This protocol outlines the first critical realist synthesis to examine the influence of Canadian drug policy on paramedic practice, with the aim of generating foundational insights into how paramedics are positioned within, and affected by, drug policy. The review will include federal and provincial (British Columbia) policy documents, focusing on a region experiencing the highest rates of illicit drug-related mortality. Guided by critical realism and reported in accordance with RAMSES guidelines, this review will use both inductive and deductive coding within a Context–Mechanism–Outcome (CMO) framework to analyse how policy mechanisms enable or constrain paramedic involvement in the care of people who use drugs (PWUD). While clinical outcomes of out-of-hospital care for PWUD have been studied, the structural and policy-level influences on paramedic practice remain underexplored. This work addresses that gap by mapping the drug policy landscape through a realist lens, laying the groundwork for future research into paramedic-supported, integrated models of care and the role of policy in shaping their enactment.
Read the protocol: https://osf.io/qvcx6