving neurological (17.1%) and cardiovascular (16.6%) conditions and non-conveyed patients (11.5%). Self-directed learning activities post-feedback included reflection (61.5%), considering alignment with own judgement (41.1%) and discussions with colleagues (37.0%).

Conclusion: The study identifies critical gaps in current feedback practices within ambulance services and provides directions for feedback designs that would enhance existing systems and approaches. Training programs should educate ambulance staff on effective feedback utilisation and management of both positive and negative feedback. Cultivating a supportive feedback culture within ambulance services is crucial for fostering continuous professional growth and improving patient care outcomes.

Does critical care paramedic deployment improve delivery of post-resuscitation care following out-of-hospital cardiac arrest? A retrospective cohort study

Alan Cowley, Dan Cody, Dr Paul Rees — Sun, 01 Jun 2025 00:00:00 +0100

Introduction: The Return of Spontaneous Circulation (ROSC) care bundle is a set of interventions designed by NHSE for use in the post-resuscitation care of patients following out-of-hospital cardiac arrest (OHCA). Compliance with these standards is critical in providing optimal, standardised care and improving outcomes. This study aimed to investigate the impact of Critical Care Paramedics (CCPs) on delivery of post-ROSC care.

Methods: A retrospective observational study was conducted across a large UK ambulance service. All patients with sustained ROSC following resuscitation for OHCA over a 1-year period were included. Two groups were compared, with regards to post-ROSC care delivery – a standard care group, and a group where a CCP was present.

Results: 997 incidents were included; 891 incidents in the CCP group and 106 incidents in the non-CCP group. The presence of a CCP was associated with a statistically significant increase in compliance with the ROSC bundle. 75% of incidents with a CCP present were fully compliant, compared with 64% of incidents without a CCP. The mean % compliance across the standards was significantly higher in the CCP group. Secondary outcome analysis showed statistically significant benefits in compliance for several care parameters when a CCP was present.

Conclusion: This retrospective study confirms that the presence of a CCP improves delivery of post-ROSC care. This highlights the potential benefits of having CCPs as part of the standard pre-hospital care resuscitation team. Further research is needed to confirm these findings and to examine the relationship between the ROSC bundle and patient outcomes.

Perceptions of older people regarding drone delivered defibrillators for out-of-hospital cardiac arrest: A qualitative study

Sun, 01 Jun 2025 00:00:00 +0100

Introduction

Out-of-hospital cardiac arrest (OHCA) presents a significant public health challenge. When used, bystander use of automated external defibrillators (AEDs) can improve survival. Drone delivery of AEDs may improve rates of bystander defibrillation, but although the majority of cardiac arrests are in older people there is minimal evidence on the perceptions of older people regarding the technology.

Aim

To explore the perspectives of individuals aged 65 and older on the deployment of drone technology for AED delivery in OHCA situations.

Methods

Semi-structured qualitative interviews to gather insights into their perceptions about drone AED delivery. Responses were analysed and presented thematically.

Results

Three main themes were identified from 12 interviews between May and July 2024; 1) the interaction between the human and the drone; 2) perceived societal benefits of drone AED delivery for OHCA; and 3) safety and public perception. Participants expressed complex reactions to drone delivered AEDs, and expressed concerns about correct AED usage and the emotional difficulty of leaving a patient unattended. Many anticipated guilt about possibly being unable to use the AED effectively in high-stress situations. Participants acknowledged drones' potential to save lives by reducing response times in OHCA, but raised safety and public education concerns. There was a strong consensus on the importance of public education and training to build confidence in using both AEDs and drone technology.

Discussion

While participants appreciated the rapid delivery of AEDs via drones for OHCA, they expressed significant concerns about their ability to use the devices and the emotional burden associated with emergency situations. The findings emphasise the need for enhanced public education and psychological support to ensure effective bystander intervention in general. Additionally, prior to any roll-out of drone-delivered AEDs, there should be a specific programme of education to bridge the gap between technological acceptance and practical application.

Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: a single site feasibility study (POCTPara).

Sun, 01 Jun 2025 00:00:00 +0100

Introduction

Paramedics play an important role in urgent and emergency care to address growing demand. Point-of-care testing (POCT) devices are increasingly portable and may assist with appropriate non-conveyance, but limited research exists to support this. This feasibility study aimed to inform the design of a larger study to determine if it is practical for paramedics to use blood analysis POCT.

Methods

An eight-month single-site feasibility sequential explanatory mixed method study was conducted between April and December 2023 with a team of specialist paramedics who were provided with Abbott® i-STAT Alinity™ POCT devices with CHEM8+ and CG4+ cartridges. Using a qualitative evaluation of paramedic participants’ experience with a POCT device and a descriptive analysis of case report form (CRF) and routine ambulance service data collection.

Results

Seven specialist paramedics were recruited; 287 patients were screened, 252 (88%) excluded, and 35 (12%) recruited. Lack of mental capacity excluded 76% of cases. The mean age was 82 years; 40% females and 60% males. Hospital conveyance rates were 4 (11%) of the recruited patients. In those recruited and not conveyed, the median time on scene was 120 minutes. The success rate to obtain a test result at the first attempt was 81% (CHEM8+) and 84% (CG4+). Test result failure rates were 13% (CHEM8+) and 3% (CG4+). Focus group data revealed that paramedic participants considered POCT useful for decision making and device procedures acceptable. Paramedics reported that extended time on scene was related to trial procedures and waiting times to discuss test results with healthcare professionals.

Conclusions

The POCT devices were acceptable and practical for use by our specialist paramedic participants. The results of this feasibility study should inform the design of a larger study to test the impact, understand challenges in recruitment and retention, and the clinical presentations where POCT can be applied.

The Role of the Generalist Paramedic in Enhanced Practice

Caitlin Wilson, Samantha McCabe-Hogan — Sun, 01 Jun 2025 00:00:00 +0100

Dear Editor,

We are writing to highlight the evolving role of the generalist paramedic, particularly in the context of enhanced practice and portfolio careers. While much attention has been paid to specialist paramedic career pathways in primary care, urgent/community care, critical care, and mental health, the value and complexity of generalist practice remain underexplored. Generalist paramedics maintain a broad clinical scope while incorporating elements of research, education, and leadership into their practice.

The recently published Enhanced Level Practice schemas for Allied Health Professionals (NHS England, 2024) provides a structured pathway for paramedics to develop their roles while remaining in generalist practice. Enhanced practice represents a highly valued level within the healthcare workforce, characterised by experienced registered professionals who deliver complex care, manage day-to-day risks, and make substantial contributions across diverse settings. Often positioned as a precursor to advanced practice, enhanced practice is increasingly recognised as both a stepping stone and a valued career destination in its own right.

The Paramedic Career Framework (College of Paramedics, 2024) emphasizes the flexibility for paramedics to develop across the four pillars of clinical practice, leadership, education, and research. Notably, the framework identifies the role of the specialist/enhanced paramedic as a senior position within the clinical practice pillar while offering development opportunities in other areas such as education or research. This balance allows paramedics to shape their career according to individual strengths and interests, supporting both generalist and specialist pathways. This perspective is particularly relevant to paramedics embracing portfolio careers, as generalism itself may appeal to those prioritising education or research as their main focus.

Despite these advances, recognition and career pathways for generalist paramedics remain inconsistent. Generalist practice requires enhanced decision-making, adaptability, and holistic patient care. However, the narrative often underestimates the expertise required to manage the diverse needs of patients presenting to the ambulance service, risking the marginalization of generalist contributions. A recent College of Paramedics INSIGHT article by McCabe-Hogan (2024) underscores this point, urging that enhanced practice roles must avoid being perceived as exclusive to clinical specialists. Instead, generalism should be celebrated as a distinct and valuable area of enhanced practice in its own right.

We hope this letter will spark further discussion on the role of the generalist paramedics in enhanced practice.

Yours sincerely,

Dr Caitlin Wilson and Samantha McCabe-Hogan

The impact of a drone-delivery of an automated external defibrillator: simulation feasibility study

Sun, 01 Jun 2025 00:00:00 +0100

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in Europe. Early defibrillation is associated with improved outcomes. Whilst this may be delivered by members of the public using an automated external defibrillator (AED), they are used infrequently. Drone delivery of an AED may enable quicker defibrillation compared to awaiting arrival of emergency medical services. Little is known about how members of the public may react to AED delivery or the potential impact of retrieving an AED on the provision of high-quality cardiopulmonary resuscitation (CPR).

Methods: A feasibility study using a simulated OHCA scenario was completed by members of the public. Participants performed CPR on a manikin, guided by an ambulance service call handler, which was interrupted by AED delivery. CPR quality and interruption for AED retrieval were recorded, and participants feedback collected using a survey.

Results: Twelve participants completed the study. Overall, a median of 61% (interquartile range [IQR] 21 to 79) of chest compressions were delivered at the correct speed, and 99% (IQR 78 to 100) at the correct depth. CPR was discontinued for a median of 112 (range 77 to 156) seconds to retrieve an AED and deliver a shock. Participants described the scenario as stressful and challenging, were supportive of the concept of drone delivery by AED and emphasised the value of call-instructions and guidance.

Discussion: This small study demonstrated feasibility of a process and outcomes evaluation of simulated drone delivered AED to members of the public. The retrieval process was associated with notable interruption in the delivery of CPR, but it remains unknown whether this may be offset by expedited use of the AED. Understanding the likely overall impact of drone delivery of AEDs on patient outcomes is critical before this approach should be considered in clinical practice.

Literature review: What are the key factors which affect female healthcare workers on their return to work after maternity leave?

Jennifer Dod, Gail Lansdown — Sun, 01 Jun 2025 00:00:00 +0100

ABSTRACT

Background:

The demographic of the paramedic workforce is changing and a higher proportion of paramedics than ever are women of childbearing age. With ongoing issues with recruitment and retention it is essential that the needs of women returning to work from maternity leave are understood in order to retain them in their jobs after they have children. This review focused on understanding the factors affecting female healthcare workers on their return to work from maternity leave with focus on female paramedics.

Methods:

A systematic search strategy using four electronic databases (CINAHL, British Nursing Database, Pubmed and Academic Search Complete) was conducted in June 2023. The PRISMA systematic approach was used to conduct a review of the literature, and selected studies were identified using predefined inclusion and exclusion criteria. Papers were narratively synthesised to produce key themes for discussion.

Results:

623 records were initially found: 11 remained after eliminating duplicates and a consideration of title and abstracts. Six of the articles did not meet the inclusion/exclusion criteria leaving five and a further three were found via snowballing and internet searches giving a final total of eight included articles. No literature that specifically related to female paramedics was found. Thematic analysis of the papers identified five main themes: work factors, health and wellbeing, childcare, identity and home support.

Conclusion:

The factors which affect female healthcare workers on their return to work after maternity leave are multiple, complex and varied. Women need good support from their workplace in order to have a successful transition back to work and the availability of childcare for shift workers was problematic. Further research is needed in this area to fully understand the issues facing female paramedics returning to work after maternity leave as many papers identified were dated and there is no contemporary UK data pertaining to female paramedics.

Ambulance clinicians’ preparedness for unplanned prehospital childbirth: a rapid evidence review

Liam Smith, Gregory Whitley, Marishona Ortega — Sun, 01 Jun 2025 00:00:00 +0100

Introduction

Unplanned prehospital births present one of the most challenging and complex incidents for ambulance personnel to attend. This rapid review aimed to consider the barriers to providing effective maternity care in the emergency prehospital setting.

Methods

A rapid evidence review was performed using Medline and CINAHL Complete between 2000 and 2024. A critical appraisal and thematic synthesis were also carried out. Qualitative studies written in English that considered staff and patient perspectives for prehospital maternity care were eligible for inclusion in this review.

Results

Six studies were identified, and three analytical themes were generated: intrinsic, extrinsic, and non-technical factors impacting obstetric care. Most ambulance clinicians felt insufficiently prepared for unplanned prehospital childbirth. Undergraduate level training and continuing professional development opportunities were considered poor and acknowledged as improvement areas. Academic and ambulance service organisations should work towards addressing clinician’s lack of exposure and confidence with maternity incidents.

Conclusion

Without regulatory and organisational input, unplanned prehospital births will continue to challenge both newly qualified and seasoned ambulance clinicians. There is an inherent need for revised maternity training standards for prehospital personnel that aims to address the barriers identified within this review paper. To set forth a provision of multidisciplinary and collaborative education opportunities, prehospital clinicians need to be acknowledged as key care providers for pregnant women in the emergency setting.

Addressing the Lack of Ethnic Diversity in the UK Paramedic Profession: A Call for Action

Ufuomanefe Jones — Sun, 01 Jun 2025 00:00:00 +0100

Ethnic minorities are starkly underrepresented among United Kingdom (UK) paramedics, with their numbers significantly lower than in other allied healthcare professions. This disparity is not reflective of the diverse population the NHS serves. To achieve truly patient-centred care, the paramedic workforce must be representative of the communities it serves. This professional practice paper aims to discuss the role of Higher Education Institutions (HEIs), NHS England (NHSE) and NHS Ambulance Trusts in addressing this issue.

The paper examines traditional entry routes to paramedic education and highlights financial constraints and limited entry points as significant barriers for aspiring paramedics from diverse backgrounds. Furthermore, a lack of ethnic diversity in paramedic leadership positions is identified as a discouraging factor. The paper then critically appraises existing initiatives aimed at promoting diversity, such as the College of Paramedics campaign. It acknowledges that raising awareness is a valuable step forward and advocates for a more comprehensive approach to achieve greater impact.

The paper lists some of the strategies employers could adopt to foster a more inclusive workplace culture and support the career progression of paramedics from ethnic minority backgrounds. These strategies include targeted outreach programmes, mentorship initiatives, diversity and inclusion training for all staff, and revisions to promotion policies.

The paper concludes by emphasising the need for a multi-pronged approach involving collaboration between educational institutions, ambulance services, professional bodies, and the government. Through the implementation of targeted recruitment strategies, fostering inclusive workplaces, and providing career development opportunities, stakeholders can work together to build a more diverse and representative paramedic workforce, ultimately leading to improved equitable health outcomes at individual, group and population level