Defining Paramedic Practice in Canada:
Framing Concepts
Bowles, R., Donelon, B., & Tavares, W.

INTRODUCTION/BACKGROUND

DISCUSSION: Framing Concepts

The Paramedic Association of Canada (PAC) has developed a new
Canadian Paramedic Profile that will describe the roles that paramedics in
Canada assume and the essential capabilities they require to perform
those roles. The redeveloped framework is intended to reflect current and
emerging paramedic practice.

Three core concepts or themes emerged as central to the development of the Canadian
Paramedic Profile.

In July, 2014, commissioned a study to support the development of an
initial Framework and Draft Roles describing Paramedic practice in
Canada. The guiding research question for this work was:

Paramedics are health care providers who function in the diverse and variables settings of paramedic
practice. Participants in the study described three features that distinguish the paramedic’s context from
that of other health care providers. First, paramedicine’s roots are in out-of-hospital response to
emergency and non-urgent situations, yet paramedics are increasingly providing care in location-based
(e.g. mass gatherings, industry, etc.), community-based, and in-facility settings. Second, the
paramedic’s traditional focus on emergency, urgent, and non-urgent care is evolving to include aspects
of primary care (e.g., monitoring patients with chronic conditions in their own homes) and preventative
care. Third, this has led to the need for alternate treatment, referral, and patient disposition pathways.

What key capabilities or attributes are essential in all
paramedics in Canada, regardless of designation?

Paramedic Context of Practice

METHODS
Embedded Contexts and Relationships

This mixed methods study included two parallel and concurrent activities:
an analysis of language found in 99 peer-reviewed, professional, and gray
literature sources and semi-structured interviews with 20 key stakeholders
in Canadian Paramedicine. We followed general principles of grounded
theory to conduct iterative thematic analysis of both sets of data
individually, then as a combined data set.

The individual patient encounter remains the essential unit of paramedic practice. However, the paramedic
community recognizes that a “call” involves much more that the assessment, differential diagnosis,
intervention, treatment, and transport of the patient. In addition to dealing with the patient’s immediately
presenting medical condition or injury, paramedics must be aware of and function within a number of
“nested” contexts and relationships. The patient’s presentation is always embedded within the personal
context of the patient, occurs within a specific location or environment, involves the patient’s overall health
history, and is situated within their social and cultural context. Similarly, paramedics must form short- and
long-term relationships with the patient and those around the patient (e.g., family members, bystanders),
their partners, other responders, and the extended team of health care providers that will be involved in the
care of the patient over time. Being aware of these contexts and relationships is essential in defining and
describing the roles that paramedics assume and the capabilities they require.

RESULTS
The working framework consists of a central Role: the Paramedic
Practitioner; six enabling Roles: Clinician, Reflective Practitioner, Team
Member, Leader at the Patient’s Side/Health & Social Advocate, Educator,
and Professional; and three cross-cutting themes: Patient Safety,
Compassion, Problem-solving.

The Health:Social Continuum
Throughout this project, the literature and the participants have emphasized the interplay
between the health and social aspects of paramedic practice. Every patient encounter is
embedded in a series of contexts and relationships. Paramedics practice from a unique and
privileged position, often encountering patients within the patient’s personal setting. Thus
paramedics have access to information about the patient’s immediate environment and
social/cultural context that are not always available to other health care providers. These
health and social factors are always present in any patient encounter, but their importance may
differ from call to call. Often, the precipitating health problem is the key aspect of the patient
encounter. However, in some cases, the patient’s health problem may be secondary to
underlying social determinants of the patient’s health and well-being. Paramedics must
consider, adapt to, and integrate this constantly changing and unpredictable mix of health and
social needs into their interactions and care for the patient.
ACKNOWLEDGEMENTs
This project was funded by the Paramedic Association of Canada, and supported by the Alberta
College of Paramedics, Centennial College, and Justice Institute of British Columbia.

JUSTICE INSTITUTE OF BRITISH COLUMBIA