The expanded role of paramedics: Managing community paramedicine and highly acute patient care within emergency medical services

The Prehospital Visitation Units (PVUs) are single-responder units operating in the Central Denmark Region, Denmark. PVU paramedics work within the expanded role of community paramedicine, while maintaining their usual tasks of responding to patients with acute and life-threatening conditions. This study explored paramedics’ motivations for working on the PVU, their experiences of utilizing collaboration partners, and their role in handling patients with acute and life-threatening conditions when working as single responders. A mixed-methods study using a convergent parallel design was conducted, integrating results by linking findings from each data source during the interpretation process. Quantitative data were collected through questionnaires (administered January–March 2024) that PVU paramedics completed at the end of each shift. Qualitative data were obtained through semi-structured interviews with all 10 paramedics operating the PVUs during the data collection period (September–November 2023). Data were analyzed using descriptive statistics and reflexive thematic analysis. Paramedics were motivated to work on the PVU because it provided opportunities for professional growth, autonomy, and engagement in patient-centered care. They reported frequent use of collaboration partners and that these contributed positively to their work. However, the most frequently used collaboration partners were within other parts of the emergency medical services (EMS). In the questionnaire (response rate: 63%), paramedics reported assisting on 39 cases with patients experiencing acute or life-threatening conditions, arriving first on scene in 44% of cases. They contributed with, for example, rapid assessments, critical interventions, and coordination with following emergency teams. Working in the expanded role of paramedicine was perceived positively by paramedics, and any task that contributed to high-quality patient-centered care, whether acute or not, was considered meaningful. The findings can inform policy on EMS single-responder units.