Indigenous peoples research in paramedicine: Embracing ways of knowing

Introduction

Paramedicine is practised in communities, not in isolation. As paramedics, we enter homes, stand on Indigenous land, and work with families and communities shaped by history, resilience, colonisation, sovereignty and strength. In these interactions, we do more than manage illness and injury. We engage with peoples lived experience, and with understandings of health and care shaped by culture, place and community. Those experiences are never culturally neutral, and neither is the knowledge that informs how we study and understand them. ¹

Globally, Indigenous Peoples continue to experience disproportionate burdens of illness and inequitable access to care, realities that are well described epidemiologically.^2,3 What is discussed less often within paramedicine is the epistemological dimension of this inequity. For example, whose knowledge systems shape the questions we are asking? Whose assumptions underpin the methodologies we apply? Whose standards determine what counts as valid ‘quality’ evidence?

Paramedicine, as an academic discipline, has developed largely within Western biomedical paradigms. Those paradigms have delivered substantial advances, but they also shaped our hierarchies of evidence and our definitions of rigour and quality. Put simply, those paradigms are not neutral. They reflect ontological and epistemological commitments that have historically been privileged within universities and academic journals.

This editorial arises from reflection within the journal's editorial team as part of Paramedicine's ongoing evolution. We routinely examine our editorial practices and the intellectual and scholarly direction of the journal with a view to strengthening it and the discipline it serves. From such reflection, it became clear that engagement with Indigenous scholarship was an area where we could do more and be better. That recognition was not prompted by a single event; it emerged gradually through conversations, consultation and through observing what was present in our published articles and, perhaps more importantly, what was not.

It would be naïve to suggest that academic publishing has been untouched by history. For a long while now, Indigenous scholars have documented the ways in which academic institutions and journals have marginalised Indigenous epistemologies and privileged Western methodological norms as universal standards of quality. ⁴ In some instances, Indigenous scholarship has been evaluated through Western epistemological and methodological criteria that are incongruent with Indigenous ways of knowing, being and doing.^5,6 In others, Indigenous communities have been positioned as subjects of research rather than as epistemic authorities and co-creators. ⁷ Health research, including paramedicine research, has not been exempt from this history.

This editorial aims to achieve three things. First, to reflect on why Indigenous Peoples ways of knowing are not peripheral to paramedicine, but central to its integrity and maturation. Second, to articulate clearly that Paramedicine seeks to give voice to these ways of knowing within what it publishes, not as symbolic inclusion, but as epistemic recognition. Finally, we will outline how the journal intends to embed Indigenous presence, authority and research principles structurally across its governance and editorial processes.

Partnerships and guidance

While we (non-Indigenous paramedic academic and Editor-in-Chief Paul Simpson and Māori nursing academic Eillish Satchell) have the honour of communicating our approach to the readership, the philosophy and strategy discussed herein are the result of partnering with and listening to Indigenous Peoples from several countries. Over several months, we have connected with and learned from Indigenous people in roles spanning academic leadership and scholarship, editorial publishing, frontline clinical care, and education. These conversations have been invaluable and constitute what we believe to be a shared outcome, and we are grateful for the contributions, support and guidance.

Embracing voice and recognising authority

There is a difference between publishing research about Indigenous communities and embracing Indigenous ways of knowing. The former can occur entirely within Western paradigms, but the latter requires recognition that Indigenous knowledge systems are coherent, rigorous, and grounded in their own ontological and epistemological frameworks.^8,9

Indigenous scholars have articulated these foundations clearly in some countries. In Australia, research involving Aboriginal and Torres Strait Islander peoples is grounded in principles of Spirit and Integrity, Reciprocity, Respect, Equality, Survival and Protection, and Responsibility. ¹⁰ Knowledge is relational and inseparable from Country.

In Aotearoa New Zealand, Mātauranga Māori offers an epistemological and ontological lens grounded in Te Āo Māori – the Māori world. ¹¹ Methodologies informed by mātauranga Māori, such as Kaupapa Māori Methodology, uphold knowledge generation as a relational practice that seeks to uphold tino rangatiratanga while achieving collective aspirations. ¹² A wonderful example is present in the work published in this journal by Satchell et al. investigating family experiences of emergency ambulance care in the context of a death. ¹³

In Canada, Indigenous data sovereignty principles, including Ownership, Control, Access and Possession, articulate community authority over research processes and outcomes. ¹⁴ These principles emerged directly in response to extractive research traditions. In the United States and elsewhere, Indigenous scholarship grounded in tribal sovereignty emphasises nation-to-nation relationships, formal tribal review processes and epistemologies embedded in land, story and collective memory. ¹⁵

These traditions are not peripheral to paramedicine research; rather, they constitute established bodies of scholarship with theoretical depth and methodological integrity. ¹⁶ They also represent decades of critique and reconstruction in response to colonial research practices.

Amplification of Indigenous voice within paramedicine as a discipline, and within Paramedicine as a journal, requires recognising this scholarship not as alternative but as essential. ⁹ It also requires acknowledging that journals inherently exercise epistemic authority. Decisions about what counts as quality shape the discipline, and our editorial team have been vocal about this at Paramedicine. However, if standards of rigour are applied without attention to epistemological context, marginalisation can be reproduced, even unintentionally. ⁹ We remain committed to the view that rigour remains essential; what must shift is our understanding of how rigour is demonstrated across different knowledge traditions.

Plurality, sovereignty and epistemic maturity

We have previously written about paramedicine as a maturing discipline, ¹⁷ but maturation must not only be methodological in a research sense; it must also be epistemic. A profession embedded in diverse communities that remains epistemologically monocultural will have negative consequences. If we want our discipline to be socially accountable, we must engage seriously with the knowledge systems of the communities we serve.

This is not however a call for uniform methodological change, neither is it a rejection of biomedical science traditions. Rather, it is a recognition that epistemic plurality will strengthen the discipline. It will broaden the base upon which our scholarship rests and ensure research is responsive to community-defined priorities.

As an international journal, for us to achieve what has been described above, we must recognise that Indigenous Peoples culture and ways of knowing are not monolithic. There is no single voice to apply that can speak on an international level. Aboriginal and Torres Strait Islander peoples are not Māori. Māori are not Inuit. Inuit are not Métis. Native American nations are not Sámi. Each community carries distinct histories, governance systems, and research traditions grounded in sovereignty. To speak of a singular Indigenous perspective risks homogenising diverse Indigenous knowledge systems and political contexts, something Indigenous scholarship has long challenged. ¹⁸

Paramedicine will not therefore adopt a single international lens regarding Indigenous Peoples scholarship. Plurality reflects sovereignty, and commitment to that plurality requires a willingness to learn across contexts rather than subsume them.

Structural commitment and shared authority

There is no best practice strategy for enhancing Indigenous epistemology and authority within journal editorial process and culture; all journals have their own vision, mission and underlying disciplinary context. Our approach has been and will continue to be grounded in partnership with and learning from Indigenous Peoples, our editorial team and guidance from our professional publishing partner.

Some journals have implemented a specific Indigenous Advisory Group adjacent to an Editorial Board, a decision that may be appropriate in some contexts. These structures can create space for partnership, however that alone does not redistribute authority, and they run the risk of being performative rather than meaningful. If Indigenous engagement remains external to editorial decision-making structures, the risk is that epistemic control remains largely unchanged.

Paramedicine intends to engage Indigenous Peoples scholars on multiple levels and where possible embed them within its editorial community and involve them in decision-making. This may mean such scholars contributing to formal journal roles but must extend beyond titles and tenures and include broader sustained engagement. This includes engagement where appropriate in manuscript deliberations, contribution to reviewer guidance and involvement in shaping strategic priorities. We will pursue an Indigenous-led special issue in which Indigenous scholars determine scope and intellectual framing. We will work to enhance the Indigenous literacy of our editorial team, reviewer base and readership. Collectively, we feel these actions are not symbolic nor performative and believe they represent authentic, structural evolution towards shared authority over knowledge.

Research involving Indigenous communities must be grounded in governance, relational accountability and reciprocal benefit, principles which are not procedural formalities. They reflect decades of Indigenous scholarship challenging extractive research traditions and articulating alternatives grounded in partnership and respect. We take the opportunity to highlight the critical research guidance in this space and encourage readers and researchers to engage meaningfully with these. Guidance examples include but are not limited to: Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: Guidelines for researchers and stakeholders ¹⁰ and AIATSIS Code of Ethics for Aboriginal and Torres Strait Islander Research ¹⁹ (Australia), Te Ara Tika Guidelines for Māori Research Ethics ²⁰ (Aotearoa New Zealand) and Ethics of Health Research Involving First Nations, Inuit and Métis People ²¹ (Canada).

It is also important to recognise that in some Indigenous contexts, research guidance is less formally codified and is instead reflected across a constellation of principles, community practices and emerging scholarship, shaped by distinct historical and structural realities.

In closing, we emphasise that Paramedicine does not approach this work as reputational positioning. Our position is that Indigenous ways of knowing are integral to the discipline's development. Amplifying voice means recognising epistemic authority, embedding Indigenous scholars and research principles within governance and decision-making structures, cultivating scholarship proactively, and applying standards of rigour in ways that are contextually appropriate.

Philosophical and structural maturation rarely occurs in a single moment or at a single point in time. In formulating our approach, we emphasise this is not a completed task, but a commitment to sustained action. It is a beginning. If paramedicine as a discipline is to describe itself as community-oriented and socially accountable, our research architecture and culture must reflect that aspiration.