British Columbia

Focus on Paramedicine Research in BC

Paramedicine in British Columbia:
A profile of current research and operational initiatives

By Dr Ron Bowles, with thanks to Peter Thorpe (BCEHS) and Dave Deines (APBC).
British Columbia is the westernmost province of Canada. BC Emergency Health Services (BCEHS)
provides ground and air emergency medical services to BC’s 4.75 million inhabitants (Statistics Canada,
n.d.) through more than 180 stations in metropolitan, urban, rural, and remote communities throughout
the province. BC’s 4,600 paramedics and dispatchers are represented by the Ambulance Paramedics of BC
(APBC). Justice Institute of British Columbia (JIBC) is a public post-secondary degree-granting institution
providing paramedic education and continuing medical education for a wide range of health and
community-based practitioners across the province and internationally.This article focuses on current
research and operational initiatives, with a particular focus on a Paramedic Association of Canadasponsored study that provided the foundation for the new Canadian Paramedic Profile.
BC Emergency Health Services (BCEHS)
provides emergency patient care and
inter-facility ground and air patient transfers,
and emergency medical dispatch services
across the province of British Columbia
(BC). BC, Canada’s westernmost province,
covers 950,000 square kilometers and
has a population of approximately 4.75
million (Statistics Canada, n.d.). BCEHS’s
4,600 employees provide air and ground
ambulance support, inter-facility transfers,

clinical oversight and research, with
ambulance stations in over 180 remote,
rural, urban, and metropolitan communities.
Last year, the service responded to over
475,000 911 (emergency call) events and
provided 96,000 patient transfers (BCEHS,
2015/2016).
In recent years there has been an increasing
demand for emergency patient care.
Without changes, provincial demand is
projected to increase by 6.1% annually. In
2016, BCEHS released an action plan called
Transforming Emergency Health Services that
outlined key innovations and the strategic
investment of additional resources to
help improve patient care and ensure the
provincial service is more sustainable moving
forward.
In addition, BC is implementing community
paramedicine in rural and remote
communities throughout the province. The
program aims to help stabilize paramedic
staffing and bridge health service delivery
gaps in communities that are sometimes
underserved and have aging populations
living with chronic and complex diseases.
Community paramedicine will add at least
80 FTE community paramedic positions by
2018, with 76 communities selected to date.

Summer 2017 | Ambulancetoday

Justice Institute of British Columbia is a
public post-secondary degree-granting
institution providing education and training
for a wide range of community, health,
justice, and public safety practitioners.
The Health Sciences Division offers
initial education for Emergency Medical
Responders, Primary Care Paramedics,
Advanced Care Paramedics, and Community
Paramedics, as well as a Diploma in Health
Sciences and a wide range of continuing
and professional education for all health
professionals.
JIBC has an active applied research program,
with prehospital and paramedic-related
research as one of four strategic priorities. In
the last several years, JIBC has participated
in several projects to support the evolution
of paramedicine as a profession in Canada.
One study built on the Canadian EMS
Research Agenda (Jensen et al., 2013)
project by exploring the role of educational
research in paramedicine. This study involved
a review of then-current paramedic research
and interviews with key stakeholders in
Canadian paramedic education and practice,
with the goal of identifying trends and gaps
in education-related research that JIBC could
contribute to.
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Focus on Paramedicine Research in BC

British Columbia

The results of that study included the
development of a model for describing four
dimensions of paramedic practice: Who the
practitioners are; What types of care they
provide; Where they practice; and, What
patient disposition options are available?
This framework is useful for analyzing the
evolution of paramedic practice into new
practice settings, different types of care, and
alternative outcomes (Bowles & Van Beek,
in press).
JIBC also housed a national study, funded
by the Paramedic Association of Canada

(PAC), to support the development of
the new Canadian Paramedic Profile.
Three paramedic researchers, Dr. Ron
Bowles, Dr. Becky Donelon, and Dr. Walter
Tavares conducted a mixed methods
study to articulate the key attributes and
characteristics required of paramedics in
Canada, regardless of their certification
level or practice setting. The study included
concurrent streams: a discourse and content
analysis of how paramedics are described in
academic, professional, and grey literature;
and in-depth semi-structured interviews
with twenty-one key stakeholders in
Canadian paramedicine. The results were
analyzed individually, then combined for
more in-depth analysis. Following a process
of inductive analysis, the study identified a
series of framing concepts, cross-cutting
themes, and roles that describe current and
anticipated paramedic practice in Canada to
2025 (Tavares, Bowles, Donelon, 2016).

and embedded sets of interpersonal
relationships, and a recognition that all
patient encounters have both a medical/
health and a social/cultural context which
must be considered. The four cross-cutting
themes included patient safety, compassion,
communication, and adaptability/problemsolving. The study identified six roles that
paramedics assume: Clinician, Professional,
Educator, Team Member, Advocate, and
Reflective Practitioner. These roles are
integrated within the overall role of
Paramedic Practitioner. These roles form the
structure of the recently released Canadian
Paramedic Profile (Paramedic Association of
Canada, 2017).

The study found three framing concepts
that are essential to understanding
paramedicine in Canada: paramedics now
practice in a diverse and growing set of
practice contexts (e.g., industry, community,
in-facility), paramedics engage in multiple

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Focus on Paramedicine Research in BC

British Columbia

strengthening personal resiliency that
has been designed, from the ground up,
by experts in emergency response, for
persons who are employed or volunteer in
professions that require them to respond to
a wide range of emergency situations.
Paramedicine is a rapidly evolving discipline,
with paramedics taking on new job functions
in non-traditional contexts while continuing
to provide urgent and emergency care in
the out-of-hospital setting. Within British
Columbia, key stakeholders in paramedicine
including BC Emergency Health Services,
Ambulance Paramedics of BC and Justice

Institute of British Columbia are working
to better prepare and support paramedic
practitioners through innovative operational
initiatives, advanced education and training
programs, and ongoing applied research.
For more information please see
the websites below:
BC Emergency Health Services:
www.bcehs.ca
Ambulance Paramedics of BC:
www.apbc.ca
Justice Institute of British Columbia:
www.jibc.ca

JIBC is also engaged in research that
References
supports individual paramedic, allied health
BCEHS (2016). Transforming Emergency Health Services action plan: A response to Demand Modeling Study.
and public safety practitioners. Recent and
Victoria, BC: British Columbia Emergency Health Services. Retrieved June 12 from: http://www.bcehs.ca/
current studies include an exploration of
about-site/Documents/transforming-emergency-health-services-action-plan.pdf
precipitates to workplace violence against
Bowles, R. & Van Beek, C. (in press). Four Dimensions of Paramedic Practice. Australasian Journal of
Paramedicine.
paramedics. The study explores what factors,
if any, are associated with propensity for
Jensen, J. L., Bigham, B. L., Blanchard, I. E., Dainty, K. N., Socha, D., Carter, A., ... & Morrison, L. J. (2013).
The Canadian National EMS Research Agenda: a mixed methods consensus study. Canadian Journal of
the violent victimization of paramedics in
Emergency Medicine, 15(02), 73-82.
Canada. In this study, violence is defined as
Paramedic Association of Canada. (2017). Canadian Paramedic Profile. Ottawa, ON: PAC.
verbal assault, intimidation, physical assault,
Statistics Canada (n.d.). BC Annual Population Estimates. Retrieved June 9, 2017 from: http://www2.gov.
sexual harassment, and sexual assault. A
bc.ca/gov/content/data/statistics/people-population-community/population/population-estimates.
second study addresses the development
Tavares, W., Bowles, R., & Donelon, B. (2016). Informing a Canadian paramedic profile: framing concepts,
of personal resilience. This study evaluates
roles and crosscutting themes. BMC Health Services Research, 16(1), 477.
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