Paramedical Ethics During Acute Emergency Medical Service (EMS) Referral



How to Cite

Campeau A. Paramedical Ethics During Acute Emergency Medical Service (EMS) Referral. Australasian Journal of Paramedicine [Internet]. 2016Jul.31 [cited 2023Mar.26];13(3). Available from:



Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism.




Grounded Theory Methodology was used to analyse interview data from paramedics in Ontario, Canada, who had experience making field-referrals for patients suffering from ST elevation myocardial infarction and acute stroke.




Paramedics describe extensive use of an ethic of applied beneficence, and patient advocacy during calls on a borderline for inclusion in referrals to medical specialists.




The management of complex ethical dilemmas is often cited as an example of professionalism. Paramedics have developed a unique type of ethicality to address the complexities of emergency field-referrals that reflects their field of practice, and is consistent with the literature on professional level ethical practice.



Freidson E. Professionalism: The third logic. Chicago: University of Chicago Press; 2001.

Ontario Ministry of Health and Long-Term Care, Basic Life Support Standards Patient Care Standards; 2007. Available at:

Paramedic Association of Canada; 2015. Available at:

Shields A, Flin R. Paramedics’ non-technical skills: a literature review. Emerg Med J 2013;30:350–4.

Trivendi K, Jeremiah DS, Cone DC. Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms? Prehosp Emerg Care 2009;13:207–14.

Chenkin J, Gladstone D J, Verbeek PR, et al. Predictive value of the Ontario Prehospital Stroke Screening Tool for the identification of patients with acute stroke. ibid. 2009;13:153–9.

Lee CH, Van Gelder CM. Cone, DC. Early cardiac catheterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms. ibid. 2010;14:153–8.

Tai YJ, Yan B. Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke. Intern Med J 2013;43:1176–82.

Bloom BS, editor. Taxonomy of Educational Objectives. Vol. 1: Cognitive Domain. New York: McKay, 1956.

Jensen J. Paramedic clinical decision-making: results of two Canadian studies. International Journal of Paramedic Practice 2011;1:186–93.

Purtilo RB, Doherty RF. Ethical dimensions in the health professions. St. Louis, MO: Elsevier Saunders, 2011.

Bigham B, Blanchard I, Jensen J, et al. Ethical dilemmas: an intro to ethics in EMS research. Canadian Paramedicine. Available at:

Jensen J, Croskerry P, Travers AH. Paramedic clinical decision-making during high acuity emergency calls: design and methodology of a Delhi study. BMC Emerg Med 2009;9:1–4.

Metz D. Running hot: structure and stress in ambulance work. Cambridge, MA: Abt Books; 1981.

Nelson BJ. Work as a moral act: how emergency medical technicians understand their work. In: Barely S and Orr J, editors. Between Craft and Science, Ithaca: Cornell University Press; 1997. p. 154–84.

Campeau A. The space control theory of paramedic scene management. Symbolic Interaction 2008;31:285–302.

Campeau A. The paramedic kairotope theory: Findings. Journal of Paramedic Practice 2011;3:376–80.

Guba EG, Lincoln YS. Competing paradigms in qualitative research. In: Denzin NK and Lincoln YS, editors. Handbook of Qualitative Research. Thousand Oaks, CA: Sage; 1994. p. 105–17.

Stauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd edn. Thousand Oaks, CA: Sage; 1999.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks, CA: Sage; 2006.

DiCicco-Bloom B, Crabtree BF. Making sense of qualitative research: the qualitative research interview. Med Educ 2006;40:314–21.

Freidson E. Profession of medicine: a study of the sociology of applied knowledge. Chicago, IL: University of Chicago Press; 1988.

Hanks RG. The medical-surgical nurse perspective of advocate role. Nursing Forum 2010;45:97–107.

Trapani J. Critical care nurses as dual agents: enhancing inter-professional collaboration or hindering patient advocacy? Nurs Crit Care 2014;19:219–21.