Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
REVIEW

Defining the paramedic process

Holly Carter A and James Thompson B C
+ Author Affiliations
- Author Affiliations

A Ambulance Victoria, 375 Manningham Road, Doncaster, Vic. 3108, Australia.

B Paramedic Education, School of Medicine at Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.

C Corresponding author. Email: james.thompson@flinders.edu.au

Australian Journal of Primary Health 21(1) 22-26 https://doi.org/10.1071/PY13059
Submitted: 1 May 2013  Accepted: 30 August 2013   Published: 1 November 2013

Abstract

The use of a ‘process of care’ is well established in several health professions, most evidently within the field of nursing. Now ingrained within methods of care delivery, it offers a logical approach to problem solving and ensures an appropriate delivery of interventions that are specifically suited to the individual patient. Paramedicine is a rapidly advancing profession despite a wide acknowledgement of limited research provisions. This frequently results in the borrowing of evidence from other disciplines. While this has often been useful, there are many concerns relating to the acceptable limit of evidence transcription between professions. To date, there is no formally recognised ‘process of care’-defining activity within the pre-hospital arena. With much current focus on the professional classification of paramedic work, it is considered timely to formally define a formula that underpins other professional roles such as nursing. It is hypothesised that defined processes of care, particularly the nursing process, may have features that would readily translate to pre-hospital practice. The literature analysed was obtained through systematic searches of a range of databases, including Ovid MEDLINE, Cumulative Index to Nursing and Allied Health. The results demonstrated that the defined process of care provides nursing with more than just a structure for practice, but also has implications for education, clinical governance and professional standing. The current nursing process does not directly articulate to the complex and often unstructured role of the paramedic; however, it has many principles that offer value to the paramedic in their practice. Expanding the nursing process model to include the stages of Dispatch Considerations, Scene Assessment, First Impressions, Patient History, Physical Examination, Clinical Decision-Making, Interventions, Re-evaluation, Transport Decisions, Handover and Reflection would provide an appropriate model for pre-hospital practices.

Additional keywords: ambulance, emergency medical services, EMS, nursing process, paramedic role, pre-hospital care.


References

Ackley BJ, Ladwig GB (2011) ‘Nursing diagnosis handbook: an evidence-based guide to planning care’, 9th edn. (Mosby Elsevier: Philadelphia, PA)

Alfaro-LeFevre R (2010) ‘Applying nursing process: a tool for critical thinking.’ 7th edn. (Lippincott Williams & Wilkins: Philadelphia, PA)

American Academy of Orthopaedic Surgeons & American College of Emergency Physicians (2009) ‘Critical care transport.’ (Jones & Bartlett Learning: Sudbury, MA)

Andersson T, Värbrand P (2006) Decision support tools for ambulance dispatch and relocation. The Journal of the Operational Research Society 58, 195–201.

Attree M, Murphy G (1999) Nusing process: paradigm, paradox or Pandora’s box? Nurse Education Today 19, 592–597.
Nusing process: paradigm, paradox or Pandora’s box?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3mvV2msA%3D%3D&md5=46c680a1d75eca4344c5ebb7654ee761CAS | 10808903PubMed |

Ball L (2005) Setting the scene for the paramedic in primary care: a review of the literature. Emergency Medicine Journal 22, 896–900.
Setting the scene for the paramedic in primary care: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2Mnhs1Ogtw%3D%3D&md5=d823b2e0cd309a465d5506d81fd37350CAS | 16299210PubMed |

Bissell RA, Seaman KG, Bass RR, Racht E, Gilbert C, Weltge AF, Doctor M, Moriarity S, Eslinger D, Doherty R (1999) Change the scope of practice for paramedics? an ems/public health policy perspective. Prehospital Emergency Care 3, 140–149.
Change the scope of practice for paramedics? an ems/public health policy perspective.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3ktVWkug%3D%3D&md5=39f6b0cbf2659f6d9721e67ad0aba7fcCAS | 10225648PubMed |

Boyle M, Koritsas S, Coles J, Stanley J (2007) A pilot study of workplace violence towards paramedics. Emergency Medicine Journal 24, 760–763.
A pilot study of workplace violence towards paramedics.Crossref | GoogleScholarGoogle Scholar | 17954828PubMed |

Bryar R (1987) The nursing process: a literature review. Midwifery 3, 109–116.
The nursing process: a literature review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1c%2FjvVeqsw%3D%3D&md5=c560c76f8f541a5bde8d4f58394d12a8CAS | 3312964PubMed |

Campeau AG (2008) The space-control theory of paramedic scene-management. Symbolic Interaction 31, 285–302.
The space-control theory of paramedic scene-management.Crossref | GoogleScholarGoogle Scholar |

Carlson S (1972) A practical approach to the nursing process. The American Journal of Nursing 72, 1589–1591.

Caroline N (2008) ‘Emergency care in the streets.’ 6th edn. (Jones & Bartlett: Sudbury, MA)

Cooper SJR, Grant J (2009) New and emerging roles in out of hospital emergency care: a review of the international literature. International Emergency Nursing 17, 90–98.
New and emerging roles in out of hospital emergency care: a review of the international literature.Crossref | GoogleScholarGoogle Scholar |

Crossman M (2009) Technical and environmental impact on medication error in paramedic practice: a review of causes, consequences and strategies for prevention. Journal of Emergency Primary Health Care 7, 990 374

Daniels R (2004) ‘Nursing fundamentals: caring and clinical decision making.’ (Cengage Learning: Melbourne)

Field MJ, Lohr KN (Eds) (1990) ‘Clinical practice guidelines: directions for a new program.’ (National Academies Press: Washington, DC)

Hauswald M (2002) Can paramedics safely decide which patients do not need ambulance transport or emergency department care? Prehospital Emergency Care 6, 383–386.
Can paramedics safely decide which patients do not need ambulance transport or emergency department care?Crossref | GoogleScholarGoogle Scholar | 12385602PubMed |

Hedges JR, Feero S, Moore B, Shultz B, Haver DW (1988) Factors contributing to paramedic onscene time during evaluation and management of blunt trauma. The American Journal of Emergency Medicine 6, 443–448.
Factors contributing to paramedic onscene time during evaluation and management of blunt trauma.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1czis1Cjsw%3D%3D&md5=b230c14dcac4aa59a16944fc8d856168CAS | 3415736PubMed |

Hood LJ, Leddy SK (2006) ‘Leddy & Pepper’s conceptual bases of professional nursing.’ 6th edn. (Lippincott Williams & Wilkins: Philadelphia, PA)

Hunter LP, Lops VR (1994) Critical thinking and the nurse-midwifery management process. Journal of Nurse-Midwifery 39, 43–46.
Critical thinking and the nurse-midwifery management process.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c3ltl2hug%3D%3D&md5=113e3f37444096801298f2733e0a6736CAS | 8195893PubMed |

Jensen JL, Croskerry P, Travers AH (2009) Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study. BMC Emergency Medicine 9, 17
Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study.Crossref | GoogleScholarGoogle Scholar | 19772558PubMed |

Joyce CM, Wainer J, Piterman L, Wyatt A, Archer F (2009) Trends in the paramedic workforce: a profession in transition. Australian Health Review 33, 533–540.
Trends in the paramedic workforce: a profession in transition.Crossref | GoogleScholarGoogle Scholar | 20166901PubMed |

Lang ES, Spaite DW, Oliver ZJ, Gotschall CS, Swor RA, Dawson DE, Hunt RC (2012) A national model for developing, implementing and evaluating evidence-based guidelines for prehospital care. Academic Emergency Medicine 19, 201–209.
A national model for developing, implementing and evaluating evidence-based guidelines for prehospital care.Crossref | GoogleScholarGoogle Scholar | 22320372PubMed |

Levine SD, Colwell CB, Pons PT, Gravitz C, Haukoos JS, McVaney KE (2006) How well do paramedics predict admission to hospital? A prospective study. The Journal of Emergency Medicine 31, 1–5.
How well do paramedics predict admission to hospital? A prospective study.Crossref | GoogleScholarGoogle Scholar | 16798145PubMed |

Linwood R, Day G, FitzGerald G, Oldenburg B (2007) Quality improvement and paramedic care: what does the literature reveal for pre-hospital emergency care in Australia? International Journal of Health Care Quality Assurance 20, 405–415.

Maguire BJ, Hunting KL, Smith GS, Levick NR (2002) Occupational fatalities in emergency medical services: a hidden crisis. Annals of Emergency Medicine 40, 625–632.
Occupational fatalities in emergency medical services: a hidden crisis.Crossref | GoogleScholarGoogle Scholar | 12447340PubMed |

Mann NC, Hedges JR (2002) The role of prehospital care providers in the advancement of public health. Prehospital Emergency Care 6, S63–S67.
The role of prehospital care providers in the advancement of public health.Crossref | GoogleScholarGoogle Scholar | 11962587PubMed |

Mason GMC (1997) The relationship between research and the nursing process in clinical practice. Journal of Advanced Nursing 26, 1045–1049.
The relationship between research and the nursing process in clinical practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FjvFKrsw%3D%3D&md5=3751239eeb65605039d1959cdf012db1CAS |

McKenna L, Innes K, French J, Streitberg S, Gilmour C (2011) Is history taking a dying skill? An exploration using a simulated learning environment. Nurse Education in Practice 11, 234–238.
Is history taking a dying skill? An exploration using a simulated learning environment.Crossref | GoogleScholarGoogle Scholar | 21195667PubMed |

Mitchell JRA (1984) Is nursing any business of doctors? A simple guide to the “nursing process”. BMJ 288, 216–219.
Is nursing any business of doctors? A simple guide to the “nursing process”.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2c7gsFGltQ%3D%3D&md5=b169dbe78d03a757194cce21c663b785CAS |

National Rural Health Association (USA) (1997) Rural and frontier emergency medical services toward the year 2000.

O’Meara P (2011) So how can we frame our identity. Journal of Paramedic Practice 3, 57

Ogilvie W (2010) Patient assessment – getting back to basics. Texas EMS Magazine, Jan/Feb 2010, pp. 36–41.

Owen C, Hemmings L, Brown T (2009) Lost in translation: maximising handover effectiveness between paramedics and receiving staff in the emergency department. Emergency Medicine Australasia 21, 102–107.
Lost in translation: maximising handover effectiveness between paramedics and receiving staff in the emergency department.Crossref | GoogleScholarGoogle Scholar | 19422406PubMed |

Reichard AA, Marsh SM, Moore PH (2011) Fatal and nonfatal injuries among emergency medical technicians and paramedics. Prehospital Emergency Care 15, 511–517.
Fatal and nonfatal injuries among emergency medical technicians and paramedics.Crossref | GoogleScholarGoogle Scholar | 21834620PubMed |

Sibson LE (2005) ‘The nursing process. Compendium of clinical skills for student nurses.’ (Whurr Publishers: London)

Sibson LE (2008) An introduction to reflective practice. Journal of Paramedic Practice. 1, 121–125.

Stirling CM, O’Meara P, Pedler D, Tourle V, Walker J (2007) Engaging rural communities in health care through a paramedic expanded scope of practice. Rural and Remote Health 7, 839

Sundström BW, Dahlberg K (2012) Being prepared for the unprepared: a phenomenology field study of Swedish prehospital care. Journal of Emergency Nursing 38, 571–577.
Being prepared for the unprepared: a phenomenology field study of Swedish prehospital care.Crossref | GoogleScholarGoogle Scholar | 22088772PubMed |

Tanner CA (2006) Thinking like a nurse: a research-based model of clinical judgement in nursing. The Journal of Nursing Education 45, 204–211.

Thompson JE, Collett LW, Langbart MJ, Purcell NJ, Boyd SM, Yuigi Y, Ossolinski G, Susanto C, McCormack A (2011) Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital. Postgraduate Medical Journal 87, 340–344.
Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital.Crossref | GoogleScholarGoogle Scholar | 21310805PubMed |

Turner J, Judge TP, Ward ME, Johns BM, Wilby J, Roberts G, Trautner S (2000) A new worldwide systems model for emergency medical services: statement from the Cape Town EMS summit, South Africa, January 1998. Pre-hospital Immediate Care 4, 183–188.

Walker S (1996) Reflective practice in Accident and Emergency setting. Accident and Emergency Nursing 4, 27–30.
Reflective practice in Accident and Emergency setting.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zit1Kisw%3D%3D&md5=00141bb85df731d1565169d52e55c02bCAS | 8696852PubMed |

Williams B, Onsman A, Brown T (2010) Is the Australian paramedic discipline a full profession? Journal of Emergency Primary Health Care 8, 990383

Wyatt A (2003) Paramedic practice – knowledge invested in action. Journal of Emergency Primary Health Care 1, 990057

Yong G, Dent AW, Weiland TJ (2008) Handover from paramedics: observations and emergency department clinician perceptions. Emergency Medicine Australasia 20, 149–155.
Handover from paramedics: observations and emergency department clinician perceptions.Crossref | GoogleScholarGoogle Scholar | 18062789PubMed |