Paramedicine and prehospital scholarship show an increasingly impressive ability to appropriately engage in reflexive and reflective processes. The work of paramedics is arguably understudied (Wankhade et al, 2021), widely misunderstood (Eaton, 2019; McCann, 2022) and complex (Eaton et al, 2018), with a professional identity instability instilled by paramedic, public and policy alike (McCann, 2022). A profession that has traditionally—in the eyes of many within the medical community—played a subsidiary role alongside the dominance of the doctor-nurse game (Stein, 1967), is increasingly positioning itself as a key player within the post-COVID NHS recovery and future ambitions of contemporary clinical care.
Therefore, when reading a recent randomised control trial looking into CPR quality by Sumera et al (2024), it was disheartening to read within the introduction that there remains evidence that CPR quality among EMS providers—arguably a publicly perceived staple of the professional role—may be substandard. What this article achieved, however, aside from offering a seminal contribution surrounding the role of a ‘CPR Quality Officer’, was to show just what can be achieved when paramedic-led research effectively tackles a challenge within clinical practice, using not only a paramedic perspective, but also a multicentre international cohort of student paramedics to partake in the trial. Furthermore, their innovative use of simulation has highlighted the potential possibilities of paramedic scholarship in redefining its role in optimising clinical practice that is both achievable and professionally empowering.
While NHS ambulance services continue to be involved with highly impactful studies, there will always be emerging questions about the professional role, scope, identity, and performance of paramedics, not least their future. As paramedicine experiences continuous and arguably unsustainable professional development, driven by unpredictable sociopolitical demand and operating amid an NHS facing a multifaceted acute-on-chronic perma-crisis, the need for professional reflexivity and academic empowerment is both immediate and profound.
Sumera et al (2024) is interesting for the consideration of a very simple academic review process; the question of, ‘so what?’. This simple provocative inquiry has the potential to divide opinion and influence the next academic or operational contribution. It highlights what we can achieved while showing our willingness to lead in the criticality of our own performance. While this paper will likely see an operational impact in cardiac arrest management, the reader must shine a critical lens, asking not only ‘so what?’ but also, crucially, ‘what's next?’.
This editorial challenges readers to determine the next challenge to be tackled by the profession: unchartered clinical territories ready to be explored or wider clinical contributions to be made. Paramedicine is no longer a subsidiary of the wider system. Therefore, we must continue to establish our presence and define our future, which can only be done by empowerment of our role, scope and identity through academic contributions and falsification of our own assumed fundamentals.