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Introduction<\/strong><\/p>\n\n\n\n A recent study defined\nparamedicine as \u201ca domain of practice and\nhealth profession that specialises across a range of settings including, but\nnot limited to, emergency and primary care. Paramedics work in a variety of\nclinical settings such as emergency medical services, ambulance services,\nhospitals and clinics as well as non-clinical roles, such as education,\nleadership, public health and research. Paramedics possess complex knowledge\nand skills, a broad scope of practice and are an essential part of the healthcare\nsystem. Depending on location, paramedics may practice under medical direction\nor independently, often in unscheduled, unpredictable or dynamic settings\u201d <\/em>(1).<\/em> <\/p>\n\n\n\n This definition represents\none part of an ongoing global effort to better understand and more accurately\nreflect paramedicine and paramedic practice. Within Canada, the paramedic\ncommunity has made similar efforts with the 2011 National Occupational Competency\nProfile (NOCP) (2) and reflecting advances in the profession additional\ninvestigations in 2016 such as the Paramedic Profile and Roles (3,4). Yet we continue to experience a disconnect between practice\nand activities such as education, warranting a re-examination. Examining and\nunderstanding contemporary (and future) paramedic practice in Canada will\nensure that activities such as initial and continuing education and assessment\nare better informed. In this article, we will briefly describe this disconnect\nand its implications, then outline a recent effort by the Paramedic Association\nof Canada (PAC) and the Canadian Standards Association (CSA) Group to correct\nthis problem, led by recent advances in competency framework development\nprocesses and a national group of experts.<\/p>\n\n\n\n First, paramedics in\nCanada care for diverse patient presentations, in highly variable emergency and\nnon-emergency contexts. In order to do so, they require a broad set of clinical\nand non-clinical competencies, and these can be difficult to define due to the\ncomplexity and diversity of paramedic practice. Indeed, paramedic practice is\nunique and complex in that it can encompass several differentiated and\nundifferentiated patient presentations, across a spectrum of acuity and health\nand social needs, in constantly changing and challenging environments or\ncontexts of practice. These contexts of practice are growing (e.g., industrial\nsites, isolated locations), as are the roles paramedics are playing in\nhealthcare (e.g., community paramedicine programs, palliative care, integrated\ncare programs), and in the scopes of practice. This growth, diversity,\nbroadening and increasing complexity of practice presents a challenge when we\nattempt to describe it. Existing descriptions may be outdated or incomplete,\ncalling for updated ways of reflecting and guiding the profession nationally.<\/p>\n\n\n\n This difficulty in finding\nsuitable descriptions of or guidance for paramedicine in Canada becomes evident\nwhen we examine examples of the disconnect between practice and existing\nframeworks. Paramedics in Canada care for patients from differing\nenvironmental, social and cultural contexts on a daily basis that are not\nsufficiently represented in practice documents. For example, paramedics attend\na significant number of calls to older adults (approximately 40%) (5), and yet there is a\nnoticeable lack of focus in paramedic competencies on issues related to the\ncare of older adults, or on intimate partner violence, victims of human\ntrafficking, mental health patients, chronic disease conditions, social\ndeterminants of health and much more. Further, perspectives and considerations\nof other minority and vulnerable populations that paramedics regularly care for\nhave also been ignored. This includes the unique health and social care needs\nof Canada\u2019s Indigenous communities, members of the LGBTQ+ community, refugees,\nindividuals experiencing homelessness, and many others. The non-clinical\naspects of paramedicine, such as desirable traits and non-technical skills are\nequally as varied and pose additional challenges when we attempt to represent\npractice (6). <\/p>\n\n\n\n As a result of these\nlevels of complexity and diversity, existing descriptions of paramedic practice\nmay fail to adequately or inappropriately represent practice. What can and does\nresult when descriptions of practice are limited in this way, is a poorly\naligned curriculum and workforce for the communities and patients they intended\nto serve, as well as a disconnect between what paramedics do and how the\nprofession is described, examined, positioned, structured and advanced. Simply\ntranslating descriptions of paramedic practice from one jurisdiction to another\nmay be insufficient. Attempting to represent paramedic \u2018competencies\u2019 in Canada\nwell, must acknowledge a) jurisdictional variations; b) competencies within\nparamedicine are not well understood or researched; c) competencies are subject\nto continuous change and influence; and d) competencies must ultimately guide\nthe preparation of paramedics for practice throughout their career. <\/p>\n\n\n\n The National Occupational Competency Profile<\/strong><\/p>\n\n\n\n PAC published the first\nNOCP in 2001. The NOCP has since been used by regulators, paramedic services, educators\nand education accreditation agencies. Recognizing the shifting role of\nparamedicine in Canada in public safety and healthcare contexts, PAC renewed\nthe NOCP in 2011. In 2016 additional work commissioned by PAC, examined the\nroles paramedics should embody as part of their work (e.g., clinician,\nreflective practitioner) (3,4). <\/p>\n\n\n\n Paramedic practice\ncontinues to evolve and there is a duty to ensure the NOCP reflects the\ncomplexity of contemporary paramedic practice, and outlines the features\nrequired for competent practice in diverse contexts across Canada. Earlier we\noutlined the diverse contexts, presentations, and populations in which Canadian\nparamedic practice is enacted. Now, we propose that such contexts must be\nconsidered when we attempt to describe or represent paramedic practice. In\ndoing so, we may realise that paramedic practice comprises interdependent\nhealthcare and social care aspects. Indeed, as the role and scope of practice\nof paramedics has evolved, emergency care has become merely one aspect of\nbroader practice, and as a profession we have the opportunity to evolve and\ndevelop larger social care and advocacy roles (7,8). As one example, community paramedicine has emerged across\nCanada as a non-urgent and public health care service across the country, which\nrequires consideration and appropriate recognition within our renewed\nunderstanding of practice.<\/p>\n\n\n\n Developing the National Occupational Standard for Paramedics<\/strong><\/p>\n\n\n\n PAC has partnered with the\nCSA Group to manage the renewal of the NOCP and incorporate it into a new\nstandard following accredited processes of the Standards Council of Canada \u2013\nthe National Occupational Standard for Paramedics (NOSP).<\/p>\n\n\n\n Development Group (DG)<\/em><\/p>\n\n\n\n PAC has appointed Dr. Alan\nBatt, a Professor in the Paramedic Programs at Fanshawe College, Ontario, and\nAdjunct Senior Lecturer in Paramedicine at Monash University, Australia to lead\nthe NOSP development project on behalf of PAC. Dr. Batt\u2019s research focuses on\nimproving the development of competency frameworks in healthcare professions,\nand better understanding contemporary professional practice. His award-winning\ndoctoral research is being used to improve the development of competency\nframeworks in multiple healthcare and non-healthcare professions.<\/p>\n\n\n\n Dr. Batt is supported by\nresearch assistants Jennifer Bolster and Meghan Lysko. They will work closely\nwith Jeanne Bank, a consultant for the CSA Group, and a committed Development\nGroup (DG) of PAC, Canadian Paramedicine Educator Chapter (CPEC), and other\nparamedic educator members, including Pierre Poirier, Dr. Ron Bowles, Cheryl\nCameron, Dr. Becky Donelon, No\u00ebl Dunn, Dr. Tim Essington, William Johnston, Rene\nLapierre, Paige Mason, Dugg Steary, and Dr. Walter Tavares.<\/p>\n\n\n\n Technical Committee (TC)<\/em><\/p>\n\n\n\n A Technical Committee (TC)\nhas been established pursuant to the CSA Directives. This TC contains\nrepresentation from industry, education, research, government\/regulatory, the\nprofession, allied professions, the public, and international representation in\na balanced matrix format. This ensures no one stakeholder or sector dominates\nthe efforts of the committee to reach consensus. The TC will work in\ncollaboration with the DG to produce a draft NOSP over the coming months.<\/p>\n\n\n\n Development process<\/strong><\/p>\n\n\n\n The NOSP will be developed\nfollowing the CSA Group\u2019s standards development process and using a six-step\nmodel for developing competency frameworks recently published by members of the\nDG (9) – see Figure 1. The development process will be\ncollaborative and ensure the inclusion of diverse stakeholders\u2019 and end-users\u2019 views\nthroughout the process. Each step will be conducted in collaboration between\nthe DG and TC. The development of the NOSP will be informed by the principles\nguiding paramedicine in Canada (10), and the 2016 Paramedic Profile and roles (3).<\/p>\n\n\n\n Step 1.<\/strong><\/p>\n\n\n\n The DG have drafted the\npurpose, intended uses, terminology, and scope of the Standard, along with\nidentifying potential stakeholders and end-users who should be consulted as\npart of the development of the NOSP. This step involved collaboration with the\nconsultant leading the development of the Canadian Organization of Paramedic\nRegulators (COPR) Paramedic Essential Regulatory Requirements (PERRs) project\nto ensure the projects are aligned with regards to terminology and other\ndevelopmental considerations. This draft document is now with members of the TC\nfor input and feedback.<\/p>\n\n\n\n Step 2.<\/strong><\/p>\n\n\n\n The TC and DG are working\nto identify the contexts of paramedic practice in Canada for consideration in\nthe Standard. These contexts will inform the creation of working groups (WG),\nand subsequent methodology and data collection methods. We expect a call for WGs\nto be issued in the next month. Membership of WGs is open to all across Canada\ninvolved in paramedicine.<\/p>\n\n\n\n Step 3.<\/strong><\/p>\n\n\n\n The DG will outline\nsuggested methods of data collection for discussion with the TC. The DG will then\nplan the methods required for data collection, submit appropriate ethics applications,\nand oversee the conduct of the data collection methods with WGs over a several month-long\nperiod. The DG will analyse the data and prepare a summary for the TC.<\/p>\n\n\n\n Step 4.<\/strong><\/p>\n\n\n\n The DG will analyse the\ndata inductively and iteratively to identify competency statements. The group\nwill create a draft Standard for consideration by the TC. Working with the TC,\nthe group will clarify, refine, and edit the draft Standard. <\/p>\n\n\n\n Step 5.<\/strong><\/p>\n\n\n\n A working draft of the Standard\nwill be published on the CSA Group website, open for public review and comment\nfor a minimum period of 60 days. During this time, the DG and TC will solicit\nfeedback from diverse stakeholders, including individual healthcare\nprofessionals, in order to inform the finalised version of the NOSP. Comments\nreceived from the public review will be reviewed and actioned by the TC. The\nfinalised version will be available to view on the CSA Group website free of\ncharge.<\/p>\n\n\n\n Step 6.<\/strong><\/p>\n\n\n\n The development of the\nNOSP will incorporate evaluation approaches throughout the development process,\nand a clearly outlined plan for the continuous update and maintenance of the\nNOSP.<\/p>\n\n\n\n Contact the development team<\/strong><\/p>\n\n\n\n If you wish to contact the\nDG, please contact us via this form: <\/a>https:\/\/forms.gle\/zQUbNodND7LjSQ4t7<\/a>. We will provide regular\nupdates on the development of the NOSP in Canadian Paramedicine, and via social\nmedia.<\/p>\n\n\n\n References<\/strong><\/p>\n\n\n\n 1.\n Williams B, Beovich B, Olaussen A.\nThe Definition of Paramedicine: An International Delphi Study. JMDH. 2021 Dec\n30;14:3561\u201370. <\/p>\n\n\n\n 2. Paramedic\nAssociation of Canada. National Occupational Competency Profile for Paramedics.\nOttawa: Paramedic Association of Canada; 2011. <\/p>\n\n\n\n 3. Paramedic\nAssociation of Canada. Canadian Paramedic Profile: Paramedic Roles. Ottawa:\nParamedic Association of Canada; 2016. <\/p>\n\n\n\n 4. Tavares\nW, Bowles R, Donelon B. Informing a Canadian paramedic profile: Framing\nconcepts, roles and crosscutting themes. BMC Health Services Research.\n2016;16(1):1\u201316. <\/p>\n\n\n\n 5. Duong\nHV, Herrera LN, Moore JX, Donnelly J, Jacobson KE, Carlson JN, et al. National\nCharacteristics of Emergency Medical Services Responses for Older Adults in the\nUnited States. Prehospital Emergency Care. 2017;0(0):1\u20138. <\/p>\n\n\n\n 6. Batt AM,\nWilliams B, Brydges M, Leyenaar M, Tavares W. New ways of seeing: supplementing\nexisting competency framework development guidelines with systems thinking.\nAdvances in Health Sciences Education. 2021 May 18; <\/p>\n\n\n\n 7. Ford-Jones\nPC, Chaufan C. A critical analysis of debates around mental health calls in the\nprehospital setting. Inquiry (United States). 2017;54. <\/p>\n\n\n\n 8. Batt A.\nExplore and evolve. International Paramedic Practice. 2019 Sep;9(3):53\u201353. <\/p>\n\n\n\n 9. Batt A,\nWilliams B, Rich J, Tavares W. A Six-Step Model for Developing Competency\nFrameworks in the Healthcare Professions. Frontiers in Medicine. 2021;8:2601. <\/p>\n\n\n\n 10. Tavares\nW, Allana A, Beaune L, Weiss D, Blanchard I. Principles to Guide the Future of\nParamedicine in Canada. Prehospital Emergency Care. 2021 Aug 10;0(0):1\u201311. <\/p>\n","protected":false},"excerpt":{"rendered":" Alan M. Batt, Pierre Poirier, Jeanne Bank, Jennifer Bolster, Ron Bowles, Cheryl Cameron, Becky Donelon, No\u00ebl Dunn, Tim Essington, William Johnston, Rene Lapierre, Meghan Lysko, Paige Mason, Dugg Steary, and Walter Tavares on behalf of the NOSP Development Group and CSA Technical Committee. Published as: Batt, A.M., Poirier, P., Bank, J., Bolster, J., Bowles, R., […]<\/p>\n","protected":false},"author":1,"featured_media":2128,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"saved_in_kubio":false,"_uag_custom_page_level_css":"","footnotes":""},"categories":[76,66],"tags":[],"class_list":["post-3930","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-nosp"],"uagb_featured_image_src":{"full":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false],"thumbnail":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide-150x70.jpg",150,70,true],"medium":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide-300x55.jpg",300,55,true],"medium_large":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false],"large":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false],"1536x1536":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false],"2048x2048":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false],"kubio-fullhd":["http:\/\/alanbatt.net\/wp-content\/uploads\/2018\/04\/PAC-Logo-385pxWide.jpg",384,70,false]},"uagb_author_info":{"display_name":"Alan","author_link":"http:\/\/alanbatt.net\/?author=1"},"uagb_comment_info":0,"uagb_excerpt":"Alan M. Batt, Pierre Poirier, Jeanne Bank, Jennifer Bolster, Ron Bowles, Cheryl Cameron, Becky Donelon, No\u00ebl Dunn, Tim Essington, William Johnston, Rene Lapierre, Meghan Lysko, Paige Mason, Dugg Steary, and Walter Tavares on behalf of the NOSP Development Group and CSA Technical Committee. Published as: Batt, A.M., Poirier, P., Bank, J., Bolster, J., Bowles, R.,…","_links":{"self":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/3930","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3930"}],"version-history":[{"count":2,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/3930\/revisions"}],"predecessor-version":[{"id":3956,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/posts\/3930\/revisions\/3956"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=\/wp\/v2\/media\/2128"}],"wp:attachment":[{"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3930"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3930"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/alanbatt.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3930"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"http:\/\/alanbatt.net\/wp-content\/uploads\/2022\/02\/image-1.png\")