Peer-assisted learning: time for nomenclature clarification

Introduction: Although paramedicine is an integral element of healthcare systems, there is a lack of universal consensus on its definition. This study aimed to derive a global consensus definition of paramedicine. Methods: Key attributes pertaining to paramedicine were identified from existing definitions within the literature. Utilising text analysis, common attribute themes were identified and six initial domains were developed. These domains formed the basis for a four-round Delphi study with a panel of 58 global experts within paramedicine to develop an international consensus definition. Results: Response rates across the study varied from 96.6% (round 1) to 63.8% (round 4). Participant feedback on appropriate attributes to include in the definition reflected the high level of specialized clinical care inherent within paramedicine, and its status as an essential element of healthcare systems. In addition, the results highlighted the extensive range of paramedicine capabilities and roles, and the diverse environments within which paramedics work. Conclusion: Delphi methodology was utilized to develop a global consensus definition of paramedicine. This definition is as follows: paramedicine is a domain of practice and health profession that specialises across a range of settings including, but not limited to, emergency and primary care. Paramedics work in a variety of clinical settings such as emergency medical services, ambulance services, hospitals and clinics as well as non-clinical roles, such as education, leadership, public health and research. Paramedics possess complex knowledge and skills, a broad scope of practice and are an essential part of the healthcare system. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable or dynamic settings. We believe that the generation and provision of this consensus definition is essential to enable the further development and maturation of the discipline of paramedicine.

Search filters aid clinicians and academics to accurately locate literature. Despite this, there is no search filter or Medical Subject Headings (MeSH) term pertaining to paramedics. Therefore, the aim of this study was to create two filters to meet to different needs of paramedic clinicians and academics. We created a gold standard from a reference set, which we measured against single terms and search filters. The words and phrases used stemmed from selective exclusion of terms from the previously published Prehospital Search Filter 2.0 as well as a Delphi session with an expert panel of paramedic researchers. Independent authors deemed articles paramedic-relevant or not following an agreed definition. We measured sensitivity, specificity, accuracy and number needed to read (NNR). We located 2102 articles of which 431 (20.5%) related to paramedics. The performance of single terms was on average of high specificity (97.1% (Standard Deviation 7.4%), but of poor sensitivity (12.0%, SD 18.7%). The NNR ranged from 1 to 8.6. The sensitivity-maximising search filter yielded 98.4% sensitivity, with a specificity of 74.3% and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and thus a NNR of 1.48. We have created the first two paramedic specific search filters, one optimised for sensitivity and one optimised for specificity. The sensitivity-maximising search filter yielded 98.4% sensitivity, and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and a NNR of 1.48. A paramedic MeSH term is needed.

Paramedic-performed out-of-hospital ultrasound is a novel skill that has gained popularity in some services in recent years. In this setting point-of care ultrasound (POCUS) can provide additional information that can assist with management and guide transport to the most appropriate facility. We sought to explore the different educational approaches used for training paramedics in ultrasound in the out-of-hospital setting. Ovid MEDLINE, EMBASE, EBM Reviews, The Cochrane Library, CINAHL plus, The Monash University Research Repository and the British Thesis Library were searched from the 1st of January 1990 to the 6th of April 2016. Google Scholar was searched and reference lists of relevant papers were examined to identify additional studies. Articles were included if they reported on out-of-hospital and POCUS educational approaches for paramedics. A total of 2002 unique articles were identified of which 18 articles met the inclusion criteria. Most articles reported combined cohorts of emergency providers with varying years of experience though most operators were POCUS naïve. The most common clinical assessment for which paramedic POCUS curricula was described was the focused assessment sonography for trauma (FAST) examination. Education programs varied from two-minutes to two-days with all studies including both didactic and practical training. Education programs for POCUS for paramedics vary considerably, and do not appear to align with qualification level or clinical experience. Further research investigating education and subsequent clinical application of POCUS by paramedics is required, as well as prospective, outcome based studies in order to measure the clinical utility of out-of-hospital POCUS.