Invited commentary – A research agenda for paramedicine

A research agenda for paramedicine

One of the foundational elements of a healthcare profession is a discipline-specific body of knowledge that continues to evolve through research that investigates important areas of practice, particularly areas that are not well supported by contemporary evidence. In the field of paramedicine, this evidence may span clinical interventions, health conditions and injuries that paramedics may encounter, patients with special needs, workforce health and wellbeing, systems of care, and integration with other health services to name a few. The potential range of research questions and the limited resources available for research inevitably lead to debate about how to prioritise research to provide the greatest benefit to the community and the profession.

Research questions may be formulated based on personal observation, organisational imperatives, or convenience and pragmatic factors associated with the necessary completion of a higher education research project. Research may also be driven by public health policy, funding opportunities, or the needs of service users. Individuals should be free to undertake research that has personal interest and practice applications. However, this may also lead to a fragmented body of knowledge that may not address higher level strategic priorities. For example, a review of published paramedicine research identified a relatively narrow focus on clinical topics and a limited methodological focus. ¹

In this edition, Pap and colleagues describe the substantial growth in paramedicine research over the past two decades, but also note limitations that may reduce the impact of much of this work. ² The authors recommend that a strategic approach be used to prioritise research to maximise impact and improve the translation of outputs to practice changes and development of the profession. This strategic approach to research through the development of a research agenda is evident in other health professions. There are clearly benefits in identifying high-level research goals, which include greater leverage for grant funding and opportunities for collaboration with other health professions and those who benefit from the research, including patients. However, the authors also note that while conceptually sound, there are also limitations and challenges associated with the establishment of a research agenda.

Pap and colleagues describe the outcome of a modified Delphi process that enabled participants to reach consensus on the top 10 areas of research for inclusion in a research agenda for Australia and Aotearoa New Zealand. The initial round included 109 research items, and subsequent rounds resulted in 37 items that met the cutoff for inclusion, with each listed in order of priority. The finding that potential roles for paramedics in non-traditional areas of health were ranked number one is consistent with the level of interest this topic has generated in other forums. The result may have been influenced by recent debate on community paramedicine and the growing evidence of paramedic integration within primary healthcare roles in the United Kingdom over the past two decades. ³

While new and emerging roles for paramedics were a priority item, the specific elements of this and related items need to be elucidated by those with an interest in these fields of research, with Pap and colleagues noting that the impact and outcomes of paramedic participation in new roles should be the priority. This demands consensus on outcome measures, with potential areas of focus that may include patient safety, patient satisfaction, clinical reasoning and decision making, health team dynamics and acceptance of the role, education and ongoing credentialling requirements, impact on the broader paramedic workforce, as well as funding and reimbursement questions. Robust and reliable research models will be required to undertake this work and should include an interprofessional team of researchers with specific skills, such as expertise in workforce reform and health economics. To say that this is a significant task may be an understatement. Work already undertaken in England on these questions may help to inform this potential project.^4,5

The other research items considered during the Delphi rounds, including those that did not make the final list, show the diversity of research topics generated by participants in an earlier companion study. ⁶ This should provide a valuable resource for researchers and students planning higher degree research, without detracting from the overarching intent of the research agenda.

Of interest and concern is the finding that the item ‘culturally safe care provision’ did not achieve the level of consensus required to be included in the final list. This is a significant omission given that strategies to improve Indigenous health and reduce racism and practitioner bias in healthcare are national priorities in Australia and Aotearoa New Zealand.^7–9 It is essential that paramedics and other healthcare practitioners provide patient and family-centred care that is culturally safe. Yet there is currently very little evidence of research in the field of paramedicine that investigates means of ensuring that different needs of patients, families and carers align with their cultural or spiritual preferences. ¹⁰

Overall, this well-designed study provides a contemporary list of items that should guide paramedic researchers and the broader field of paramedicine, including those who deliver health services. There are significant barriers and enablers to achieving these important research goals, with a companion paper describing these as ‘system’, ‘process’, and ‘human’ issues. ⁶ Without restating these, there is clearly an urgent need to develop additional research capacity within paramedicine, particularly within the paramedic academic workforce. Much work is required to engender the research workforce of the future and to demonstrate that clinical and research roles do not need to be mutually exclusive.

Funding and institutional support for research remain challenging. There are currently few opportunities for paramedicine-specific research funding from Australian competitive grants administered under the National Competitive Grants Program (NCGP). Both research capacity and leverage to obtain funding will require collaboration with established research-active academics, including those from other health disciplines who bring a wealth of expertise in not only research methods but in areas of health that are relevant to paramedicine. This agenda cannot progress if researchers are siloed within the field of paramedicine.

This ambitious but timely project provides a map for paramedicine research in Australia and Aotearoa New Zealand. However, the next stage will require sound navigation skills and significant support and commitment to translate the agenda from concept to outcomes that inform practice, education, and policy development. Let the journey begin.