Spotlight on Research

Little is known about paramedics who have left the ambulance service to work in specialist or advanced roles within emergency departments (EDs). This qualitative study explored the lived experiences of such paramedics focusing on role transition, influences on effective clinical practice and perceptions of role optimisation. Three emergency care practitioners (ECPs), three student ECPs and two advanced clinical practitioners—all HCPC-registered paramedics—were recruited to the study and interviewed. Role transition to the ED involves significant adjustment to a new clinical environment, responsibilities and decision-making. Prehospital history-taking and physical assessment skills, along with experience of autonomous working were voiced as pertinent enablers of effective ED practice. The paramedics felt supported in their roles and spoke positively about future role expansion into areas such as the resuscitation bay and paediatrics. Difficulties in accessing medication emerged as a significant barrier to daily practice that could affect the patient experience and influenced perceptions of sub-optimal working. Some participants also reported confusion among their ED colleagues regarding paramedic competencies which could make inter-professional working difficult. Independent prescribing for advanced paramedics will address some of these issues, but interim improvements are required to extend existing local arrangements for the supply of medicines by ED staff to include paramedics, improving the quality and safety of care they provide and, ultimately, the patient experience.