Three-hundred and seventy-four respondents submitted an expression of interest to participate in the project, including a complete email address for future correspondence. Figure 1 shows demographic information of respondents at all stages of the project. These demographic percentages are in line with current PHECC registration data with 72% of paramedicine professionals identifying as male and 29% of registrants falling into both the 46–55 years, and the 36–45 years age groups [18]. Figure 1 also shows response numbers for each round. As a snowballing methodology was used for recruitment it is not possible to calculate a response rate for the initial recruitment. That said as can be seen in the response numbers from Round 2 and 3, 74% of those eligible to complete the final round of the Delphi did so.
Respondent demographic information
Figure 2 shows the components that were identified in the first round for each of the four essential elements of the study.
Research priorities
Sixteen categories were developed from the first-round open-ended responses in regards to Research Priorities (Fig. 2).
Essential elements and components identified through the Delphi study
In the second round, 72% of respondents indicated that Staff Wellbeing was a category within the Research Priorities that should be addressed in the next 2 years. Components of the Staff Wellbeing category included: critical incident stress management; ergonomics; first responder wellbeing; human factors; job satisfaction; musculoskeletal injuries; peer support; resilience; salary; and work conditions. As this number was greater than the pre-set consensus number of 70%, this category was deemed to have reached consensus as a priority and was not presented again in the third-round questionnaire.
In the third round, 79% of respondents indicated that Education and Professionalism was a Research Priority for the next 2 years. This category included: barriers to research; bridging courses; career progression; EMT education; professional learning and registration; previous education; simulation-based learning; and transition to practice. In addition, 73% of respondents indicated that Acute Medical Conditions (Anti-Emetics, COVID-19, ECGs, fluids, NSTEMI, OHCA, pain relief, sepsis, stroke and vaccination side effects) was also a priority area for the next 2 years. No other priority area reached consensus for any individual time frame. A full breakdown of the Research Priorities that did not reach consensus can be seen in Fig. 3.
Percentage of respondent breakdown for each time frame for Research Priorities that did not reach consensus
In terms of a subgroup analysis for Research Priorities, both genders reached consensus stating that Education and Professionalism was a Research Priority for the next 2 years; however, females did not reach consensus on Acute Medical Conditions being a priority in the next 2 years. Consensus was almost reached for males when indicated that Emerging Paramedic Roles/Skills should be a priority area in the next 2 years (69%); however, this result was not seen for females. It should be noted that the gender distribution between the different roles was not equal with only one female advanced paramedic (AP) included in this cohort and a greater female percentage in the EMT and “Other Roles” category.
The professional role of the participants also led to some differences in responses. When compared to the overall cohort results, Paramedics approached consensus on Acute Medical Conditions (68%) and Emerging Paramedic Roles/Skills (68%) being priority areas in the next 2 years. APs approached consensus on Education and Professionalism (67%) being a priority area in the next 2 years; however, they did reach consensus on Resources and Emerging Paramedic Roles/Skills being priority areas in the next 2 years. Those who indicated that they came from “Other Roles” reached consensus on Health System Integration (70%), Trauma (70%) and Guidelines and Governance (90%) as priorities in the next 2 years.
Key resources
Ten categories were developed from the first-round open-ended responses with regard to Key Resources (Fig. 2).
No Key Resources reached consensus in the second round of the Delphi study as no category had 70% of the cohort select the same Likert level. All options were re-presented in the third-round questionnaire. In the third round, consensus was reached with participants indicating that there were a number of Key Resources categories that were imperative. This included Education (Access to upskilling/Research skills, Access to university and Continuous professional education; 83%), Staffing (Defined roles, EMT investment, Flexible work arrangements/Time allowance, recruitment of clinical personnel and staff engagement surveys; 78%) and Leadership (Leadership reform, Management buy-in and training, Paramedic representative groups and Transparency from leadership; 70%). No other Key Resources reached consensus for any individual level of importance. A full breakdown of the Key Resources areas that did not reach consensus can be seen in Fig. 4.
Percentage of respondent breakdown for each importance level that did not reach consensus with regard to Key Resources
In relation to subset analysis for Key Resources by demographic variables, females approached consensus (68%) on the fact that Leadership was a resource change that was imperative to allow the research to occur. Although EMTs did not differ in their consensus items when compared to the full cohort, Paramedics (64%) and those categorised as Other Roles (40%) did not reach consensus for Leadership as an imperative resource change. APs reached consensus for imperative resource changes in Research Development (72%) and Government (72%). Participants categorised as working in “Other Roles” reached consensus for imperative resource changes in the areas of Government (70%) and Resources (70%).
Key processes
Five categories were developed from the first-round open-ended responses in regards to Key Processes (Fig. 2).
In the second-round, 70% of respondents indicated that Education was a Key Processes change that was imperative for research to be completed and thus was deemed to have reached consensus. Components of the Education category included; Education Pathway Restructure, Engagement with Universities, Recruitment of Education Specialists. This Key Processes change was the only option not presented again in third round questionnaire. No other Key Processes reached consensus in the third round at any Likert level. A full breakdown of the Key Processes areas that did not reach consensus can be seen in Fig. 5.
Percentage of respondent breakdown for each importance level that did not reach consensus for Key Processes
For the subgroup analysis by gender, females reached consensus on the imperative importance of the Key Processes change areas of Cooperation (74%) and Opportunity (74%). In addition, when examined by role, EMTs felt it was imperative to see changes in the area of Opportunity (89%), and APs felt it was imperative to see changes in the areas of Translation (83%) and Cooperation (72%).
Outcomes
Eleven categories were developed from the first-round open-ended responses in regard to Outcomes for the future strategy (Fig. 2).
None of the Outcomes reached consensus in the second round of the Delphi study as no category had 70% or more of the participants select the same Likert level. All options were re-presented in the third-round questionnaire. In the third round, consensus was reached where participants indicated that certain Outcomes were essential for inclusion in the research strategy. These included Practitioner Wellbeing (mental health of practitioners; 85%), Evidence-based Practice (CPGs with clear evidence base; 78%), Practitioner Development (development of clinical and research skills; 77%), Patient Outcomes (morbidity, mortality and pain management; 75%), Staff Satisfaction (including staff retention; 75%), and Alternate Pathway Outcomes (patients diverted from ED and treated in the community; 71%). A full breakdown of the Outcome measures that did not reach consensus can be seen in Fig. 6.
Percentage of respondent breakdown for each importance level that did not reach consensus for Outcomes required in the strategy
In subgroup analysis for the Outcomes, consensus differed by gender. Although the male cohort responded similarly to the full cohort, females approached consensus on Alternate Pathway Outcomes, Evidence-based Practice or Staff Satisfaction (all 68%). Females reached consensus on the Outcomes of Integration of technology (74%) as a useful but not essential measure to be included in the strategy. When analysed by Clinical Role, EMTs did not reach consensus on Alternate Pathway Outcomes (53%) being essential and Paramedics did not reach consensus on Patient Outcomes (52%) or Evidence-based Practice (68%) being essential. APs did reach consensus on Service Measures being useful but not essential (83%) and they did not reach consensus on Practitioner Development being essential (61%). Finally, participants categorised as Other Roles did reach consensus for Outputs to be an Outcome measure that is useful but not essential (80%).
Figure 7 provides an overall summary of the results which was shared with participants after study competition.
Final research priorities established from the Delphi study
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