Conference Report

Paramedics Connecting
Through Applied Research
(Paramedics CARe)
Conference Canada 2021

Abstract
The Justice Institute of British Columbia convened its first annual Paramedics
Connecting Through Applied Research (Paramedics CARe) between May 27 2021
and June 11 2021 over four morning sessions held online. The conference was
co-sponsored by the CSA Group, the Justice Institute of British Columbia, and the
University of Waterloo through a Connections grant from the Social Sciences and
Humanities Research Council of Canada. The aim of the Paramedics CARe is to
mobilise knowledge on the latest research in Canadian paramedicine and foster
intersectoral and interdisciplinary collaboration between academic researchers,
educators, provincial and municipal governments, private small and medium
enterprises (SMEs) that support paramedic practice, and the public through patient
advocacy groups. In this Conference Report, the authors share some featured
presentations, discuss lessons learned and visions for the future of paramedicine.

Key words
l Paramedicine l Paramedic practice l Research methods l COVID-19
Accepted for publication: 28 February 2022

T

he ‘Paramedics Connecting Through Applied
Research’ (Paramedics CARe) brought
together industry leaders, practitioners,
policymakers, educators, researchers, and students
to discuss current trends in paramedic research and
develop an applied research agenda to support the
future of Canadian paramedicine. Paramedicine has
evolved beyond the traditional role of transporting
individuals to primary healthcare centres for

treatment. While paramedics have been acquiring
new responsibilities and roles, research in
paramedicine has also evolved, and is becoming
increasingly intersectoral and transdisciplinary.
Paramedics CARe connected leading experts in a
four-morning virtual conference between May 27
and June 11 2021 to discuss paramedicine from
their respective disciplines and perspectives, share
current trends in research, initiate a conversation on
how these initiatives will impact the lives of
Canadians, and explore ways to mobilise research
knowledge more effectively for an intersectoral and
transdisciplinary audience.
The conference was divided into four morning
sessions and held virtually due to the ongoing
COVID-19 pandemic. Each day began with opening
remarks delivered by Dr. Ron Bowles, Dean of the
Office of Applied Research and Graduate Studies at
the Justice Institute of British Columbia, followed by
between three and five presentations. The
presentation summaries written by the respective
authors are presented herein. For the final morning
of the conference, the presentations were followed
by a breakout activity, concluding remarks and virtual
happy hour for networking.
Over the four sessions, more than 20 authors
presented interesting talks about their visions for
the field of paramedicine, the research they’d been
undertaking and the gaps in the system they were

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Plinio Morita, Associate Professor, School of Public Health Sciences, Faculty of Health, University of Waterloo; Department of
Computer Engineering and Automation, Faculty of Electrical and Computer Engineering, State University of Campinas,
Campinas, Sao Paulo, Brazil; Assistant Professor, Institute of Health Policy, Management, and Evaluation, University of Toronto,
Toronto, Canada; Department of Systems Design Engineering, University of Waterloo; Research Scientist, Research Institute for
Aging, University of Waterloo and Schlegel Villages and Centre for Global eHealth Innovation, Techna Institute, University
Health Network; Waterloo, Canada; Arlene Oetomo, PhD Candidate, School of Public Health Sciences, Faculty of Health,
University of Waterloo, Waterloo, Canada; Ron Bowles (Corresponding author), Dean, Office of Applied Research & Graduate
Studies, Justice Institute of British Columbia, Vancouver, Canada. Email for correspondence: rbowles@jibc.caCountry: Canada



working to address. In the following section,
readers will find ten presentation summaries written
by their respective authors that will be followed by
a discussion, lessons learned, recommendations for
future research, future events and a conclusion.

Canadian paramedicine as a complex
system of systems

Dr. Ron Bowles of the Justice Institute of British
Columbia opened the Conference by presenting a
view of paramedicine in Canada as a complex
‘system of systems’. Dr. Bowles noted that the
Paramedics CARe sessions aimed to mobilise
knowledge and foster intersectoral and
transdisciplinary collaboration between academic
researchers, educators, provincial and municipal
governments, small and medium enterprises (SMEs),
and patient advocacy groups that support
paramedic practice. This goal demonstrates and
highlights some of the dynamic systems,
practitioners, organisations, and stakeholders,
whose interactions constitute the profession of
paramedicine. Dr. Bowles described the Canadian
Paramedic Information System project, a 3-year
project that analysed existing information and data
systems, explored operational and academic
literature, and gathered data from key informants
with the goal of identifying data needs and core
concepts that will support evidence-informed
evolution and practice of Canadian paramedicine.
The resulting ‘map’, recently published as a
National standard, describes a series of overlapping
micro-to-macro ‘systems’, consisting of data
describing patients and practitioners, patient
encounter data, operational characteristics of
paramedic service organisations, varied practice
settings, professional organisations and stakeholders
to broader healthcare, social and cultural
considerations. Dr. Bowles noted that systems-ofsystems conceptualisations are valuable metaphors
that are becoming increasingly common in models
and research exploring practice, occupational
requirements, and the profession as a whole.

Stirred, not shaken

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Canadian paramedicine’s response
to COVID-19
Dr. Ron Bowles described the initial findings of a
study exploring the innovative responses of
Canadian Paramedic Service Organizations (PSOs)
to the COVID-19 pandemic. A key finding was the
complexity of these challenges and the ubiquity of
COVID’s impact across all aspects of Canadian
society. Thematic analysis situated these challenges

Conference Report

within an emergent framework:
l Maintaining safety
l Ensuring ongoing and COVID-related operations
l Providing safe and effective clinical care
l Addressing stresses on the overall healthcare and

public safety systems.
Yet, neither challenges nor innovations were
discrete; both issues and responses typically
impacted multiple categories of this framework. For
example, personal protective equipment (PPE) use
was constrained by a lack of understanding of PPE
requirements for COVID, differing—and often
rapidly changing—guidance from multiple levels
and sources of authority, stressed or broken supply
chains, the need for rapid research, development of
alternative practices and supplies, establishing
effective training and procedures, and integration
with PPE practices of related health and emergency
services. Success factors in the innovative responses
of Canadian PSOs included a focus on business
continuity, nimbleness and adaptability,
development and leveraging of interpersonal and
interorganisational relationships, and effective
information and decision-making and
communication practices.

COVID-19 and paramedic practice
An interdisciplinary approach to
qualitative research
Frontline professionals are experiencing numerous
policy and protocol changes in addition to facing
an enhanced risk of personal exposure during the
COVID-19 pandemic. The COVID-19 outbreak
offers an opportunity to capture their experiences
during substantial and rapid changes to workplace
policy, protocols, and professional roles. In this talk,
Lindsey Boechler and Cheryl Cameron discussed
overlapping findings from three recent research
projects, written with colleagues Polly Ford-Jones, J
Chris Smith and Patrick Suthers, which explored the
lived experiences of Canadian paramedics, nurses,
and police officers throughout the first wave of
COVID-19. These studies highlighted the
importance of employing interdisciplinary,
qualitative research approaches to capture the
perspectives of frontline professionals. An
interdisciplinary approach led to learnings
surrounding culture, equity, change management,
and leadership that would not otherwise have been
captured. Research findings also revealed that
frontline professionals are encountering ethical
dilemmas and suffering moral distress rooted in
similar experiences. While historical systemic issues
and inequities are being exacerbated by COVID-19,
added stress and uncertainty have also led to

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Caring for those who care for us
Prevention of musculoskeletal disorders
among paramedics
Taking care of those who care for us is of utmost
importance to maintaining public health and safety.
On a daily basis, paramedics encounter numerous
ergonomic hazards (e.g. high forces, awkward
postures, repetitive movements), which put them at
increased risk for musculoskeletal disorders
(MSDs). The new Canadian Standard on the
ergonomic design of ambulances sets out minimum
requirements and provides guidance to support
manufacturers and paramedic services in designing
and procuring ambulances and its related
equipment that are in accordance with research to
maintain and enhance the safety, wellness, and
performance of paramedics.
In this presentation, Dr. Amin Yazdani, Director
of the Canadian Institute for Safety, Wellness, and
Performance, School of Business, Conestoga
College Institute of Technology and Advanced
Learning, presented the new evidence-informed
standard and discussed its research and
development process. More specifically, Dr.
Yazdani shared findings from three research studies
to provide the audience with an understanding of
the state of research related to ambulance design,
the extent of ergonomic considerations found in
existing Canadian provincial ambulance design
standards and regulations, the application of
standards in the ambulance design and
procurement processes, and the barriers to
integrating ergonomics into product design when
standards do not adequately address ergonomic
considerations. An overview of key areas found
within the standard was also provided.

Gender and sex matters
Disrupting the paramedic work
environment with gender-based analysis
The difference between sex and gender are
important concepts to paramedicine evidence and
practice. Sex is the biological profile that includes
chromosomes, sex organs and particular groupings
of hormones, whereas gender is a socially
constructed stereotype that is culturally reinforced
through roles defined as feminine or masculine.
Knowing this difference helps paramedics to

develop a critical thinking approach and enables
them to challenge both their own bias and the
evidence that supports their clinical decisions. This
presentation explored where the current approach
of ‘one-size-fits-all’ clinical guidelines currently
taught and used in practice, and a lack of
addressing gender bias does not benefit all patients.
Dr. Becky Donelon, Manager of Emergency Health
Services, Alberta Health, brought forward the
importance of paramedics being able to challenge
their own clinical knowledge and bias in the
following two key aspects:
l Recognising that the data provided as evidence
in clinical protocols is, in most cases, only
representative of white males
l Recognising the bias in interpreting patient
presentations by relying on preconceived notions
and expectations of gender stereotypes.
The discussion focus considered how clinical
judgement underpinned by weak or lacking
representative evidence is poor practice and that it
matters to the patient how paramedics understand
biological differences of sex and gender.

Ageing in place
Technology and innovation
Older adults (aged 65+ years) are the fastest
growing demographic. It is estimated that by 2050,
they will represent 25% of Canada’s population.
Recent studies have shown that over 90% of
Canadians would prefer to stay in their own homes
as they age. This will present new challenges to
current social infrastructure and health
professionals who provide medical, nursing,
paramedicine and remote care across the country.
In April 2021, the National Research Council of
Canada (NRC) launched a 7-year ‘Aging in Place
Challenge Program’ to address these challenges. In
this talk, Dr. Amaya Arcelus, Programme Director,
introduced the NRC and its mandate, along with
the programme plan. She described the design
approach and the extensive stakeholder
engagement carried out during programme
development. The programme is structured on the
four main pillars of safety, health, connection and
standards. It consists of collaborative projects
between NRC researchers and partners from
private and public sectors, who will develop novel
technologies, applications, and recommendations
to support aging in place. As older adults and
caregivers are at the center of the programme’s
vision, it includes a community of ‘Experts by
Experience’ (older adults and caregivers) who
advise on programme direction and priorities,
provide feedback on individual projects, and
participate in research activities.

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increased interprofessional conflict across
paramedicine, nursing, and policing. Rapid
knowledge mobilisation of early research findings
was vital in diminishing tension and supporting
frontline professionals through the continuing
COVID-19 pandemic.



National standards for community
paramedicine
Paramedicine is evolving into a health specialty that
provides on-demand access to care and enables
new care pathways that do not require or include
traditional emergency department dispositions. Dr.
Matthew Leyenaar, Director of Emergency Health
Services at the Prince Edward Island Department of
Health and Wellness, explained that the assessment
approaches taught to paramedics for identifying
and treating high-acuity patients follow a de facto
standard but adaptation of assessment practices to
low-acuity care not requiring emergency
department care have not been established. Other
parts of the healthcare continuum have
implemented standardised multidimensional
assessment instruments with demonstrated
improvements, particularly with respect to patient
needs in continuity of care and decision-support
tools for clinicians.
The Common Assessments for Repeated Paramedic
Encounters (CARPE) Study was a pragmatic cohort
study that used a standardised multidimensional
assessment instrument as a prototype in scheduled
home visit community paramedicine programmes.
The study demonstrated that patients seen in these
programmes had higher levels of chronic disease
comorbidities and mental health concerns. A
standardised multidimensional assessment instrument
has clinical utility to improve assessment practices
when care planning is designed to support care-inplace and avoid transportation to emergency
departments. The framework for evaluating
assessment practices in clinical settings that
implement standardised processes can be adapted to
service delivery models, either within paramedicine
or within other clinical settings.

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Predictive modeling in paramedicine

Predictive modeling may help paramedic services
and paramedics better plan for and deliver
healthcare services. In this talk, Dr. Ian Blanchard,
Adjunct Assistant Professor of Community Health
Sciences at the University of Calgary, and Dr. Luc de
Montigny, Research Coordinator (Urgences-santé)
and Adjunct Professor at McGill University, compared
prediction to other types of analyses, discussed the
challenges and pitfalls of predictive modeling, and
described ongoing work and potential applications
for this technique in paramedic systems and care.
Predictive modeling, or forecasting, is a technique
where researchers attempt to predict future
outcomes. It is different from explanatory modeling
that explores what has happened in the past. One of
the biggest challenges of any type of modeling is
data quality, and avoidance of bias in the study

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design. This is particularly important in predictive
modeling where data limitations can be amplified.
Two examples of ongoing predictive studies in
Canadian paramedic systems were described:
l One with the aim of determining if supplymanagement based on 911 call demand
forecasting can outperform current practice
l Another with the aim of developing prehospital
risk estimation techniques for 911 call-taking.
The bottom line is that paramedics will play a
critical role in the development and interpretation
of these models to help inform their practice and
the systems in which they work.

Post-traumatic stress injuries
and paramedicine

Paramedicine is known to increase the risk of
psychological work-related injuries. Occupational
burnout and exhaustion result in reduced
motivation and work performance. Occupational
stress injuries (OSIs) are also common.
Ongoing work is needed to encourage a
proactive approach to health and a holistic
approach to care. Workplace stigma remains
prevalent among other care and recovery barriers.
Given the high cost of mental health disability,
the cost related to absenteeism and presenteeism,
and the need to reduce psychological injuries and
suicide, this session—presented by Dr. Katy Kamkar
(PhD, CPsych), Assistant Professor of the
Department of Psychiatry at the University of
Toronto and Chair of the Canadian Psychological
Association, Traumatic Stress Sector—focused on
the emotional, cognitive/psychological and
behavioural symptoms related to moral injury,
compassion fatigue and burnout. It also covered
ways of building individual and organisational
protective factors and reducing modifiable risk
factors as part of primary, secondary and tertiary
prevention continuum of care, and discussed
psychological health and safety implementation
strategies to help reduce risk and promote
individual and organisational resilience—in turn,
optimising occupational health and safety.

The future of paramedicine
Canadian vision
The Canadian Organization of Paramedic Regulators
(COPR) was established in 2008 to address labour
mobility challenges arising from amendments to
Chapter 7 of the Agreement on Internal Trade.
Jacqueline Messer-Lepage, Treasurer of COPR,
outlined its mission and vision that supports a
progressive approach to paramedic regulation
across Canada.

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Digital behavioural monitoring
Paramedics are often faced with extremely complex
cases and have very little time to make informed
decisions. Paramedics are becoming responsible for
delivering home care to individuals in need. Still,
they arrive at patients’ homes with very little
information about the health and behaviour of their
patients. Yet they are asked to make complex
informed decisions with a limited amount of
information at their disposal.
In this talk, Dr. Plinio Morita, Director of the
Ubiquitous Health Technology Lab (UbiLab) at the
School of Public Health and Health Systems,
University of Waterloo, discussed the future of
remote patient monitoring (RPM) and the Internet
of Things (IoT) as tools that will enable paramedics
to remotely access the telemetry data of their
patients, which could include vital signs (e.g. heart
rate, blood pressure), as well as behavioural
indicators (e.g. levels of physical activity, sleep
patterns). Dr. Morita explored the integration of
digital health technologies into paramedic practice,
providing advanced situational awareness about
their patients and as a mechanism to develop early
warnings to triage homecare patients.
Digital health technologies are changing our
healthcare landscape, and paramedics need to be
prepared and equipped to use these technologies
for improving their practice and patient care.

Discussion

The talks presented outline just some of the
excellent research and efforts being made in the
field of paramedicine across Canada. The talks fell
into three major categories: work environment,
technology and the future of paramedicine, each of
which is summarised in this section.

Work environment
Three talks discussed the intricacies of the work
environment. Dr. Amin Yazdani presented on the
new Canadian standard on ergonomic ambulance
design to maintain and enhance safety and wellness
among paramedics. Dr. Becky Donelon discussed
the importance of critical thinking and lack of
understanding gender biases leading to poor
practice and how awareness and support for
evidence would support clinical decisions. Dr. Katy
Kamkar presented on occupational burnout and the
need to take a proactive approach to building
individual and organisational protective factors for
optimising occupational health and safety.
The COVID-19 pandemic has dramatically affected
our lives and impacted every aspect of daily living.
The work presented by Lindsey Boechler, Cheryl
Cameron and written with colleagues Polly FordJones, J Chris Smith and Patrick Suthers explores
how paramedics, nurses and police officers
experienced challenges with ethical dilemmas and
suffered moral distress. Using qualitative methods,
their work revealed how systemic issues were
exacerbated by COVID-19, and how by sharing
results through rapid knowledge mobilisation they
were able to support frontline professionals.

Technology
The talks from Drs. Ian Blanchard and Luc de
Montigny and Dr. Plinio Morita, demonstrated how
data could be used to improve patient outcomes
through predictive modeling and remote telemetry
through integration of digital health tools. Both also
highlighted how paramedics must be involved in
the development of these tools and how they will
be better equipped in the future. Dr. Amaya Arcelus
discussed the Aging in Place Challenge Program’s
mandate and how it is geared towards finding
novel solutions to support ageing in place.

Towards the future
Paramedicine, as Dr. Ron Bowles described in his
talk, can be viewed as a ‘system of systems’—an
integral component of the Canadian healthcare
landscape, best understood through intersectoral
and transdisciplinary collaboration. Work such as
the Canadian Paramedic Information System project
provides a framework for exploring the various
‘systems’ or components of paramedicine, and their

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In implementing its mandate, COPR members
worked to increase harmonisation of regulatory
activity across jurisdictions. To support regulatory
alignment, COPR launched national examinations
for Primary and Advanced Care Paramedics and
Emergency Medical Responders. In 2019, COPR also
launched a national portal to streamline
international paramedic entry into Canada. The
creation of this portal served to establish common
criteria among COPR jurisdictions for pre-screening
international applicants seeking licensure/
registration/certification in Canada.
Most recently, COPR launched a national project
to develop pan-Canadian Essential Regulatory
Requirements (PERRs). The introduction of these
competencies and standards will address key
regulatory gaps and ensure that practitioners meet
clinical and academic requirements necessary to
support health systems nationwide.
Moving into the future, COPR members are
developing immersive and virtual technology
solutions to further enhance the evaluation of
international and national practitioners. These
adaptations in regulatory approach serve to
advance safe and appropriate patient care within a
forward-thinking regulatory environment.



relationships with each other and with broader
health, community, and social-cultural systems.
Initiatives, such as the work presented by
Jacqueline Messer-Lepage and COPR, and
harmonising regulations and standards of practices
described by Dr. Matthew Leyenaar, further
highlight the evolution of paramedicine in Canada
and in meeting the healthcare needs of Canadians.

Lessons learned

The 1st annual Paramedics Connecting Through
Applied Research (Paramedics CARe) brought
together presenters of varied backgrounds and
expertise—from those providing direct care in the
community to visionaries who see transformative
potential for technology in paramedicine. There
were repeated calls for proactive, interdisciplinary
research and approaches to ensure the progress of
the field and development of robust programmes.
As paramedicine continues to evolve as a
profession, and as the practice of paramedicine
increases in scope and complexity, research within
and about the profession must similarly incorporate
multiple perspectives and a variety of disciplinary
approaches. Events such as the Paramedic CARe
conference provide valuable opportunities for
researchers and stakeholders in paramedicine to
look through a variety of lenses, to see both new
and familiar challenges in different ways.
In its first annual offering, this conference was
held in virtual format. Split over several weeks, this
allowed participants and presenters to make time in
their busy schedules to attend rather than having to
book an entire week off. The virtual sessions were
kept shorter to minimise fatigue and scheduling
during a mutually agreeable time ensured that
global attendees could also participate. Additionally,
as every session was a standalone event,
participants were not forced to pick between
concurrent sessions. Participants enjoyed the
presentations, sharing their positive feedback via
emails and comments.

Future research

innovation will continue to be driven by local and
regional operational needs and opportunities.
Bringing together a wide range of knowledge users
from practitioners to suppliers of industry
equipment will create opportunities to energise
current, and innovate future, research ideas.
Additionally, enabling participation of paramedicine
students and early career paramedics will help to
mobilise the results of this research, resulting in
direct and lasting impacts for the health of
Canadians. The intentional creation of a space for
sharing and discussing current and emerging
research methods will further help advance
paramedicine and the science(s) supporting it.

Next events

Paramedic CARe was organised by the Ubiquitous
Health Technology Lab at the University of
Waterloo and the Justice Institute of British
Columbia. Attendees tuned in from around the
world, with attendance at individual sessions
ranging from between 30 and 55 registrants.
Following the success of this conference and the
format, the next Paramedics CARe conference will
be held in Ontario, Canada tentatively scheduled
for June 2022. At present, the format will include
four sessions and, depending on public health
requirements, will include both virtual and inperson activities. The landscape of paramedicine
has changed, and the themes of this conference
highlight the importance of harnessing digital
technology, both through research and practice.

Conclusion

The conference saw a range of presenters from
various backgrounds and expertise, addressing a
diverse set of social, health, and practice challenges.
The knowledge and networking opportunities
through the Paramedic CARe conference highlight
the diverse, complex, and dynamic evolution of
paramedic practice in Canada. IPP
Acknowledgements: The authors wish to thank all
the presenters for their valuable contributions to the
conference and for their contribution to this paper.
The authors would also like to thank the CSA Group
for their support, and gratefully acknowledge that
this work was funded through the receipt of a Social
Sciences and Humanities Research Council (SSHRC)
Connections Grant.

© 2022 MA Healthcare Ltd

A key message emerging from the presentations
was the need for national structure(s) and events,
such as Paramedic CARe, to connect and foster
collaboration between various stakeholders in
Canadian paramedicine. Without such structures,

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