Defining the discipline:
Roles and boundaries of Paramedicine
R. Bowles, C. van Beek, G. Anderson

INTRODUCTION/BACKGROUND

METHODS (Continued):

FINDINGS:

Medieval reference to “learned professions” included divinity,
medicine and law. Today, Wikipedia defines profession as “a
vocation founded upon specialized educational training, the
purpose of which is to supply objective counsel and service to
others…” Underlying a profession is a consistent and examinable
set of knowledge that is required for success that is clearly
articulated in a scope of practice with a code of conduct to direct
the use of this knowledge set. The path to professional
designation typically involves advancements from:

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 within
boundaries interact to develop a model for describing contested
visions of what constitutes the field of paramedicine.

One series of questions in the present study examined the current
and future roles of paramedicine. Four themes emerged from
analysis of these questions: Practitioner, Location of Care, Type of
Care, and Transportation. Figure 1 presents these four themes as
domains for describing paramedic practice. There is general
agreement on the centre or core (inner circles) of paramedic
practice: an advanced care provider who arrives at the patient’s
side in an ambulance, assesses and treats the patient, then
transports to medical care. However, new roles and non-traditional
aspects of paramedic care tend to involve changes to one or more
of these dimensions.

•
•
•
•

Part-time to full time occupation
Training school to university level education
Local to national associations and oversight
Codes of conduct to licensing

While paramedicine is moving along the path towards recognition
as a profession, there is little consensus on what constitutes the
roles and the boundaries of paramedicine.
Emergency Medical Services (EMS) is a relatively young
discipline, emerging in the 1960s through the extension of lessons
learned in military trauma management to the civilian setting, and
the application, at the patient’s side, and of CPR and advanced
cardiac life support procedures previously available only in the
operating theatre or intensive care unit. Early ambulance services
developed into integrated EMS that now include layered levels of
response and deeper integration with the overall medical system
(Bledsoe et al., 2005; Caroline, 2010; PAC, 2001). Advancing
technology and evolving medical practice have led to increased
expectations and a vastly expanded scope of practice for
paramedics. The present study examined the current level of
agreement on role of paramedicine as practiced in EMS.

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 Justice Institute of British Columbia. 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.

Figure 1: Roles and Boundaries of EMS/Paramedicine.

Defining “profession”:
To be considered a profession, a discipline should have:
• a clearly defined scope of practice with purpose & goal statements;
• a code of professional conduct;
• a unique “knowledge-based group”;
• a common language set and venue for knowledge dissemination;
• standards that are consistent with other peer groups.
• qualifications for education, experience, professional development;
• recognized certification that requires maintenance;

Paramedicine is a rapidly changing field (O’Meara et al., 2012).
Stakeholders in this study identified a wide range of emerging and
future roles for paramedics. Paramedics now function on
ambulances, in emergency wards, and in nursing homes and the
broader community, providing critical care and preventative care in
a variety of traditional and non-traditional settings. Current
discussions and national initiatives, such as the National EMS
Research Agenda and the National Occupational Competency
Profile for Paramedics in Canada (NOCP) Revision project, tend to
frame the changing role of paramedicine as evolution from an
emergency service to a health care discipline. While these roles
are often framed as polar (implying that the discipline must be one
OR the other), participants’ definitions, descriptions, and
discussion in this study imply that paramedic practice is
fragmented and evolving – but at present there is no single best
description of the field. It may be better to describe paramedicine
at the present as both an emergency service AND a health
discipline.
The development of paramedicine and EMS as a profession
continues to be a “work in progress”.
Bledsoe et al., 2005;
Caroline, 2010;
O’Meara PF, et al. (2012). Extending the paramedic role in rural Australia: a story of
flexibility and innovation. Rural and Remote Health 12: 1978. (Online)
PAC, 2001

Table 1: Criteria defining a profession.

JUSTICE INSTITUTE OF BRITISH COLUMBIA