The experience of paramedics providing care to people living with dementia



How to Cite

Courtney-Pratt H, Eccleston C, Lucas P, Tierney L, Harris W, Campbell B, Lawler K. The experience of paramedics providing care to people living with dementia: Working with uncertainty. Australasian Journal of Paramedicine [Internet]. 2022May2 [cited 2023Mar.26];19. Available from:


Paramedics are key to the provision of emergency care in the community. Those living with dementia use paramedic services at a high rate, due to a range of issues related to comorbid conditions and other acute events which mean care cannot continue in the home. There is a paucity of literature related to care provided in such instances. Anecdotally, a perception exists that providing care to this group of people is challenging for paramedics in situations where high level assessment and emergency care are paramount.

Paramedics in one Australian state were sought to participate in an exploratory study to enhance understanding of how they currently worked with people who lived in the community and had dementia. Sixteen participants were recruited to the study, and they worked in a number of areas, including urban and rural. Experience was broad, ranging from one to 36 years in the paramedic role. Inductive thematic analysis of interviews revealed key themes that framed the paramedic role and permeated interactions, assessment and decision-making.

Paramedics participating in this study recognised people living with dementia who had high level impacts of the condition, suggesting those with less visible symptoms may remain hidden. With the projected increase of people diagnosed with dementia it is imperative that paramedics are aware of, and integrate dementia knowledge, skills and confidence into their practice. Deeper exploration of the area that includes volunteer ambulance personnel and further inquiry of the role of paramedics in relation to those living with dementia is needed. A focus on education and professional development to equip paramedics to work with people living with dementia is recommended. The findings suggest that greater work in this area is required.


Australian Institute of Health and Welfare. Deaths in Australia [updated 25 Jun 2021]. Available from:

GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2022;7:E105–25.

Gitlin LN. Whose responsibility is it? Balancing individual, family, and societal needs for supporting seriously ill older adults. Journal of the American Geriatrics Society 2019;67:s457–60.

Alzheimer’s Australia. Living with dementia in the community: challenges and opportunities. A report of national survey findings. Alzheimer’s Australia, 2014. Available from:

Voss S, Brandling J, Taylor H, Black S, Buswell M, Cheston R, et al. How do people with dementia use the ambulance service? A retrospective study in England: the HOMEWARD project. BMJ Open 2018;8:e022549.

Goniewicz M. Effect of military conflicts on the formation of emergency medical services systems worldwide. Academic Emergency Medicine 2013;20(5):507–13.

Manring M, Hawk A, Calhoun JH, Andersen RC. Treatment of war wounds: a historical review. Clinical Orthopaedics and Related Research 2009;467(8):2168–91.

Amador S, Goodman C, King D, Machen I, Elmore N, Mathie E, et al. Emergency ambulance service involvement with residential care homes in the support of older people with dementia: an observational study. BMC Geriatrics 2014;14:95.

Buswell M, Lumbard P, Fleming J, Ayres D, Brayne C, Goodman C. Using ambulance service PCRs to understand 999 call-outs to older people with dementia. Journal of Paramedic Practice 2016;8(5):246–51.

Shepherd H, Livingston G, Chan J, Sommerlad A. Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis. BMC Medicine 2019;17:130.

Pulst A, Fassmer AM, Hoffmann F, Schmiemann G. Paramedics’ perspectives on the hospital transfers of nursing home residents – a qualitative focus group study. International Journal of Environmental Research and Public Health 2020;17(11):3778.

Voss S, Brandling J, Pollard K, Taylor H, Black S, Buswell M, et al. A qualitative study on conveyance decision-making during emergency call outs to people with dementia: the HOMEWARD project. BMC Emergency Medicine 2020;20(1):1–9.

Brooke J, Stiell M. Development of clinical and inter-personal skills to support people living with dementia. Journal of Paramedic Practice 2017;9(8):348–53.

Hunter D, McCallum J, Howes D. Defining qualitative exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare. Journal of Nursing and Health Care 2019;4(1).

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77–101.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 2007;19(6):349–57.

Johnson R, Waterfield J. Making words count: the value of qualitative research. Physiotherapy Research International 2004;9(3):121–31.

Coar L, Sim J. Interviewing one’s peers: methodological issues in a study of health professionals. Scandinavian Journal of Primary Health Care 2006;24(4):251–6.

Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006;18(1):59–82.

Liamputtong P. Qualitative research methods (3rd ed.). Melbourne: Oxford University Press, 2009.

Colbeck M, Maria S. A comparative taxonomy of Australasian paramedic clinical practice guidelines. Australasian Journal of Paramedicine 2018;15(3).

Thompson J, Drummond C. Exploring paramedic patient assessment. Journal of Paramedic Practice 2013;5(6):342–7.

Svensson A, Bremer A, Rantala A, Andersson H, Devenish S, Williams J, et al. Ambulance clinicians’ attitudes to older patients’ self-determination when the patient has impaired decision-making ability: a Delphi study. International Journal of Older People Nursing 2022;17:e12423.

Harris W, Stirling C, Williams AM, Lucas P. Care of frail and older adults: a content analysis of paramedic operational clinical practice guidelines. International Emergency Nursing 2021;56:101007.

Lucas PV, McCall MJ, Eccleston C, Lea E, Stratton B, Annear M, et al. Prioritising the development of paramedic students’ interpersonal skills. Journal of Paramedic Practice 2015;7(5):242–8.

Buswell M, Lumbard P, Prothero L, Lee C, Martin S, Fleming J, et al. Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence. Emergency Medicine Journal 2016;33(1):61–70.

Choonara E, Williams J. What factors affect paramedics’ involvement of people with dementia in decisions about their care? A qualitative study. British Paramedic Journal 2021;5(4):1–8.

Lawler K, Kitsos A, Bindoff AD, Callisaya ML, Eccleston CE, Doherty KV. Room for improvement: an online survey of allied health professionals’ dementia knowledge. Australasian Journal on Ageing 2021;40(2):195–201.

Smyth W, Fielding E, Beattie E, Gardner A, Moyle W, Franklin S, et al. A survey-based study of knowledge of Alzheimer’s disease among health care staff. BMC Geriatrics 2013;13(1):1–8.