Ethics part 1: what do paramedics owe patients?

Paramedic science and practice make up a rapidly developing field that has long since gone beyond the traditional realm of responding to life-threatening emergency calls in an ambulance. Indeed, patients request an ambulance for a diverse range of conditions, including non-urgent, low-acuity illnesses as a result of patient misperception of either their condition or the appropriate use of an ambulance (Brooker et al, 2019). Further, there is pressure for ambulance services to reduce inappropriate conveyance (Carter, 2018) and meet ever-increasing demand (National Audit Office, 2017). Paramedics, therefore, act as clinical gatekeepers that can initiate prehospital treatment, refer for further care (e.g. to a general practitioner (GP) or specialist team), or discharge at home with advice.

Likewise, in the UK, the utility of paramedics has extended into patient-facing services including primary and urgent care, secondary care such as palliative care, urology, paediatrics, and emergency departments, as well as integrated care, responding as part of a multidisciplinary team to the community from hospitals. As such, paramedic scope and role are becoming highly variable. As a result, paramedic care delivery is changing, no longer being a single linear encounter; it may well be a longitudinal, multifactorial relationship, whereby the main point of contact for a patient, is a paramedic.