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Despite documented threats and challenges to professional workers, occupations and professions of all kinds remain motivated to pursue professionalization projects aimed at improving their social location. However, to drive professionalization from within an occupation means resisting or adapting to a variety of pressures from other professions, managerial organizations, and neoliberal government agendas. Emerging research has highlighted that some professions can adapt to or resist these pressures, while others falter. How intraprofessional dynamics impact professionalization in these conditions is less understood. This thesis aims to address this gap through a qualitative case study of paramedic professionalization in Ontario, Canada. Data from interviews with paramedic leaders and a document analysis were used to examine how intraprofessional dynamics have impacted paramedic professionalization. Drawing on various theoretical and conceptual threads from neo-Weberianism and neo-institutional theory, each empirical chapter examines a topic related to professionalization: regulation, higher education, and expansions in work. The findings of each chapter reveal widespread intraprofessional stratification, and at times, conflict. Some paramedic leaders are driven to improve paramedic status, recognition, and autonomy, however, must do so in increasingly flexible, collaborative, and subtle ways. While intentional stratification is at times pursued as an innovative strategy in response to organizational and government pressures and mandates, it comes at a cost to professional unity. Others are resistant or skeptical of professionalization that may change the physical, boots-on-the-ground ethos of frontline paramedics. The finding of this thesis sheds light on the intraprofessional dynamics of an understudied occupation and how they relate to contemporary scholarly debates about the processes and outcomes of contemporary professionalization. / Thesis / Candidate in Philosophy / Professions are a special type of occupation that has high social status. Social scientists have long studied how occupations try to gain status and recognition, a process called professionalization. In recent years, researchers have highlighted that it may be more challenging for occupations to professionalize as they face pressures from governments and their employers. This thesis aims to contribute to this research by presenting three papers examining paramedic professionalization in Ontario, Canada through the eyes of paramedic leaders and documents. Paper 1 found that paramedic leaders are divided on the need for changes to paramedic regulation to professionalize. Papers 2 and 3 found that paramedics are pursuing new roles for paramedics in healthcare and academics as a professionalization strategy. Paramedics face an internal conflict that has limited their ability to pursue a collective professionalization strategy. If differences across the profession cannot be resolved, it may continue to fracture the profession.

Sammanfattning   Ambulanssjuksköterskan arbetar idag i stressiga, krävande miljöer och ska då fatta snabba, korrekta beslut som kan vara livsavgörande för en svårt sjuk patient. Om en individ upplever att dennes yrkessituation inte kan kontrolleras eller hanteras kan personen till slut reagera med uppgivenhet, detta är en definition av långvarig stress.   Syftet med denna studie var att undersöka hur litteraturen identifierar och beskriver upplevelser av stress hos ambulanssjuksköterskor och vilka preventiva interventioner som finns idag för att hantera ambulanssjuksköterskans stress i samband med traumatiska möten av svårt sjuka patienter. Metoden för studien var en deskriptiv litteraturstudie där artiklar hämtades via Google Scholar, Medline via PubMed och Cinahl.   Resultatet av denna studie visade att det i de flesta fall saknas en strategi för att möta den yrkesrelaterade stress som ambulanssjuksköterskor utsätts för. För att kunna upptäcka och undvika symtom på stress behövs mer preventiva interventioner och uppföljningar före eller i direkt anslutning till en kritisk händelse. Det behövs mer forskning i ämnet och fåtalet artiklar uppvisar förslag angående djupgående hjälpmedel för stresshantering och stressrelaterade sjukdomar.   Slutsats Att ambulanssjuksköterskan i sitt arbete upplever stress och är tvungen att hantera den är ett faktum. För att komma åt detta problem behövs både engagemang och preventiva strategier av arbetsgivare för att stötta ambulanssjuksköterskan i hanteringen av stressupplevda situationer. / Abstract   The paramedic nurse today works in stressful, demanding conditions, and is constantly forced to make quick, correct decisions vital for a critically ill patient. Should an individual experience a work environment, which cannot be handled or controlled, the ultimate reaction is one of complete resignation. This is a symptom of prolonged stress. The purpose of this study is to examine how scholarly literature identifies and describes stress experiences among paramedic nurses. It also aims to evaluate the means of preventive interventions currently available to manage stress symptoms arising from traumatic encounters with severely ill patients. Method: This study is a literature review based on scientific articles collected from Google Scholar, Medline via Pubmed, and Cinahl.   The outcome of this study showed that, in most cases, there is a lack of means to meet the work-related stress that paramedic nurses are exposed to. In order to detect and avoid stress symptoms, more preventive interventions and monitoring are needed – both before and directly following critical situations. In the academic literature examined, the need for further research within this field is obvious, but there are few suggestions of any long-term preventive conclusions against stress and stress-related diseases.   Conclusion: Paramedics experience stress in their work and are forced to successfully cope with it. Employers have to take action to actively engage in these issues, and provide strategies to support the paramedic nurse in managing stressful situations.

Paramedics are responsible for the care of patients requiring emergency assistance in the out of hospital setting. These health care providers need to make many decisions during the course of an emergency call. This thesis on paramedic clinical decision-making includes two studies, intended to determine which decisions paramedics make that are most important for patient safety and clinical outcome, and what thinking strategies paramedics rely on to make decisions. Forty-two decisions were found to be most important for outcome and safety. The highest decision density of an emergency call is during the on-scene treatment phase. Paramedics use a mix of thinking strategies, including rule out worst scenario, algorithmic, and exhaustive thinking. The results of these studies have implications for future research, paramedic practice and training.

Syftet med undersökningen var att undersöka olika rutiner vid hantering av skeppsapotek ur säkerhetssynpunkt och hur sjukvårdarsansvariga upplever rutiner kring hantering av skeppsapotek. Undersökningen bygger på intervjuer och enkätundersökningar från sjukvårdsansvarigbefäl. 19 enkäter delades ut till en klass med sjukvårdare i Kalmars sjöfartshögskola via en kontaktperson, av dessa intervjuades fyra personer. Enkäter av samma slag skickades även ut via internet. Undersökningens resultat visar på att det saknas tydliga riktlinjer för hur rutiner vid hantering av skeppsapotek ska skötas. Dock ur säkerhetssynpunkt upplevde sjukvårdarna inte detta som något problematiskt. Dessutom kunde man identifiera tre olika rutiner som användes ute till sjöss, nämligen rutiner med hjälp av Excell dokument, journalföring med papper och penna och rutiner med hjälp av underhållsprogrammet AMOS. När det gäller samarbete mellan fartyg och läkemedelsleverantörer upplever respondenterna att det genomgående fungerar bra. Dock att det förekomma problem, t.ex. fel beställningar eller att läkemedelsleverantörer skickar läkemedel med kort utgångsdatum. / The purpose of this study was to investigate different routine for handling ship´s pharmacy from a safety point of view and how the paramedics experience the routine procedures regarding the handling of ship's pharmacy. The survey was based on interviews and surveys from medical responsible officers. 19 questionnaires were distributed to a class of paramedics in Kalmar Maritime Academy via a contact person, of those 19 four people were interviewed. Surveys of the same nature were also sent out via the internet. The survey results show that there are no clear guidelines on how procedures for handling ship’s pharmacy must be maintained. However, from safety point of view paramedics did not see this as somewhat problematic. In addition, the study could identify three different routine procedures that were used at sea, namely routines using Excell documents, keeping a journal and routines with the help of the maintenance program AMOS. In terms of cooperation between the ship and drug suppliers are experiencing respondents that consistently works well. However, there exist problems such as wrong orders or drug suppliers send drugs with short expiry dates.

Work conducted as part of this thesis evaluated the lifting techniques of paramedics using a novel link-segment model that was validated against a commercially available software package, 3D Static Strength Prediction Program (3DSSPP). Twenty-five paramedics visited the Biomechanics Lab at Queen’s University to participate in testing sessions mimicking the daily lifting and carrying tasks performed by paramedics on the job. Participants were outfitted with the Xsens Motion Tracking System and asked to lift and carry bags ranging from 5-20kg. Output from the Xsens system was used in a 3D-inverse dynamic model to estimate loading at the L5/S1 joint. The compressive and shear force estimates at this joint are of particular interest given their correlation with low back pain and injury. Across all conditions the greatest compressive forces were seen during bag pickup and bag release. Additionally, reaching forward 50 cm at pickup increased peak spinal compressive loads by nearly 300N and 500N for a 5kg and 10kg handbag respectively. Not surprisingly, at bag release greater trunk lean values were correlated with higher compressive force estimates. Single-shoulder backpack carries showed similar loading characteristics when compared to double-shoulder backpack carries. Shear force estimates remained well below acceptable levels across all conditions. Based on paramedic feedback, a supplementary testing session was performed with a single participant to evaluate multi-bag carries and stair climbing. The results of this testing session showed that loading was reduced at pickup and release when the load was distributed across two bags. This research led to the development of four recommendations that have been presented to the Association of Municipal Emergency Medical Services of Ontario. 1. Paramedics should not lift single bags or a combination of bags that exceed 20kg. 2. Prior to lifting, bags should be located as close to the paramedic as possible. 3. When placing bags on the ground and when picking bags up off of the ground, paramedics should use a squat lift technique to prevent forward and side bending. 4. When multiple bags are carried the load should be evenly distributed within bags and across sides of the body. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2011-09-30 19:26:18.28

As ambulance staff, are there any risks that critical incidents may be experienced as traumatic and affect the individual negatively? What the outcome will be for those affected depends on how well prepared the ambulance staff is. Research shows that peer support is an important feature to reduce the risk of the caregiver to suffer from posttraumatic stress disorder and how the continued careing becomes. The first support, however, is the most important thing when a carer experiences a critical incident. The aim of this study was to identify how ambulance staff experiences peer support. The methodology of the study was a triangulation, which means that quantitative and qualitative methods are mixed. This methodology makes it possible to study the subject as deeply as possible and still maintain a high validity and reliability. A questionnaire was designd and sent out to the informants. There were 169 persons who were asked to participate. The survery was voluntary and anonymous. A total number of 100 carers with different job titles chose to participate. A majority of the ambulance staff said that they had experienced a critical incident that influenced them at work. The results show that peer support is important to most people and that a majority of those affected chose to talk to their colleague in connection with the incident. When peer support was not used this had to do with personal chemistry and/or that it was not considered necessary. The results show that it would be desirable if a professional kept regular monitoring or reflection with those affected by a critical incident. Not a colleague since personal chemistry may lead to unsatisfactory results.

M.A. (Clinical Psychology) / South African paramedics are thought to be exposed to a high number of critical incidents as compared to paramedics elsewhere (Ward, Lombard & Gwebushe, 2006). Therefore, South African paramedics are at particular risk of suffering from negative effects associated from the exposure to critical incidents. This study aimed to gain an in-depth understanding of the meaning which paramedics attach to the experience of “critical incidents” (Mitchell, 1983). This information may be beneficial for those working in Emergency Medical Services in South Africa to further understandings of paramedics’ experience of work related trauma. Five paramedics, sourced from both public and private ambulance service, between the ages of 27 and 36 years old, who have had between 8 to 12 years of working experience were interviewed regarding their lived experiences of critical incidents. The semi-structured interviews were transcribed and analysed based on the Interpretative Phenomenological Analysis (IPA) framework suggested by Smith and Osborn (2008). The analysis of each of the participant’s transcripts provided four master themes, some of which are supported by superordinate themes. The master themes are: 1) Experiencing the trauma of critical incidents, 2) Experiencing in the “World” of EMS, 3) Intrinsic factors and active attempts of coping with stress, and 4)Personal consequence of being a paramedic. For most of the participants, their narratives highlighted that the organisational variables were considered to be more important than the nature of the critical incidents they experienced. Critical incidents were deemed traumatic as there was a disparity between the participant’s expectations of what was expected and what they were confronted with in “reality”. In addition, the participants described forming an emotional bond with their patients or the patient’s family, which added to their distress. The participants’ narratives emphasised the importance of the role of the EMS organisation in influencing their experiences. Despite employing a number of coping strategies to mediate the effects of organisational as well as critical incident stress, the participants reported experiencing longterm negative psychological symptoms that have impacted on their personal and familial lives. These findings support the growing body of knowledge that demonstrates that organisational variables play an important role in either mediating or exacerbating posttrauma outcomes.

The decline in the number of lead paramedics at an Indiana fire department has stressed the local emergency medical system (EMS), jeopardized public safety, accelerated personnel burnout, and increased overtime expense. Using Herzberg’s motivation hygiene theory as a guiding lens, this phenomenological study explored the effects of the Indiana fire department’s policies related to lead paramedic job satisfaction. The purpose of this study was to investigate possible hygiene factors, relabeled as workplace satisfaction factors, which led to a decrease in the number of lead paramedics within EMS from 2007–2017. The reduction in lead paramedic numbers led to unanticipated and unbudgeted increases in overtime expenditures that were absorbed through alternative staffing models and budget reallocations. From a purposeful sample of 20 paramedic participants, data were collected through semistructured interviews that included a self-administered workplace satisfaction ranking activity. Following data coding and analysis, thematic analyses indicated that the fire department had failed to meet workplace satisfaction factors of work conditions, policy and administrative practices, and supervision, causing paramedics to not seek, to drop, or to consider dropping lead paramedic designations. This study may lead to positive social change at three levels: (a) organizational, by identifying workplace satisfaction factors that could increase the number of lead paramedics as well as reduce paramedic burnout; (b) community, by decreasing overtime expenditures and improving the standard of staff care; and (c) national, by illustrating for external EMS agencies the benefit of workplace engagement studies when facing similar paramedic workplace dissatisfaction.

Background: First responders (firefighters, paramedics, and police officers) are often exposed to potentially psychologically traumatic events. When combined with insufficient social support and reduced help-seeking behaviours, such exposures may increase the risk of mental health challenges, particularly among paramedics who report the highest rates of mental disorders. Objective: The current study used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify critical barriers and facilitators to help-seeking and accessing mental health care, and the feasibility and sustainability of a first responder clinic. Methods: Semi-structured qualitative interviews included 11 paramedics (frontline, mid-and-senior management, and union), recruited using purposive and snowball sampling. Interviews were analyzed using content and thematic analyses. The TDF and CFIR guided study design, interview content, data collection, and analysis. Results: Barriers included the complexities of stigma, confidentiality, cultural competency, and trust. Conclusions: The findings will be instrumental in developing evidence-based approaches to mental health care for paramedics.