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Background The COVID-19 pandemic and subsequent public health guidance to reduce the spread of the disease have wide-reaching implications for children’s health and wellbeing. Furthermore, paediatric emergency departments (EDs) have rapidly adapted provision of care in response to the pandemic. This qualitative study utilized insight from multidisciplinary frontline staff to understand 1) the changes in paediatric emergency healthcare utilization during COVID-19 2) the experiences of working within the restructured health system. Methods Fifteen semi-structured interviews were conducted with frontline staff working in two paediatric EDs and two mixed adult and children EDs. Participants included emergency medicine clinicians ( n  = 5), nursing managerial staff ( n  = 6), social workers ( n  = 2) and nursing staff (n = 2). Thematic Analysis (TA) was applied to the data to identify key themes. Results The pandemic and public health restrictions have had an adverse impact on children’s health and psychosocial wellbeing, compounded by difficulty in accessing primary and community services. The impact may have been more acute for children with disabilities and chronic health conditions and has raised child protection issues for vulnerable children. EDs have shown innovation and agility in the structural and operational changes they have implemented to continue to deliver care to children, however resource limitations and other challenges must be addressed to ensure high quality care delivery and protect the wellbeing of those tasked with delivering this care. Conclusions The spread of COVID-19 and subsequent policies to address the pandemic has had wide-reaching implications for children’s health and wellbeing. The interruption to health and social care services is manifesting in myriad ways in the ED, such as a rise in psychosocial presentations. As the pandemic continues to progress, policy makers and service providers must ensure the continued provision of essential health and social services, including targeted responses for those with existing conditions.

Background Paramedicine is undergoing a transformative shift as practitioners seek recognition beyond traditional emergency response roles toward being fully integrated healthcare professionals. Central to this evolution is the process of professionalisation, marked by efforts to expand scope of practice, formalise education and regulation, and achieve greater systemic integration. Despite these developments, significant barriers remain. Purpose This study explores key barriers to the professionalisation of paramedics across five developed healthcare systems, highlighting shared and context-specific challenges. Methods A qualitative study underpinned by a critical theory paradigm was conducted using semi-structured interviews. Over a five-month period (Dec 2022–Apr 2023), 15 expert stakeholders from clinical, educational, policy, and leadership roles in paramedicine and pre-hospital emergency care were recruited across five countries. Interviews were conducted via Microsoft Teams, transcribed verbatim, and analysed thematically with a reflexive and interpretive approach. Results Four main themes were developed: Current Barriers to Expansion– including outdated legislation, inconsistent regulatory frameworks, limited funding, workforce shortages, and insufficient integration within healthcare systems. Elevating Professional Status– focusing on the need for protected titles, standardised education, credentialing, and a stronger professional identity. Impact of COVID-19– participants reflected on the profession’s temporary visibility during the pandemic, followed by policy and funding shifts that diluted that momentum. Future Continuing and Emerging Barriers– encompassing structural and cultural resistance, lack of leadership pathways, and challenges in sustaining innovation and collaboration. Conclusion The study highlights persistent barriers to paramedic professionalisation, including fragmented regulation, uneven educational standards, and systemic underinvestment. Although COVID-19 demonstrated the adaptability and potential of the profession, sustaining progress requires targeted policy reform, stronger regulatory frameworks, investment in education and leadership, and commitment to workforce development. Recognising paramedics as integral healthcare providers is essential to advancing the profession and improving patient care.

Background While paramedicine is an evolving profession globally, there remain many disparities around titles and roles within the various jurisdictions that may not be fully captured in the literature. Aim The aim of this study is to gain a multi-national perspective on the current and future roles within paramedicine, highlighting the challenges and opportunities that shape the profession’s ongoing evolution. Methods A mixed-methods approach was adopted for this survey, incorporating both quantitative and qualitative data. A survey link was distributed internationally to paramedicine professionals via email, journals, and social media. Quantitative data were analysed using Microsoft Excel’s statistical functions, with results presented as frequencies, percentages, and numerical summaries. Qualitative data were analysed using narrative synthesis and integrated with quantitative findings to provide a comprehensive overview. Results The study gathered responses from 158 participants representing 59 organisations across 16 countries. Ireland had the highest number of respondents ( n  = 56) followed by Australia ( n  = 41) and England ( n  = 21). Participants outlined current paramedic roles ( n  = 54) and future roles planned within their respective organisations ( n  = 39). Participants described aspirational, non-traditional roles that they felt paramedics may adopt into the future ( n  = 86). Respondents practitioner titles varied across a range of clinical, managerial, and academic specialties, with examples provided ( n  = 33). Respondents provided various descriptions of the clinical levels of practitioners available within their organisations ( n  = 41).Various ambulance care models were identified with various combinations ( n  = 24). Paramedic medical oversight was predominantly provided by a physician ( n  = 56) although ( n  = 22) other examples were described. Regulation of paramedic practice provided descriptions of various regulatory bodies ( n  = 8) with examples of paramedic models of regulation described ( n  = 9). Respondents described various patient safety framework models implemented within their respective organisations ( n  = 10). Conclusion The findings from this study highlight that paramedicine is rapidly evolving in response to varying local healthcare needs and sector-specific challenges. Rather than striving for a uniform standard of practice, the results suggest that paramedicine should be viewed as a flexible and adaptive domain, capable of specialising across diverse clinical, managerial, and academic settings. The diverse titles, roles, and models described by participants reflect the growing complexity of the profession. Furthermore, the study indicates that paramedic practice is often shaped by local contexts, such as organisational needs and healthcare gaps, which create innovative opportunities for expanding the scope of the profession. By embracing this variability and focusing on the development of versatile healthcare practitioners who can adapt to societal needs, paramedicine can continue to evolve effectively within well-governed healthcare systems.

Background Since its inception in 2012, the Helicopter Emergency Medical Service (HEMS) has become a key component of Ireland’s emergency care framework, particularly in supporting access to specialised care centres for major trauma, stroke, and ST-elevation myocardial infarction (STEMI). With an aging population - expected to exceed 1.1 million people aged 65 and older by 2031 - the demand for aeromedical transport of older adults is increasing. Older patients often present complex clinical scenarios due to frailty, polypharmacy, and comorbidities. However, the utilisation and effectiveness of HEMS in this population remain under-examined. This study aimed to provide a 10-year review of HEMS missions involving patients aged ≥ 65 years in Ireland. Methods A retrospective cohort study was conducted on Irish HEMS missions between January 2013 and December 2022. Data on patient demographics, mission profiles, clinical interventions, and transport decisions were collected using multiple sources including initial emergency call and dispatch information, patient care reports and end of shift logs. Results Of 7,857 total HEMS missions over the 10-year period, age data was available for 5,815 patients and 1,875 (32.2%) involved patients aged ≥ 65 years. The median patient age was 74. Primary dispatches accounted for 48.7% of missions, with acute coronary syndromes (60.1%) and trauma from road traffic collisions (26.0%) being the leading medical and traumatic causes, respectively. The standdown rate was 16.8%. Most missions occurred in spring and summer (58%) and were more common in rural counties such as Mayo and Galway. It was shown that 24% of patients were not transported by helicopter, with 5.6% of those transported taken to primary percutaneous intervention centres and 6.2% of patients transported to Dublin based hospitals. Conclusions Older adults represent a significant proportion of HEMS activity in Ireland. While HEMS plays an important role in facilitating access to emergency care for this group, particularly in rural areas, patterns in dispatch, transport decisions, and destination hospitals highlight areas for system development. Enhanced age-specific triage protocols and further integration of geriatric considerations into aeromedical planning may improve equity and effectiveness as demand continues to grow.

Background Patients served by Helicopter Emergency Medical Services (HEMS) tend to be acutely injured or unwell and in need of stabilisation followed by rapid and safe transport. It is therefore hypothesised that a particular clinical crew composition is required to provide appropriate HEMS patient care. A literature review was performed to test this hypothesis. Methods MEDLINE, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were systematically searched from 1 January 2009 to 30 August 2019 to identify peer-reviewed articles of relevance. All HEMS studies that mentioned ‘staffing’, ‘configuration’, ‘competencies’ or ‘qualifications’ in the title or abstract were selected for full-text review. Results Four hundred one studies were identified. Thirty-eight studies, including one systematic review and one randomised controlled trial, were included. All remaining studies were of an observational design. The vast majority of studies described clinical crews that were primarily doctor-staffed. Descriptions of non-doctor staff competencies were limited, with the exception of one paramedic-staffed model. Conclusions HEMS clinical crews tended to have a wider range of competencies and experience than ground-based crews, and most studies suggested a patient outcome benefit to HEMS provision. The conclusions that can be drawn are limited due to study quality and the possibility that the literature reviewed was weighted towards particular crewing models (i.e. primarily doctor-staffed) and countries. There is a need for trial-based studies that directly compare patient outcomes between different HEMS crews with different competencies and qualifications.

Background Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the “appropriateness” of attendances to the ED in Ireland. Methods The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels. Results The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k = 0.341; p < 0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites. Conclusions Multidisciplinary clinicians agree that “inappropriate” use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.

ObjectivesThis research aimed to examine the perspectives, experiences and practices of international experts in community first response: an intervention that entails the mobilisation of volunteers by the emergency medical services to respond to prehospital medical emergencies, particularly cardiac arrests, in their locality.DesignThis was a qualitative study in which semistructured interviews were conducted via teleconferencing. The data were analysed in accordance with an established thematic analysis procedure.SettingThere were participants from 11 countries: UK, USA, Canada, Australia, New Zealand, Singapore, Ireland, Norway, Sweden, Denmark and the Netherlands.ParticipantsSixteen individuals who held academic, clinical or managerial roles in the field of community first response were recruited. Maximum variation sampling targeted individuals who varied in terms of gender, occupation and country of employment. There were eight men and eight women. They included ambulance service chief executives, community first response programme managers and cardiac arrest registry managers.ResultsThe findings provided insights on motivating and supporting community first response volunteers, as well as the impact of this intervention. First, volunteers can be motivated by ‘bottom-up factors’, particularly their characteristics or past experiences, as well as ‘top-down factors’, including culture and legislation. Second, providing ongoing support, especially feedback and psychological services, is considered important for maintaining volunteer well-being and engagement. Third, community first response can have a beneficial impact that extends not only to patients but also to their family, their community and to the volunteers themselves.ConclusionsThe findings can inform the future development of community first response programmes, especially in terms of volunteer recruitment, training and support. The results also have implications for future research by highlighting that this intervention has important outcomes, beyond response times and patient survival, which should be measured, including the benefits for families, communities and volunteers.

BackgroundPatients with end-of-life care (EoLC) needs present to the emergency departments (ED) frequently and at times, it can be difficult to provide a high standard of care. Within the Irish setting, there is limited literature on the provision of EoLC in EDs and this study, therefore, aimed to evaluate the perceptions of emergency medicine (EM) clinicians regarding the provision of EoLC in EDs in Ireland.MethodsThe End-of-Life Care in Emergency Department Study was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Ireland. This study was conducted through the Irish Trainee Emergency Research Network over a 6-week period from 27 September 2021 to 8 November 2021. Analysis of the survey domains regarding knowledge and attitude has been published previously by the present authors, with this current analysis focusing on communication, education and resources for the provision of EoLC in EDs. Descriptive data on outcomes are reported with additional subgroup analysis according to years of experience in EM.ResultsOf the 694 potential respondents, 311 (44.8%) had fully completed surveys. The majority (62% n=193) were between 25 and 35 years of age with 60% (n=186) having <5 years’ experience in EM; 58% (n=180) were men. Experienced respondents (>10 years’ experience) were more likely to agree that they were comfortable discussing EoL with patients and families than those with <5 years’ experience (80% vs 32%) (p<0.001). Questions on ED infrastructure revealed that just 23.5% agreed that appropriate rooms are allocated for EoL patients, with just 11.6% agreeing that the physical environment is conducive to the provision of EoLC.ConclusionEM clinicians agree that they are comfortable breaking bad news and discussing EoLC with patients and families, but disagree that adequate resources and infrastructure are in place to provide a high standard of EoLC in Irish EDs. Challenges exist centred on training and infrastructure and addressing these may lead to enhanced EoLC in the future.

ObjectivesTime is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021.DesignWe conducted a secondary data analysis with a quasi-experimental design.SettingWe used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as ‘1 March 2020–31 December 2021’ and the pre-COVID-19 period ‘1 January 2018–29 February 2020’.Primary and secondary outcome measuresWe compared five ambulance time intervals: ‘allocation performance’, ‘mobilisation performance’, ‘response time’, ‘on scene time’ and ‘conveyance time’ between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis.ParticipantsWe included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021.Results40 004 cases were included: 19 826 in the pre-COVID-19 period and 20 178 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001).ConclusionsA ’shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.