Paramedic Workforce Disparities Marked by Geographical Positioning

Abstract

Introduction: Effective service delivery and the wellbeing of the paramedic workforce is reliant on confounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is limited literature available examining these. The objective of this review was to investigate where and how these disparities exist to make recommendations in achieving equity in the paramedic workforce and thus achieve patient-centred care universally across rural and urban populations. Methods: The JBI approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, EMT, urban OR metro*, rural OR remote and disparit* were inserted into the search engines MEDLINE, CINAHL Plus and Scopus. Titles and abstracts of the 282 results were screened by two authors and inclusion and exclusion criteria applied. The full text of the remaining 77 results were screened to inform the results of the review. Results: The search identified 282 potentially relevant articles, of which 33 informed the results of the review. The included studies identified emerging themes relevant to the objective including: (1) the skills, training availability and confidence of the workforce (2) resourcing of ambulances inclusive of both workload and case load; (3) timings of each group regarding response, scene, and transport; and (4) the health status of paramedics in each subset location. Conclusion: This review identified several disparities between rural and urban paramedic locations. However, it does not allow us to understand the extent at which these influence paramedics health and wellbeing and their ability to provide optimal patient-centred care which is equitable across locations. Further research is recommended to establish the extent to which these disparities are impacting the lives of paramedics and provision of emergency healthcare.