EMS? Paramedicine? What’s in a name?
R. Bowles, C. van Beek, G. Anderson

INTRODUCTION/BACKGROUND
The concept of using ambulances to transport injured soldiers from the battlefield to
medical aid can be traced to the Napoleonic wars (Bledsoe et al., 2005). In Canada,
organizations such as Toronto EMS document the provision of ambulance services to
prevent the spread of a cholera outbreak in the 1830’s (Newton, 2013). Modern
emergency medical systems (EMS) began to emerge in North America during the
1960s with advent of advanced medical care to treat as well as transport patients.
Military medical experience in Korea and Vietnam demonstrated that rapid
intervention, packaging, and transport of severely injured soldiers to hospital and
operating theatres saved lives. At the same time, research in cardiac resuscitation led
to the development of procedures and equipment that allowed the use of CPR and
provision of advanced cardiac care paramedics at the patient’s side. These twin
functions of caring for and carrying the ill and the injured continue to be essential
features of modern ambulance services.
Early ambulance services have developed into integrated EMS that now include
layered levels of response and deeper integration with the overall medical system
(Bledsoe et al., 2005). Advancing technology and evolving medical practice have led
to increased expectations and a vastly expanded scope of practice for paramedics.
Paramedics now function on ambulances and in nursing homes, providing critical
care and preventative care in a variety of traditional and non-traditional settings.
Various paramedic jurisdictions, such as Australian and the UK, are expanding the
role of paramedics to include community-based and primary health care.
One of the outcomes of this growth is uncertainty as to what to call the field. Modern
Emergency Medical Services provide much more than “Emergency” services. While
the term “paramedic” is commonly used to describe the ambulance practitioner in
Canada, most systems have a variety of non-paramedic personnel and
interdisciplinary teams of varied health practitioners are increasingly common. Thus,
in addition to struggling with the emergence of multiple roles and new capabilities,
practitioners in this discipline must also wrestle with how to name and define their
field.
The question of what to call EMS or paramedicine was explored in a recent project
undertaken by the Justice Institute of British Columbia (JIBC). The project had the
overall goal of developing priorities for engaging in research involving EMS
Education. Part of the project involved exploring current conceptions and future
directions for the field.
METHODS
This mixed methods study was conducted as part of an ongoing project to develop a
program of research for the Health Sciences Division (HSD) at the JIBC. The project
explored research needs and issues through an exploration of English language EMS
literature and semi-structured interviews with key stakeholders in Canadian EMS
Education.
The stakeholder interviews were analyzed to explore current conceptions of EMS and
paramedic practice. Core terms were extracted from the transcripts, then mapped
thematically to look for relationships, similarities, and differences. Thematic analysis
was used to explore how descriptions of paramedic practice, the current and future
roles of paramedicine, and its perceived boundaries interact to develop a model for
describing contested visions of what constitutes the field of paramedicine.
Several intriguing themes emerged from the study, including the contested
terminology used to describe the field.

FINDINGS:
There is no consensus, and little agreement, on what term or terms best describe the
field. The discussion on this topic was wide ranging, and participants tended to spend
more time explaining why they did not like specific terms than in talking about the
terms they preferred. In addition, participants tended to both defend and qualify the
terms they did use – often admitting the limitations of the term while offering it.
Terms tended to fall into three categories:

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The first set of terms was variations on the term EMS. Several of the participants felt
that this term was restrictive and was associated with traditional ambulance services.
Also, the term “emergency medical” placed too strong an emphasis on the emergency
aspect of paramedic practice and did not adequately acknowledge either nonemergency nor emerging non-ambulance roles. The term “emergency health
services” or EHS was offered as a core term which acknowledges both the
emergency ambulance and broader health-related roles that paramedics are
assuming.
A second set of terms focused on the identity of the provider: paramedic care,
paramedic practice, paramedicine. However, these terms were seen by several
participants as boundary terms, excluding non-paramedic providers (e.g. fire, first aid,
nurse, physician) from the discipline. One participant explicitly limited the concept of
paramedic practice to advanced medical care, seeing other providers as not within
the scope of paramedicine.
The final set of terms, variations on pre-hospital and out-of-hospital care, were offered
in contrast to each other. Pre-hospital care was seen as focusing on the ambulance
role and not acknowledging that paramedics now perform many functions that do not
result in transport to the hospital. Out-of-hospital care was seen as a broader term,
but also limiting in not acknowledging in-hospital roles.
IMPLICATIONS:
There was no consensus on what term(s) to use to describe the field. In general
conversation, the two terms that came up most spontaneously were paramedicine (or
paramedic practice) and EMS. Oddly, while almost all participants expressed
dissatisfaction with the term EMS, it continued to pop up throughout the interviews.
Interestingly, participants disagreed on which was the more inclusive term. Those who
preferred “paramedicine” noted that “emergency” limited the applicability of “EMS,”
while others saw EMS as a broader umbrella term and viewed “paramedicine” as
excluding other providers. The tension in this discussion seemed to centre around
conflicting trends related to who the practitioners are (paramedics and other health
providers), where they practice (ambulance, community or location-based, and/or inhospital), and what their role is (emergency care, definitive care, preventative care).
These tensions are explored in a separate poster describing the roles and boundaries
of paramedicine.
REFERENCES
Bledsoe, B. E., Porter, R. S., Cherry, R. A., & Clayden, D. E. (2005). Essentials of
Paramedic Care (1st Canadian Ed.). Pearson.
Newton, B. (2013). EMS history in Canada. Is it too late? Canadian Paramedicine.
Available online at: http://www.emsnews.com/read/featured-articles/ems-history-incanada

JUSTICE INSTITUTE OF BRITISH COLUMBIA