Key contributions

A snapshot of the main ways my scholarship and leadership shape workforce policy, professional practice, and health systems

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Advancing health workforce policy and regulation

I translate governance theory into practical, evidence-informed arguments (and plain-language explainers) about regulation, accountability, and public protection in paramedicine.

• Why Canada needs advanced practice roles – and why paramedics are the right place to start (Leduc, Bolster & Batt, 2026).
  In this policy commentary, we argue that Canada’s healthcare system, facing growing pressures like workforce strain, access gaps, and unsafe congestion in emergency pathways, requires fundamental reforms in role design to meet population health needs. Specifically, we propose expanding advanced practice roles for paramedics as a practical and evidence-informed solution. Paramedics are uniquely positioned to bridge gaps in healthcare delivery, especially for underserved populations in rural and remote areas. The commentary emphasizes that advanced roles should not be ad-hoc pilot projects, but should be systematically integrated into healthcare systems with clear competencies, governance, and professional frameworks, like the National Competency Framework for Paramedics (NCFP). The expansion of paramedic roles offers significant benefits for equity of access, quality of care, and workforce retention, while also fostering policy literate leadership to enhance system capacity and adaptability. Through examples from the UK and Ireland, we outline the necessary steps for Canada to implement these roles effectively, ensuring better patient outcomes and equity of access. The paper calls on policymakers to align education, funding, and outcomes measurement with these expanded roles for paramedics, building a more sustainable and responsive healthcare workforce. https://doi.org/10.5281/zenodo.18673011
• Self-regulation of paramedics in Ontario: your questions answered (Mason & Batt, 2026).
  In this piece, I worked with Paige Mason to clearly explain what self-regulation could mean for paramedics in Ontario, responding directly to common questions and misconceptions. We outline how self-regulation functions in other health professions, what problems it is intended to solve, and what it would realistically change (and not change) for patients, practitioners, and the system. The aim was to provide an accessible, evidence-informed explainer that supports informed debate rather than rhetoric, grounded in governance principles and public-interest regulation. The recording and session notes are available here: https://doi.org/10.5281/zenodo.18381478
• Scope is not the problem: why governance is the real risk in advanced practice by paramedics (Batt, Leduc & Bolster, 2026).
  In this policy commentary, we argue that debates about advanced practice in paramedicine are misdirected when they focus narrowly on “scope of practice.” Drawing on governance theory and real-world examples, we show that the true risk lies in weak, fragmented, or outdated regulatory and accountability structures. We position advanced practice as a system-level governance challenge rather than a professional turf issue, and propose reframing workforce reform around capability, oversight, and public protection. This work is published on Medium, and available on Zenodo https://doi.org/10
• Regulatory Delay? Patients Pay. Reframing Regulatory Lag as a Governance Risk (Batt & Bolster, 2026).
  Here, we examine regulatory lag not as an administrative inconvenience, but as a patient-safety and equity problem. The commentary reframes slow or unresponsive regulation as a form of governance failure that constrains workforce capability and limits access to care. We argue that when regulation fails to keep pace with evidence and system need, patients ultimately bear the cost. The paper advances a governance-first lens for understanding and addressing regulatory delay. This work is published on Medium, and available on Zenodo https://doi.org/10.5281/zenodo.18368279
• Building bridges and moving upstream: paramedics as policy architects (Bolster & Batt, 2025).
  In this peer-reviewed article, Jen Bolster and I explore how paramedics can move beyond operational roles to actively shape health policy. We argue that paramedics are uniquely positioned to act as “policy architects” because of their system-wide perspective and proximity to community need. The paper calls for intentional capacity-building in policy literacy, leadership, and governance, positioning paramedicine as an upstream contributor to health-system design rather than a downstream responder. This paper was published in Paramedicine. 2025;22(4):192-201. https://doi.org/10.1177/27536386251336008
• Professionalisation of paramedics – the role of regulation and registration (Knox & Batt, 2018).
  In this earlier piece, Dr. Shane Knox and I examined the professionalisation of paramedicine through the lens of regulation and registration, situating paramedicine alongside other self-regulating health professions. We discussed how regulatory structures shape professional identity, standards, and public trust, and highlighted the risks of partial or inconsistent regulatory models. This article reflects my longstanding interest in how governance choices influence the maturity and legitimacy of emerging health professions. It was published in Canadian Paramedicine. 2018; 41(5):6-8.

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Guiding contemporary competency framework development

I build and share practical guidance (including a six-step model, systems thinking extensions, and reporting standards) to make competency frameworks more defensible, transparent, and fit for real-world use.

My research focuses on improving how we identify the competencies required for professional practice. That is, how to figure out what should we expect a health professional to know AND do, in order to be deemed competent. Taken together, these studies show that competency frameworks are widely used and influential across health professions, but their development processes have often been inconsistent, under-reported, and insufficiently grounded in theory and real-world practice. Our scoping review first exposed this variability and lack of transparency, and subsequent work has offered tools to address it: a structured six-step model to guide deliberate development choices, a systems-informed lens to capture complexity, a reporting guideline to improve transparency, and an awakening to the importance (and current under-utilisation) of meaningful patient and public involvement.

For those building or using competency frameworks, the implications are clear: attend explicitly to purpose and context, engage a broad range of stakeholders (including patients/public), apply coherent and theory-informed methods, and report your processes transparently. Doing so enhances the legitimacy, interpretability, and impact of competency frameworks in education, assessment, governance, and workforce planning. The practical implication for competency framework development is that the defensibility of a framework increasingly depends on explicitly capturing emerging societal/system drivers and using methods that can model practice as complex, team-based, and context-dependent—so education, assessment, and regulation remain aligned with contemporary care.

• The development of competency frameworks in healthcare professions: a scoping review (Batt, Tavares & Williams, 2020).
  In this scoping review, we mapped how competency frameworks have been developed across health professions, analysing 190 studies to understand the methods and strategies used. We found enormous diversity in approaches, with inconsistent use of theory, stakeholder involvement, and reporting, and no clear gold standard for how to build these frameworks. This work underscores that while competency frameworks are widely used to describe workforce capabilities and inform education and assessment, the process for developing them has been under-specified and often lacks transparent justification for methodological choices – a gap that can undermine their defensibility and utility.Competency frameworks review paper
• New ways of seeing: supplementing existing competency framework development guidelines with systems thinking (Batt, Williams, Brydges, Leyenaar & Tavares 2021).
  In this conceptual paper, we argue that traditional guidance for competency framework development tends to overlook the complexity and context-dependence of real-world practice. Drawing on systems and ecological thinking, we outline how a systems-based lens can supplement existing methods by making visible the interacting features, relationships, and contexts that shape professional work. By reframing development through this “new way of seeing,” we aim to help developers better represent the realities of practice and generate frameworks that are more valid, nuanced, and fit for downstream uses like curriculum design and assessment. Improving competency frameworks with systems thinking approach
• A Six-Step Model for Developing Competency Frameworks in the Healthcare Professions (Batt, Williams, Rich & Tavares, 2021).
  Recognising the methodological variation and lack of guidance we documented in earlier work, we proposed a structured, theoretically informed six-step model for competency framework development. This model starts with clarifying purpose and stakeholders, moves through context exploration and identification of competencies, and emphasises transparent reporting and ongoing evaluation and maintenance. Our goal was to provide a coherent organising structure that addresses common shortcomings in the way frameworks are designed and communicated, helping developers make more deliberate, fit-for-purpose choices. A model to develop competency frameworks
• CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions (Batt, Tavares, Williams & collaborators, 2023).
  Building on evidence of variability and reporting gaps, we convened an expert panel to develop the CONFERD-HP reporting guideline. This guideline identifies a set of essential criteria that authors and developers should include when describing how a competency framework was created, with the aim of improving transparency, interpretability, and the ability to critically appraise and compare frameworks. By standardising reporting, we hope to strengthen the scientific and practical foundations of competency frameworks across health professions. Reporting the development of competency frameworks
• Does patient and public involvement influence the development of competency frameworks for the health professions? A systematic review (Murray, Palermo, Batt & Bell, 2022).
  In this systematic review, we examined how patients and members of the public have been engaged in competency framework development and whether their involvement actually influenced outcomes. We found that while many frameworks articulate a “patient-centred care” focus, authentic involvement of patients and the public in the development process is uncommon and inconsistently reported. When involvement does occur, it most often contributes to validating clinician-derived competencies and occasionally adds perspectives on behaviours and attitudes, but there is little clarity on best practices for engagement. Our work highlights both the potential value and the current under-utilisation of patient and public voices in setting professional expectations. A review of the role of public and patient engagement in developing competency frameworks

Impact of this body of work

This body of work on competency framework development has been taken up widely across health professions and education systems internationally, with more than 150 citing publications drawing on the guidance. The strongest uptake has been in medicine, nursing, dentistry, public health, pharmacy, paramedicine, physiotherapy, and psychology, alongside extensive use in health professions education and explicitly interdisciplinary contexts. Importantly, a substantial proportion of citations come from work that is not profession-specific at all, but instead uses my work to guide how competencies are conceptualised, developed, and reported across multiple professions simultaneously. This pattern reflects the intent of the work: to provide principled, fit-for-purpose guidance that transcends individual professional silos.

Geographically, citations span Canada, Australia, the United Kingdom, the United States, Europe, Asia, Africa, and South America, demonstrating international relevance across diverse regulatory, educational, and health-system contexts. Authors have used this work to support competency framework development for national professional standards, curriculum redesign, accreditation and quality assurance processes, and research methods justification. In many cases, the six-step model and associated guidance are cited explicitly in methods sections to justify development choices, stakeholder engagement strategies, and reporting approaches, indicating the use of my work as methodological infrastructure, not just background theory.

Notably, the influence of this work extends beyond health professions. Citations appear in education research, social sciences, organisational studies, and management-oriented work, where authors have adapted the principles to competency development in non-clinical or cross-sector settings. This diffusion beyond healthcare reinforces the core contribution of the work: reframing competency framework development as a context-sensitive, system-aware design problem, rather than a checklist exercise. Taken together, these citations demonstrate that this program of research has helped shape contemporary thinking about how competencies are developed, justified, and validated, supporting more defensible, transparent, and adaptable frameworks across professions, sectors, and geographical settings.

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Working with health professions to develop competency frameworks

I partner with professions and systems to apply my guidance in practice, supporting decisions about scope, stakeholder engagement, data collection/analysis, validation, and reporting.

The six-step model has has since been taken up across at least nine distinct health professions and interdisciplinary education contexts including medicine, nursing, public health, dentistry, pharmacy, psychology, allied health, and interdisciplinary health professions education, demonstrating its transferability and influence well beyond its originating discipline.

Paramedicine

Across these works with the paramedic profession in Canada, we essentially did two complementary things: (1) widen “what counts” as competency content (e.g., anti-racism, planetary health, adaptive expertise, virtual care), and (2) strengthen how paramedic practice is represented so the competency framework reflects real contexts and system influences, not just decontextualized tasks.

• Emerging Concepts in the Paramedicine Literature to Inform the Revision of a Pan-Canadian Competency Framework for Paramedics: A Restricted Review (Bolster, Pithia & Batt, 2022).
  In this restricted review, we scanned published and grey literature about (or informing) Canadian paramedicine from 2011–2022 to identify “emerging concepts” that should shape competency development as Canada’s national framework was being revised. We screened titles/abstracts/full texts and ultimately categorized 302 articles into 11 competency-relevant concept areas, including IDEA (inclusion, diversity, equity, accessibility), social responsiveness/justice/equity/access, anti-racism, healthy professionals, evidence-informed practice and systems, complex adaptive systems, learning environment, virtual care, clinical reasoning, adaptive expertise, and planetary health. We positioned these concepts as practical inputs to inform analysis, group discussions, and competency identification for the National Competency Framework for Paramedics. Review of emerging concepts in the paramedicine literature
• Identifying Features of a System of Practice to Inform a Contemporary Competency Framework for Paramedics in Canada (Batt et al., 2024).
  In this paper, we set out to better represent what paramedic practice actually looks like in Canada, because under- or mis-representations of practice can cascade into misaligned education, assessment, and care. We used a systems-thinking approach to identify the settings, contexts, features, and influences on paramedic practice (across multiple system levels), using methods like rich pictures, diagramming, and systems mapping. We describe paramedicine as person-, caregiver-, and paramedic-oriented work enacted across varied geographic, cultural, social, and technical contexts; delivered in collaboration with co-located and dispersed teams; and shaped by policy, regulatory, and legislative influences, culminating in a detailed system map intended to inform early stages of contemporary competency development. Identifying the system of paramedic practice in Canada.
• Representing Contemporary Paramedic Practice in Canada: Development of the National Competency Framework for Paramedics (Batt et al., 2024).
  In this manuscript, we describe building a contemporary National Competency Framework for Paramedics (NCFP) using a systems-thinking-informed conceptual approach and a six-step framework-development model. We outline a multi-year, multi-method process (including working groups across Canada, iterative drafting from 2022–2024, technical committee review, and a public review period from January–March 2024) and report the resulting framework as professional activities organized under five domains: Person-Centred Care, Collaborative Care, Safe Care, Self-Care, and Professional Care. Developing the National Competency Framework for Paramedics.
• Updates on developing the NCFP

Combined Laboratory and X Ray Technologists

I am working with the Alberta College of Combined Laboratory and Xray Technologists to reform their existing entry-to-practice competency profile.

Massage Therapists

I am working with the Federation of Massage Therapy Regulatory Authorities of Canada to reform their existing entry-to-practice competency profile.

Other health professions

I have worked with academics, health systems, and multiple health professions in multiple countries to adapt and use my competency framework development guidance. This includes informing decisions, advising on methods and data collection and analysis, validation of competencies, and reporting of processes and outputs.

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Supporting workforce evolution and retention

I synthesise evidence showing paramedicine’s shift toward broader, system-integrated roles and explain why retention depends on role clarity, career pathways, autonomy, and alignment between education, regulation, and practice.

Taken together, this set of evidence paints a consistent picture: paramedicine is in the midst of a substantial workforce evolution, moving from a primarily emergency-response vocation toward a broad, system-integrated profession encompassing community care, chronic disease navigation, health promotion, and interprofessional collaboration. This evolution drives expectations for expanded competencies, autonomy, adaptive scopes, and reflective practice. Crucially, retention is not just about pay or hours; it is about meaning, role clarity, career paths, and fit between education, regulation, and real-world practice.

Across these works we see that when systems lag (rigid task lists, narrow career stages, limited recognition of advanced practice), evolution creates friction; paramedics feel undervalued, underutilised, or misaligned with the work they are trained and willing to do. Conversely, frameworks and standards that recognise complexity, enable autonomy, embed support for learning, and articulate progressive career pathways contribute directly to a more resilient, engaged, and retained paramedic workforce. That alignment between workforce evolution and retention is the core insight emerging from this literature.

• Report – Career Framework for Paramedics – 1st Edition (Cameron & Batt, 2024).
  In this foundational document, we present the first Career Framework for Paramedics designed to articulate how paramedics’ roles and capabilities can evolve across a full professional lifespan. The framework maps five core pathways: clinical practice, organisational leadership, research, education, and policy/strategy, reflecting that paramedicine is no longer a single-track vocation but a profession with diverse trajectories. It also describes five progressive levels of practice, from entry-level paramedic through specialist and advanced practitioner roles to senior leadership positions, helping practitioners, employers, regulators, and education providers understand how roles and expectations change over time. The framework situates a degree (or equivalent qualification) as the recommended foundation for modern practice, promotes a career portfolio approach (acknowledging that paramedics may work across pathways and levels), and emphasises structured mentoring and continuing professional development to support growth. By aligning education, regulation, and organisational practice, the framework helps paramedics plan careers with clarity about progression opportunities and capability expectations, which we believe is critical for evolving the workforce and retaining skilled professionals in a system where roles are expanding and diversifying. Career Framework for Paramedics – https://osf.io/wdh9m/
• Report – Canadian Paramedic Landscape Review and Standards Roadmap (Batt et al. 2022)
  This research and standards roadmap situates paramedicine’s evolution within broader health system needs, documenting workforce trends such as diversification of roles (community paramedicine, mental health response, interprofessional teams) and the need for standards that support competency development over time. We see workforce evolution framed not just as acquiring new technical skills but as requiring supportive governance, mobility pathways, recognition of advanced practice, and clarity in role definition; all factors that influence whether paramedics stay in or leave the profession. The emphasis on standards and roadmap provision reflects a strategic imperative: when workforce expectations are aligned with system roles and supported by standards, retention prospects improve because practitioners see viable, meaningful career pathways. Canadian Paramedic Landscape Review and Standards Roadmap
• Report – Paramedic Chiefs of Canada (PCC) Report — Chapter 5 on Autonomy (Brydges et al., 2023)
  In Chapter 5 of the PCC report, autonomy is discussed as a cornerstone of modern paramedic practice and a driver of professional satisfaction. We see that expanded clinical autonomy, supported by education, protocols, and oversight, correlates with paramedics exercising judgment in diverse settings—from emergency scenes to community wellness checks. The text suggests that when paramedics have appropriate autonomy within clear governance structures, they experience greater professional meaning and confidence. This matters for retention: workforce evolution that empowers paramedics rather than constrains them fosters engagement and reduces burnout, whereas overly restrictive task-based models erode morale and increase turnover. Chapter 5. Professional Autonomy in: Tavares et al. Principles and Enabling Factors Guiding Paramedicine in Canada.
• Portrayals of a profession: Reflecting on media depictions of paramedics (Johnston, Cameron & Batt, 2024)
  In this commentary, we reflect on how paramedics are portrayed in popular media and contrast these depictions with the realities of contemporary practice. We show that media narratives continue to emphasise high-acuity emergencies and heroic rescues, while largely ignoring the everyday work of paramedics in mental health care, community settings, system navigation, and collaborative practice. We argue that these outdated portrayals shape public expectations, influence who enters the profession, and can contribute to disillusionment and retention challenges when reality does not match the image. Ultimately, we call for more accurate representations that reflect the evolving identity, capability, and value of paramedics within modern health systems. Portrayals of a profession: reflecting on media depictions of paramedics
• Paramedicine: An Evolving Identity (Eastwood, Johnson, Williams, Batt & Tavares, 2023)
  In this editorial, we reflect on how the identity of paramedicine is changing as the profession grows beyond its historical emergency-response roots into broader health system roles. We highlight that the lack of clear, shared boundaries about what paramedics are and do has led to confusion at policy, education, and service levels, even as practice diversifies into community care and extended functions. We argue that without intentional work to define and communicate paramedicine’s evolving identity, workforce planning, education design, and professional recognition will lag behind real practice, undermining efforts to recruit, develop, and retain practitioners who seek meaningful, future-oriented careers.Paramedicine: An evolving identity
• Textbook – Communication in Paramedic Practice (O’Toole, Batt & Reed, 2024).
  In Communication in Paramedic Practice, we focus on communication as one of the fundamental competencies shaping modern paramedic work. Despite communication being emphasised in professional standards and curricula, there has historically been a lack of resources tailored to paramedics’ real-world environments. This book fills that gap by guiding practitioners through the significance of interpersonal communication, developing self-awareness and responsiveness, and managing the realities of communication in practice, from managing distress and cultural responsiveness to documentation and interdisciplinary interactions. Case examples, scenarios, and reflective exercises help paramedics build confidence and capability so that information is shared clearly, relationships are strengthened, and safety and patient outcomes are improved. It positions communication not just as a clinical task but as a core professional capability that supports role expansion, adaptability, and resilience throughout a paramedic’s evolving career. Communication in Paramedic Practice

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Strengthening health systems: improving access to care

I focus on community paramedicine and related models that expand access through primary care, public health, and social prescribing roles, and on how to prepare clinicians for these contexts. My work has informed community paramedicine and advanced practice roles in Canada, Ireland, and Australia.

• Developing a Complex Intervention to Integrate Community Paramedics in GP Out-of-Hours Care in Ireland (Cunningham et al. 2026).
  In this mixed-methods study, we explored how to design and operationalise a complex intervention that embeds community paramedics within GP out-of-hours (OOH) primary care services in Ireland. The research demonstrates that with clear role definition, governance alignment, and joint planning between the National Ambulance Service, regulators, and the Department of Health, community paramedics and general practitioners can work synergistically to provide safe, patient-centred care in patients’ homes during periods when regular GP services are closed. The findings highlight that such integration can reduce emergency department demand and support continuity of care, while emphasising the importance of structured education, continuous professional development, and systematic evaluation to underpin competence and safety as the role evolves. https://hrbopenresearch.org/articles/9-6/v1
• Potential for Paramedic Roles in Irish General Practice: A Qualitative Study (Barry, Batt et al., 2022).
  In this open-access qualitative study, we explored how key professional stakeholders in Ireland perceive the potential for paramedics to take on roles within general practice and primary care, an idea gaining traction as GP shortages worsen and healthcare demands grow. Through in-depth semi-structured interviews with senior paramedics, GPs, practice nurses, and practice managers, we found divergent views: paramedics were generally enthusiastic about professional development and broader roles, while many in general practice were cautious, citing concerns about misalignment of training and primary care needs. Participants agreed that any future integration would need government support, clear role definition, appropriate education, and systemic planning. The study highlights both opportunity and barriers to evolving paramedic roles in primary care in Ireland, and suggests that piloted, evidence-based models will be essential for workforce and system integration. Potential for Paramedic Roles in Irish General Practice
• The Advantages and Challenges Experienced With the Implementation and Delivery of Community Paramedicine Programmes: A Qualitative Reflexive Thematic Analysis (Shannon et al., 2023).
  In this qualitative study, we explored the lived experiences of practitioners and stakeholders involved in implementing community paramedicine programs across seven countries, identifying five key themes that shape success and challenge. Participants highlighted that community engagement drives need, collaboration with stakeholders is essential for integration, clear role promotion and communication matters, supportive strategies for recruitment and staff retention are crucial, and rigorous research and evaluation underpin sustainable programs. These findings underscore how community-centred practice, interprofessional relationships, and organisational support are foundational to effective and resilient community paramedicine delivery. Advantages and challenges experienced with the implementation and delivery of community paramedicine programs
• Developing the Community Paramedicine Needs Assessment Tool (Markides et al., 2025).
  In this project, we conducted a document analysis and expert consultation to develop an initial Community Paramedicine Needs Assessment Tool (CPNAT) that guides programs to systematically identify and address health and social needs in their communities. Drawing on 38 existing needs assessment frameworks and iterative feedback from over 100 paramedicine experts and partners, the CPNAT is designed to align program planning and service design with local health and social determinants, supporting enhanced equity and responsiveness in community paramedicine. Developing the CPNAT
• Report – Advances in Community Paramedicine in Response to COVID-19 (Batt et al. 2021).
  In this research report, we reviewed how community paramedicine programs across Canada adapted and innovated in response to the COVID-19 pandemic, bringing evidence-informed insights into evolving service delivery models. We found that paramedics worked collaboratively with public health and other sectors to support vulnerable populations through in-home and community-based care, remote monitoring, virtual consultations, and tailored interventions for chronic conditions and social needs. The pandemic highlighted inequities and reinforced the importance of community paramedics in bridging primary care, public health, and social supports, showing how these programs can reduce unnecessary emergency department visits and improve access for diverse patient groups. Advances in Community Paramedicine in response to COVID-19
• Report – Community Paramedicine Practice Framework Scoping Exercise (Shannon, et al 2022).
  In this PHECC-commissioned Community Paramedicine Practice Framework Scoping Exercise, we mapped how community paramedicine is being implemented and governed across multiple jurisdictions to inform future development in Ireland. We structured the report around practical system questions—what community paramedicine programmes look like, how scope is defined, what entry and education requirements exist, how clinical governance and supervision are organised, how programmes integrate with primary care, and what barriers and facilitators are commonly experienced. We present jurisdiction-by-jurisdiction findings (including multiple Australian states and Canadian provinces) to surface patterns and options that can support Ireland’s decision-making about workforce design, education pathways, and governance arrangements for community paramedicine. Community paramedicine practice framework scoping exercise
• The development of community paramedicine: a restricted review (Shannon et al. 2022).
  In this comprehensive restricted review, we examined 98 studies on community paramedicine programmes internationally to understand their educational requirements, delivery models, clinical governance arrangements, role scope, and reported outcomes. Most of the literature came from the United States and Canada, and while service outcomes showed that community paramedicine initiatives can reduce acute healthcare utilisation, are economically viable, and produce positive patient outcomes with high satisfaction, the evidence remains uneven across key domains. The review highlights substantial variation in education and scope of role, and a lack of standardised governance and supervision models, which limits comparability and may constrain the ability of these programmes to reach their full potential. It also underscores the need for common approaches that balance standardisation with flexibility to meet diverse community needs. The development of community paramedicine; a restricted review
• Community Paramedicine Supporting Community Needs: A Scoping Review (Lunn, Bolster & Batt, 2024).
  In this scoping review, we systematically examined both peer-reviewed and grey literature to understand how community paramedicine models support health and social needs across a continuum, recognising that many of the biggest drivers of health outcomes lie in social determinants like housing, income, isolation, and access to services. Our analysis showed that community paramedicine programs have evolved from alleviating acute system pressures (e.g., reducing emergency department use) to addressing broader needs—such as harm reduction, caregiver support, fall prevention, chronic disease management, and care coordination—especially for structurally marginalised populations. A consistent theme was the importance of early, meaningful community engagement in co-designing services to ensure programs are responsive to specific local needs, though the literature revealed a lack of evidence on best practices for this engagement and for optimising supportive technologies. The review highlights opportunities for more holistic needs assessments, enhanced education for expanded roles, and stronger interprofessional collaboration to improve equity and generate upstream solutions for individuals and communities. Community paramedicine supporting community needs
• Examining Consensus for a Standardised Patient Assessment in Community Paramedicine Home Visits (Leyenaar et al. 2019).
  This study employed a modified RAND/UCLA Delphi process with international paramedicine and home care experts to identify core health, social, and environmental domains that should be included in standardised patient assessments for community paramedicine home visits. We found high levels of agreement on multi-domain assessment categories, supporting the idea that structured, comprehensive assessment tools can enhance the consistency and quality of community care. This work contributes to bridging service expectations with practice realities in non-emergency paramedicine work. Standardized Patient Assessment in Community Paramedicine Home Visits
• National consensus on the capabilities that inform the role of advanced practice paramedics: A Delphi study (Restiglian et al. 2025).
  In this international Delphi study led by Alessia Restiglian and colleagues (with my co-authorship), we sought to establish a national consensus on the essential capabilities that define Advanced Practice Paramedics (APPs) in Australia, addressing a critical gap where no recognised capability framework existed. Using a modified Delphi process with 43 clinical, academic, organisational, and regulatory experts, we refined and rated proposed capabilities derived from international literature until strong consensus was reached (96% overall). The resulting set of 33 capabilities spans four domains — Clinical Practice, Leadership & Management, Education, and Research, providing a robust foundation to standardise expectations for education, regulation, and practice for APP roles in the Australian health system. This capability framework promotes consistency in professional expectations and supports the integration and advancement of advanced paramedic roles nationally, with potential applicability for international adaptation in other health systems. National consensus on the capabilities that inform the role of advanced practice paramedics: a Delphi study

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Improving care for marginalized and under-served populations

My work (and many of my students’ work) prioritises inequities in access to care, including people who use drugs, Indigenous communities, people experiencing homelessness, and palliative care needs.

• The paramedic role in caring for people who use illicit and controlled drugs: A scoping review (Bolster et al. 2023)
  In this scoping review, we systematically mapped over 100 peer-reviewed and grey literature sources to understand how paramedics provide care to people who use illicit and controlled drugs and to identify gaps in evidence and practice. Our analysis revealed that despite paramedics frequently encountering patients affected by drug poisoning and related harms, the existing literature is overwhelmingly focused on reactive emergency responses rather than holistic, harm-reduction-oriented care. We found high mortality rates associated with paramedic-attended drug poisoning events, limited evidence on models of care that extend beyond acute response, and a notable absence of research that incorporates the voices of people who use drugs themselves. Consequently, the review highlights a pressing need for future research and practice innovation to support paramedics in delivering more person-centred, preventative, and equity-oriented care in this domain. The Paramedic Role in Caring for People Who Use Illicit and Controlled Drugs
• An Analysis of Drug Use-Related Curriculum Documents for Paramedic Students in British Columbia (Bolster & Batt, 2023).
  In this document analysis, we examined the paramedicine curriculum documents used to educate Primary Care and Advanced Care Paramedic students in British Columbia, Canada, with a specific focus on how drug-related substance use is taught. Through systematic coding and reflexive thematic analysis of 45 curriculum documents—including institutional guides, textbooks, and the 2011 National Occupational Competency Profile—we found that most educational content frames paramedics’ role narrowly around acute drug poisoning response with little attention to holistic care or harm reduction strategies. We also identified stigmatizing language and negative representations of people who use drugs embedded in curricular materials, which may shape attitudes and undermine paramedics’ ability to provide compassionate, comprehensive care. Based on these findings, we argue that curricula should incorporate broader, trauma-informed, and person-centred approaches, and that people with lived experience of drug use should be meaningfully involved in curriculum co-design to better prepare students for contemporary practice. Drug Use-Related Curriculum for Paramedic Students in British Columbia
• Dealing with dying – progressing paramedics’ role in grief support (Cameron, Lunn, Lanos, Batt 2021).
  In this paper, we explore how paramedics are frequently present at the time of death and are often expected to support family members and bystanders experiencing acute grief, despite having limited preparation for this aspect of care. We examine how paramedic education and clinical systems tend to prioritise technical and procedural responses to death, while overlooking the relational, emotional, and communicative skills required to support people in moments of sudden loss. Drawing on perspectives from paramedicine and palliative care, we argue for more intentional education, professional support, and interprofessional collaboration to strengthen paramedics’ capability to provide compassionate grief support as a routine part of contemporary practice. Dealing with dying – progressing paramedics’ role in grief support
• Investigating the Attitudes of Canadian Paramedic Students towards Homelessness (Cochrane et al. 2019).
  In this original research article, we investigated first-year paramedic students’ attitudes toward people experiencing homelessness and how these attitudes may change after clinical placement exposure. We used the Health Professional’s Attitude Towards the Homeless Inventory in a longitudinal pre/post design with a convenience sample of Ontario paramedic students, and we also captured whether participants had interactions with people experiencing homelessness during placement. Overall attitudes were positive and improved slightly over time, but we identified decreases in both confidence and interest in working with this population after placement. We conclude that paramedic education may benefit from more explicit learning focused on homelessness, social determinants of health, and structured clinical experiences to build capability and sustain compassionate care. Attitudes of Canadian paramedic students towards homelessness
• Empathy Levels in Canadian Paramedic Students: A Longitudinal Study (Pagano et al. 2018).
  In this longitudinal study, we tracked first-year paramedic students in an Ontario community college program to examine how empathy changed over the course of their first year. Using the Medical Condition Regard Scale across four presentations (intellectual disability, suicide attempt, substance abuse, and a mental health emergency), we surveyed students at three timepoints across the academic year and analysed trends descriptively due to the small final cohort completing all surveys. We found that empathy differed substantially by condition, with substance abuse consistently associated with the lowest empathy scores, and that overall empathy tended to decline over time for most conditions; females and students with prior post-secondary education generally demonstrated higher mean empathy scores than their counterparts. We concluded that paramedic education may benefit from more intentional training and support to build and sustain empathy, particularly in contexts where bias and stigma can influence care. Empathy levels in Canadian paramedic students
• Exploring empathy levels among Canadian paramedic students (Kus et al. 2018).
  In this cross-sectional study, we examined how first- and second-year Canadian paramedic students demonstrate empathy across different patient presentations, using the Medical Condition Regard Scale to compare attitudes toward physical disability, intellectual disability, suicide attempt, mental health emergencies, and substance use. We found that empathy varied significantly by condition, with the lowest scores consistently associated with substance use and mental health presentations, and the highest with physical disability. Female students demonstrated higher empathy scores than male students across all conditions, and second-year students showed lower overall empathy than first-year students, suggesting a decline as education progresses. Students themselves identified a need for more explicit empathy education, including simulation, mental health exposure, and holistic approaches to care. Together, these findings highlight the importance of intentionally embedding empathy, stigma awareness, and relational skills into paramedic education to better prepare students for the social and emotional realities of contemporary practice. Exploring empathy levels among Canadian paramedic students
• Paramedic patient advocacy: a review and discussion (Batt, Ward & Acker 2017)
  In this literature review and discussion paper, we examined the concept of patient advocacy in paramedic practice and found that, despite advocacy being widely referenced across healthcare, there was no clear or consistent body of empirical literature addressing what advocacy means specifically for paramedics. Through a comprehensive search of health and allied health databases, we identified an absence of peer-reviewed studies directly exploring paramedic advocacy, its contexts, benefits, tensions, or barriers. In response, we outlined how advocacy may manifest in contemporary paramedic work, particularly as roles expand beyond emergency response, and highlighted the need for conceptual clarity and empirical research to support advocacy as a deliberate and legitimate component of professional paramedic practice. Paramedic patient advocacy
• Connecting the Dots: Applying Network Theories to Enhance Integrated Paramedic Care for People Who Use Drugs (Bolster, Ford-Jones, Donnelly & Batt, 2025).
  In this theory-driven commentary, we explore how network theories — including Network Theory and Actor Network Theory — can help conceptualise and strengthen how paramedics integrate with broader care systems to support people who use drugs. We argue that paramedics occupy a unique position within complex care networks, frequently engaging with patients facing systemic barriers and inequities, and that applying network perspectives helps make visible the relational connections — both human and non-human — that influence care delivery effectiveness. By framing paramedics as central connectors within these networks, the paper discusses how such theoretical lenses can address gaps in system navigation, improve outcomes for people who use drugs, and inform policy reforms to support more cohesive, integrated care approaches. Future research and practice should examine roles of other key actors and identify strategies to overcome barriers experienced by people who use drugs. Connecting the dots: applying network theories to enhance integrated paramedic care for people who use drugs

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Translating evidence into policy & practice: national standards

I have contributed to and chaired the development of several national standards related to paramedic service organizations and health services.

• HSO Emergency Transport – I co-chair this Technical Committee. The revised standard is set to be released in 2026.
• CSA Z1650:21 Paramedic response to the opioid crisis: Education and training across the treatment and care continuum in out-of-hospital and community settings. This Standard provides a framework for the paramedic service organization’s (PSO) response to the opioid crisis. The framework provides practical guidance on how to address opioid use in the out-of-hospital setting, including caring for patients during a poisoning or overdose, as well as tracking the crisis across paramedic service organizations. The Standard provides guidance regarding the full continuum of care including the prevention, treatment, and referral of patients experiencing problematic opioid use. To support paramedics in their out-of-hospital and community setting roles, the Standard addresses clinical practice, training and education, community engagement, and physical and psychosocial supports. Paramedic response to the opioid crisis CSA standard
• CSA Z1660:24 National Competency Framework for Paramedics. This Standard identifies the professional activities and supporting competencies required of paramedics in Canada. It reflects current and emerging practice in Canada. This Standard also provides guidance and supporting details to aid with understanding and using the Standard, including an overview of the role description, significance of the roles, information about practice settings, and delegation, as well as inclusion, diversity, equity, and accessibility. National competency framework for paramedics.
• CSA Z1630:17 Community Paramedicine: Framework for Program Development. The Standard provides a framework for the planning, implementation and evaluation of a community paramedicine program. The purpose of the Standard is to provide guidance to help users fully understand the context, key considerations, and essential elements for community paramedicine program development. The Standard provides a framework and a systematic approach for paramedic services and their partners wishing to establish these programs. Community Paramedicine: Framework for Program Development
• CSA Z1635:22, Functional requirements and core data set for a Canadian paramedic information system (CPIS). This Standard provides the foundation and data framework for the development of a comprehensive Canadian paramedic information system (CPIS). It aims to facilitate standardized data collection related to paramedicine and to enable organizations to share their data, knowledge, and experiences with relevant stakeholders. CPIS

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Translating evidence into policy & practice: media appearances

I use public scholarship to translate research into accessible, workforce-relevant conversations about professional identity, autonomy, education pathways, and system design.

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Engaging with theory and conceptual approaches

I advance the use of theory, paradigms, and conceptual frameworks to improve the quality, clarity, and usefulness of paramedic research.

• Untangling the web: The need for theory, theoretical frameworks, and conceptual frameworks in paramedic research (Brydges & Batt, 2023).
  In this editorial, Madison and I argue that the quality and impact of paramedic research would be strengthened by more deliberate engagement with theory, theoretical frameworks, and conceptual frameworks. We describe how research without clear conceptual grounding can lack coherence, limit interpretability, and constrain the ability to explain why findings occur, especially when complex social and practice phenomena are studied. Drawing on examples from paramedicine and allied health disciplines, we outline how explicit use of theory can enhance study design, align research methods with epistemological assumptions, and support cumulative knowledge building rather than isolated empirical snapshots. We suggest that adopting and articulating theoretical and conceptual frameworks should be a standard expectation in paramedic research to improve rigour, relevance, and contribution to both practice and education. The need for theory, theoretical frameworks, and conceptual frameworks in paramedic research
• Chapter – Theoretical and Conceptual Frameworks for Paramedicine Research (Batt & Brydges, 2022).
  In this book chapter, we aim to demystify theory, theoretical frameworks, and conceptual frameworks for paramedicine researchers, recognising that these terms are often used inconsistently and can feel inaccessible in applied research contexts. We define and clearly differentiate concepts, theories, theoretical frameworks, and conceptual frameworks, and explain why engaging with them strengthens research quality, coherence, and contribution to broader bodies of knowledge. Using practical, paramedicine-specific examples, we show how theories and frameworks can inform both deductive and inductive study designs, shape research questions, guide methodological choices, and support more transparent interpretation of findings. We also offer pragmatic advice for getting started, encouraging researchers to read broadly, seek mentorship, and explicitly articulate how and why theory or frameworks are used. Overall, the chapter positions theoretical and conceptual engagement not as abstract academic exercises, but as practical tools for improving the rigour, clarity, and impact of paramedicine research. Theoretical and conceptual frameworks in paramedicine research in Introducing, designing, and conducting research for paramedics
• Chapter – Research paradigms (Cameron, Greene & Batt, 2024).
  In this book chapter, we provide an accessible, practice-oriented introduction to research paradigms for paramedicine and allied health researchers, addressing a longstanding gap in how philosophy, theory, and methodology are engaged within the discipline. We explain why every research project is underpinned by a paradigm, whether acknowledged or not, and show how explicit engagement with axiology, doxology, ontology, epistemology, theory, methodology, and methods improves alignment, rigour, and interpretability. Using clear examples drawn from paramedicine research, we describe common paradigms and the types of questions, methods, and claims they support, while also cautioning against methodologism and unreflective “default” approaches. We emphasise the value of conceptual frameworks as both a process and a product for situating research, and we encourage researchers to view paradigms not as rigid positions but as flexible tools that can evolve with questions, contexts, and values. Research Paradigms in Paramedic Research: Principles, design, and methods

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Building research capacity

I contribute to strengthening paramedicine’s research infrastructure including agenda-setting, strategy implementation, and education for research careers.

• A scoping review of out-of-hospital research in Ireland from 2000 to 2022 (Bowles et al. 2024).
  In this scoping review, we mapped and evaluated all out-of-hospital research conducted in the Republic of Ireland from 2000 through 2022 to understand the volume, nature, and quality of evidence and to identify gaps that need to be addressed. Using Joanna Briggs Institute methods, we screened over 3,200 records and included 294 research outputs, comprising peer-reviewed articles, conference abstracts, and grey literature. Our analysis showed that most published work focused on traditional clinical topics such as resuscitation and relied predominantly on quantitative methods, with relatively few outputs exploring newer or complex issues in out-of-hospital care. We also observed that most authors appeared on only a single publication and that paramedics were rarely first or senior authors, suggesting that practitioner-led research remains limited. To strengthen Ireland’s out-of-hospital research culture, we recommend a strategic approach that supports practitioner engagement, diversifies research topics and methodologies, and improves translation of findings into peer-reviewed publication venues. A scoping review of out-of-hospital research in Ireland from 2000 to 2022
• Barriers and facilitators to the implementation of a national research strategy for paramedicine in Ireland (Cummins et al., 2024).
  In this qualitative study, we explored the factors influencing the implementation of a national research strategy for paramedicine in Ireland through focus groups with practitioners, managers, policymakers, educators, and patient representatives. Participants identified individual-level barriers such as limited research skills, lack of time, and wellbeing pressures, alongside system-level barriers including operational demands, gaps in education, and underdeveloped research infrastructure. At the same time, they described facilitators including a strong and evolving professional identity, growing interest in research, collaborative networks, and emerging infrastructure that could support implementation. The findings highlight that successful implementation will require protected time, skill development, coordinated leadership, and a clear implementation plan to translate strategic intent into sustained research capacity and impact. Barriers and Facilitators to the Implementation of a National Research Strategy for Paramedicine in Ireland
• Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland: a Delphi Study (Bowles et al. 2024).
  In this Delphi study, we worked with a panel of experts from clinical practice, education, policy and research to determine the key elements that should shape a national research agenda for paramedicine in Ireland. Using iterative rounds of structured consensus building, we identified and prioritised foundational components, including core research topics, methodological priorities, capacity and infrastructure needs, and strategic processes that reflect both international experience and Ireland’s evolving out-of-hospital care landscape. The consensus highlights the importance of building sustainable research capacity, enhancing practitioner engagement, and aligning research activity with workforce, education, and system policy priorities. This study provides a coherent, stakeholder-informed foundation to guide coordinated research efforts that support paramedic practice, evidence generation and strategic decision-making across Irish health systems. Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland
• Building research capacity among Irish prehospital practitioners (Batt & Knox, 2017).
  In this paper, we reviewed the state of research engagement and capacity within Ireland’s out-of-hospital care sector to understand why paramedicine research activity has been limited and how it might be strengthened. We identified a small but growing body of work in prehospital settings, noted that many practitioners lacked formal research training and protected time for research, and highlighted barriers such as operational demands, lack of research infrastructure, and limited organisational support. We also described existing strengths, including emerging higher education pathways, increasing practitioner interest, and nascent collaborations between practitioners, educators and academics. Drawing together these insights, we argued that building research capacity in Irish paramedicine requires systematic investment in education, mentorship, collaborative networks, and structural supports that embed research as a valued and sustainable component of professional practice. Building research capacity in Irish pre-hospital practitioners
• Chapter – Education (Shannon & Batt, 2025).
  In this book chapter, we outline the educational pathways that support research-focused careers in paramedicine, from undergraduate study through to doctoral education. We use a developmental “apprenticeship” analogy to explain how learners progress from foundational research literacy at bachelor’s level, to critical synthesis and application at master’s level, and ultimately to independent knowledge generation at doctoral level. We examine honours degrees, taught versus research master’s programs, and the distinctions between PhD and professional doctorates, while also addressing practical realities such as selecting a research topic, forming a supervisory team, balancing full-time versus part-time study, and navigating funding and personal pressures. We argue that mentorship, networking, and intentional career planning are essential to building sustainable clinician–academic pathways, and that strengthening educational infrastructure is central to advancing research capacity and long-term professional development in paramedicine. Education. In: Pursuing a research career: A handbook for paramedics
• Building research capacity among Irish prehospital practitioners (Batt & Knox, 2017).
  In this paper, we reviewed the state of research engagement and capacity within Ireland’s out-of-hospital care sector to understand why paramedicine research activity has been limited and how it might be strengthened. We identified a small but growing body of work in prehospital settings, noted that many practitioners lacked formal research training and protected time for research, and highlighted barriers such as operational demands, lack of research infrastructure, and limited organisational support. We also described existing strengths, including emerging higher education pathways, increasing practitioner interest, and nascent collaborations between practitioners, educators and academics. Drawing together these insights, we argued that building research capacity in Irish paramedicine requires systematic investment in education, mentorship, collaborative networks, and structural supports that embed research as a valued and sustainable component of professional practice. Growing the next generation of paramedic researchers in Canada
• The Good, the Bad and the Ugly of Paramedicine Research Networks
• Exploring Paramedicine’s Research Infrastructure in Ontario, Canada (Tavares, Chawanda & Batt, 2025).
  In this qualitative study, we examined the infrastructure that supports paramedics in Ontario to engage in, produce, and use research, recognising that the profession’s expansion depends on stronger evidence generation and use. We conducted semi-structured interviews with 24 people involved in research capacity building and research contributions, using Cooke’s research capacity framework to inform data collection and reflexive thematic analysis to interpret findings. We identified two overarching themes: structural and cultural foundations for research, which highlighted infrastructure challenges, fragmented pathways, cultural resistance, and reliance on informal networks; and systemic integration and strategic alignment, which emphasised the need for long-term growth, better integration with the broader health system, addressing inequities in access to research infrastructure, improved data access and governance, clearer leadership for research, and stronger demonstrations of value. We conclude that Ontario’s paramedicine community faces significant barriers to building and sustaining a research and evidence ecosystem, and we outline implications and recommendations that address both internal professional structures and external partnerships. Exploring Paramedicine’s Research Infrastructure in Ontario, Canada

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Sponsoring women leaders

I focus on sponsorship (beyond mentoring) as a practical strategy to advance women’s leadership and influence in paramedicine.

• Go Sponsor…Us: Going Beyond Mentoring for Women in Paramedicine (Lanos, Mason & Batt, 2019)
  In this article, we examine why mentoring alone is insufficient to address gender inequities in leadership within paramedicine and argue for the deliberate adoption of sponsorship as a complementary and more powerful strategy. We distinguish clearly between coaching, mentoring, and sponsorship, describing sponsorship as an active, risk-bearing relationship in which senior leaders use their influence, networks, and credibility to create concrete opportunities for career advancement. Drawing on reflective accounts from both sponsors and sponsored women, we illustrate how sponsorship can counteract barriers such as gender bias, limited access to informal networks, challenges with self-promotion, and imposter syndrome. We conclude by calling for a coordinated, profession-wide commitment to sponsorship in paramedicine, including formal networks, shared resources, and visible leadership engagement, to support the development, retention, and advancement of women leaders in the profession. Going beyond mentoring for women in paramedicine
• Video – GoSponsorHer: supporting the next generation of women leaders in paramedicine (Batt, 2020).
  In this recorded presentation from the EMS Leadership Summit, I discuss the concept of sponsorship as a deliberate and active strategy for advancing women’s leadership in paramedicine. Drawing on my direct experiences sponsoring two women in the Canadian paramedic profession, I distinguish sponsorship from mentoring and describe how access to opportunity, advocacy, and visibility are often unevenly distributed in male-dominated leadership structures. I outline how informal patterns of mentorship and sponsorship tend to reproduce existing leadership demographics, and argue that intentional sponsorship by those in senior positions is necessary to disrupt these dynamics. The presentation positions sponsorship as a practical, relational intervention that organisations and individuals can use to support career progression, retention, and leadership diversity within paramedicine. Sponsorship talk at EMS Leadership Summit
• Leveling the playing field for a brighter future in paramedicine (Mason, Delport & Batt, 2018).
  In this commentary, we examine persistent gender inequities in paramedicine, particularly the marked underrepresentation of women in leadership roles despite a growing proportion of women entering the profession. Drawing on evidence from paramedicine and parallel fields such as medicine, business, and technology, we describe how structural barriers, unconscious bias, and norms around self-promotion and leadership continue to disadvantage women’s career progression. We argue that acknowledging bias, actively recognising women’s contributions, and moving beyond passive mentoring toward intentional mentorship and sponsorship are critical to creating equitable career opportunities. Using examples from Australia and other sectors, we call for both formal initiatives and everyday actions—by men and women alike—to disrupt the status quo and foster a more inclusive, representative, and sustainable future for paramedicine leadership. Leveling the gender field for a brighter future in paramedicine

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Understanding and mitigating violence against paramedic

I contribute to evidence-informed policy work aimed at reducing violence risk, supporting affected practitioners, and improving safety at high-risk calls. Across this program of research with the Violence in Paramedicine Research Group, we examined violence against paramedics as a patterned, predictable occupational hazard rather than a series of isolated or unavoidable events. Using linked quantitative and mixed-methods studies from a single Canadian paramedic service, we documented the prevalence, characteristics, and contexts of violence, showing that a substantial proportion of paramedics experience verbal abuse, threats, physical assault, and discriminatory violence over the course of their work. We demonstrated that violence is not randomly distributed across calls, but is associated with identifiable call characteristics, including specific call types, situational contexts, and environmental factors. Together, these findings established violence as a systemic workforce safety issue embedded in how emergency care is requested, dispatched, and delivered.

Several papers in this series moved beyond description to examine mitigation and reporting strategies. We showed that hazard flagging systems can function as a risk mitigation tool, but only when they are implemented with clear governance, safeguards against bias, and an understanding of their limitations. We also demonstrated that introducing a point-of-event reporting process significantly increased paramedics’ willingness to report violent incidents, addressing longstanding underreporting driven by normalisation, administrative burden, and concerns about futility. Importantly, this work highlighted that reporting systems are not neutral: their design shapes what is captured, whose experiences are visible, and whether organisations can meaningfully respond to risk.

Finally, this body of work explicitly foregrounded equity by examining sexist, racist, and homophobic violence directed at paramedics, revealing how violence is unevenly distributed across the workforce and compounded for those with marginalized identities. By integrating prevalence data, risk factors, mitigation strategies, and reporting behaviour, these studies collectively argued for a shift from individual-level resilience narratives toward system-level prevention, governance, and accountability. Taken together, the findings provide an evidence base to inform dispatch practices, reporting infrastructure, workforce policy, and organisational responsibility for creating safer working environments for paramedics.

• Mausz, J.; Johnston, M.; Batt, A.M.; Donnelly, E.A. Characteristics of 9-1-1 Calls Associated with an Increased Risk of Violence Against Paramedics in a Single Canadian Site. Healthcare. 2025. https://doi.org/10.3390/healthcare13151806
• Mausz, J.; Piquette, D.; Bradford, R.; Johnston, M.; Batt, A.M.; Donnelly, E.A. Hazard Flagging as a Risk Mitigation Strategy for Violence Against Emergency Medical Services. Healthcare. 2024.;12(9):909. https://doi.org/10.3390/healthcare12090909
• Mausz, J.; D’Eath, J.; Jackson, N.; Johnston, M.; Batt, A.M.; Donnelly, E.A. Sexist, Racist, and Homophobic Violence Against Paramedics in a Single Canadian Site. International Journal of Environmental Research and Public Health. 2024.;21(4):505. https://doi.org/10.3390/ijerph21040505
• Mausz, J.; Braaksma, M.; Johnston, M.; Batt, A.M.; Donnelly, E.A. Paramedic Willingness to Report Violence Following the Introduction of a Novel, Point-of-Event Reporting Process in a Single Canadian Paramedic Service. International Journal of Environmental Research and Public Health. 2024.;21(3):363. https://doi.org/10.3390/ijerph21030363
• Mausz, J.; Johnston, M.; Arsenau-Bruneau, D.; Batt, A.M.; Donnelly, E.A. Prevalence and Characteristics of Violence Against Paramedics in a Single, Canadian Site. International Journal of Environmental Research and Public Health. 2023:20(17):6644 https://doi.org/10.3390/ijerph20176644

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Improving quality and safety of care

I advance patient safety and quality improvement capability in paramedicine, including education approaches that embed safety as everyday practice. Across these three articles, we argue that patient safety and quality improvement must move from being implicit expectations in paramedic practice to explicit, structured components of education and professional identity. In Enhancing Patient Safety Education for Paramedics with the IHI Open School, I highlight the limited research and formal education surrounding patient safety in the prehospital setting and propose the Institute for Healthcare Improvement Open School as a practical, scalable mechanism to strengthen paramedic competence in human factors, root cause analysis, teamwork, communication, and systems thinking. I position patient safety not as an abstract concept, but as a daily ethical obligation shaped by medication calculation errors, interruptions in resuscitation, reporting cultures, and system-level design.

Building on that foundation, Patient Safety and Quality Improvement Education for Paramedics: Practicing What We Preach
and Patient Safety and Quality Improvement Education for Paramedics: The Role of the IHI Open School Chapter describe the practical integration of IHI Open School courses in undergraduate education, and the establishment of an interprofessional student-led chapter within a paramedic program. Together, these papers demonstrate how structured curriculum embedding, reflective learning, and chapter-based leadership activities can translate theory into culture change, equipping students with the tools to identify unsafe conditions, engage in quality improvement, and advocate for safer systems. Collectively, this work frames patient safety as a professional capability that must be intentionally developed, socially reinforced, and institutionally supported across paramedic education.

• Robb, S.*; Hines Duncliffe, T.*; Henderson, L.*; Steary, D.; Batt, A.M. Patient safety and quality improvement education for paramedics: the role of the IHI Open School Chapter. Canadian Paramedicine. 2019.;42(1):16-17.
• Crosetta, R.*; Smith, P.*; Cundy-Jones, J.*; Henderson, L.*; Batt, A.M. Patient safety and quality improvement education for paramedics: practicing what we preach. Canadian Paramedicine. 2018.;41(2):35-37. https://doi.org/10.5281/zenodo.17841168
• Batt, A.M. Enhancing patient safety education for paramedics with the IHI Open School. Canadian Paramedicine. 2016.;39(1):11-13. Enhancing patient safety education for paramedics with the IHI Open School