Paramedicine: An evolving identity

Paramedicine’s identity is evolving. As paramedicine strives for professional recognition, part of this process must involve defining and understanding the boundaries of the profession which will in turn inform its identity. ‘Boundary work’ – a concept used by sociologists – describes how professional bodies distinguish themselves from other professions by elucidating their field of practice. This process is an important part of establishing a group as a profession as it clarifies what resources are needed, from whom, and which should be prioritised for this group. There is a growing body of research attempting to explore what paramedicine is as a profession; however, this work may be somewhat futile while the industry expands into other healthcare domains without defining or considering its boundaries. This diversification of paramedicine into non-traditional roles has not been driven with an understanding of its professional boundaries and field of practice, but rather through a range of other drivers that are not coordinated and without clear goals about the future identity of paramedicine. As a result, there is an increasing lack of clarity about what it is that paramedics do. This confusion can be seen at governmental levels, within paramedicine education and within emergency medical services (EMSs) (otherwise known as ambulance services or paramedic/paramedicine services) themselves. A recent Canadian study identified a shift from paramedicine being considered a public safety service towards a public health service. A good example of this exists in Australia where some EMS systems operate under the governmental jurisdiction of the Department of Health and Human Services and are represented by a Health Minister, while others are part of the Department of Justice and are represented by an Emergency Services Minister. These differing identities directly impact resourcing. As part of the healthcare system, EMS, like other healthcare organisations, are expected to wade through the large workload and do their best to meet this demand. However, if operating within the boundaries of being an emergency service, it is likely there would be a greater focus on sufficient resourcing to ensure ambulances are available and able to respond to emergencies as they arise. The lack of clear boundaries also means we have not identified who should be delivering our education and what scope of practice should be covered. Whilst it is common now for paramedicine education to occur in tertiary institutions, the faculty or department in which paramedicine programs are situated and governed varies widely, and include paramedicine, nursing, biology, health and society, and even sport, health and engineering. Furthermore, much of the content of many paramedicine courses continues to revolve around the traditional model of emergency response to critically unwell patients, most if not all of whom require medical intervention in the prehospital setting. Beyond the pathophysiology and pharmacology being taught, paramedicine education includes major emergency or disaster response and logistics in