The research, published in BMC Health Services Research, examined Prehospital Assessment Units, or PAUs, which are paramedic-staffed units designed to strengthen acute care pathways by assessing patients before a decision is made about hospital conveyance. The model sits squarely within a broader international trend toward non-conveyance, in which emergency medical services are asked not merely to transport patients but to evaluate them at the scene, treat what can be treated, and connect people with the right level of care, which is sometimes no hospital visit at all. Sustainable implementation of such services, the Danish team argued, depends on cooperation across sectors that have historically operated in separate silos.

To capture how the model is landing on the ground, the researchers used a convergent parallel mixed-methods design, running quantitative questionnaires and qualitative focus groups simultaneously and then integrating the results. Data were collected between April and August 2024 across the emergency medical services, hospital emergency departments, general practice, and municipal acute care in the Region of Southern Denmark. The questionnaire drew on previously published and validated outcome measures, while the qualitative material was analysed using Reflexive Thematic Analysis, a technique in which researchers systematically code narratives and construct themes that interpret shared experiences rather than simply counting them.

The numbers tell a strikingly positive story. Of 231 healthcare professionals who responded to the questionnaire, a response rate of 51.7 percent, 166 were included after prespecified exclusions. On a one-to-five scale, the median score for the Acceptability of Intervention Measure was a perfect 5.00, with an interquartile range of 4.00 to 5.00, meaning that at least three quarters of respondents rated acceptability at four or above. The Intervention Appropriateness Measure yielded a median of 4.13, and the Feasibility of Intervention Measure a median of 4.25, with interquartile ranges of 4.00 to 5.00 and 3.75 to 5.00 respectively. In plain terms, the clinicians who interact with PAUs overwhelmingly regard them as acceptable, largely appropriate, and broadly workable.

Numbers alone, however, cannot explain why a service succeeds or stalls, and this is where the qualitative arm of the study earns its keep. Three focus groups involving 18 participants drawn from across the acute care spectrum captured cross-sector experiences in depth. The thematic analysis generated three themes: the contested work of patient selection, integration in acute care, and building understanding through shared narratives. Together, these themes map the social and organisational terrain on which the PAU model either flourishes or frays, revealing that a service can be well liked in principle while still generating friction at its operational edges.

The first theme, patient selection, points to what may be the model’s most consequential challenge. Deciding which patients can be safely assessed and left at home, and which genuinely need an emergency department, is inherently contested work, and the qualitative accounts suggest that boundaries around this decision are not always clear. When frontline staff in different parts of the system disagree about who belongs in a PAU’s remit, consistency suffers, and the researchers identified this variability as a negative implementation determinant, a factor that may hinder uniform delivery of the service across settings and shifts.

The second theme, integration in acute care, extends that concern to the institutional level. A prehospital assessment unit does not operate in a vacuum; its value depends on how smoothly it slots into emergency departments, general practice, and municipal acute care. The study found evidence of role negotiation, with professionals working out where PAU staff fit within established hierarchies and workflows. Accounts of this negotiation, alongside variability in feasibility scores, revealed further negative determinants rooted in contextual factors and unclear boundaries between services. These are not failures of the model so much as growing pains of a system learning to share responsibility for acutely ill patients across traditional dividing lines.

The third theme, however, offers a genuine cause for optimism. Shared narratives, the stories professionals tell each other about the service, emerged as a powerful engine of understanding. Qualitative narratives reinforced the quantitative findings, legitimising the PAUs and highlighting their contribution across sectors. When emergency department physicians, general practitioners, municipal staff, and paramedics exchange experiences of the unit in action, abstract scepticism gives way to concrete appreciation of what the service can and cannot do. The researchers identified this cross-sector contribution and the role of shared experience as positive implementation determinants, suggesting that communication itself is an intervention worth investing in.

The methodological machinery behind these conclusions deserves attention. By using a joint display to align quantitative ratings with qualitative determinants, the researchers could check whether the numbers and the narratives told the same story, and largely they did. The high acceptability scores were corroborated by qualitative accounts that legitimised the service, while the spread in feasibility scores was echoed by focus group discussions of selection disputes and integration struggles. This convergence strengthens confidence that the findings reflect real professional experience rather than artefacts of either surveys or interviews. The study was classified as a quality assurance initiative under Danish legislation, exempt from formal ethical review, with informed consent obtained from all participants and data handling compliant with the General Data Protection Regulation.

For health systems everywhere grappling with emergency department overcrowding and ageing populations, the Danish experience carries a clear message. Paramedic-staffed prehospital assessment units can earn the trust of the clinicians around them, and that trust is measurable, with median acceptability scores at the top of the scale. But acceptance is only the first hurdle. The contested work of deciding who can be safely left at home, and the institutional work of weaving a new service into the fabric of acute care, will determine whether such models deliver consistent benefits or uneven ones. The authors conclude that healthcare professionals reported predominantly positive experiences of the PAU model, while the challenges they identified reflect contextual factors and unclear boundaries that may hinder consistent implementation. In other words, the idea has won the argument; now comes the harder task of winning the workflow.

Subject of Research: Implementation of paramedic-staffed prehospital assessment units in acute care

Article Title: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study

Article References: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study. (n.d.). https://doi.org/10.1186/s12913-026-15764-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15764-9

Keywords: prehospital care, paramedics, non-conveyance, emergency medical services, acute care, implementation science, mixed methods, acceptability, feasibility, patient selection, health services research, Denmark

The study, published in the Journal of Emergency and Disaster Medicine, was conducted by Shannon Sherk of the University of Victoria and set out to answer two questions: what ground-level knowledge paramedics and emergency health services employees in British Columbia hold about climate hazards, and what interventions should be proposed to help pre-hospital systems adapt. The research fills a conspicuous gap. While the impacts of climate change on hospital-based clinical care have been documented extensively, the pre-hospital environment, where paramedics work in homes, on streets and along flooded highways, has been almost entirely overlooked. A recent scoping review cited in the paper concluded that no comprehensive study of strategies and solutions for pre-hospital emergency systems against climate change had yet been completed.

To gather evidence, Sherk used a mixed-methods design combining a 16-question survey with in-depth, semi-structured interviews. The survey, distributed through a British Columbia Emergency Health Service-specific Facebook group and word-of-mouth snowball sampling, ran from February 27 to March 9, 2025, and drew 109 respondents. Participants spanned all five of the province’s health regions, with Vancouver Island the most represented at 30 percent. Women comprised 54 percent of the sample, the average length of service with the ambulance service was 8.94 years, and respondents ranged from newly oriented staff to veterans with more than two decades on the road. Three interviews complemented the survey, drawing on a member of management, a union representative and a health and safety representative, all experienced paramedics.

The findings reveal a workforce that is both concerned and largely unsupported. Three-quarters of respondents believed climate change is anthropogenic, a higher proportion than the Canadian population at large, where around a third rejected human causation in 2018. More than three-quarters reported seeing a rise in climate-related hazards during their time with the service. Yet only about one in five had ever attended a climate event, workshop, protest or lecture, a disconnect the author describes as a gap between concern and educational engagement. Perceived impacts on the respondents’ own jobs scored slightly lower than perceived impacts on public health, but both were expected to worsen in the future.

Across every health region, the hazards judged most damaging to public health were the same: wildfires, in both their flames and their smoke, extreme heat, and flooding. Notably, perception did not always track mortality statistics. In 2021, fire-related deaths in the province numbered 59, while the single week of the heat dome killed more than 600. The author suggests this mismatch may indicate that slower, less quantifiable health harms, such as respiratory disease driven by smoke exposure or infectious disease linked to flooding, are being missed when systems respond only to body counts.

The interviews added texture to these numbers. All three interviewees identified hot and cold emergencies as the highest-acuity hazards. Heat deaths during the dome occurred almost exclusively indoors, while cold deaths fell primarily on people living outdoors, particularly homeless individuals whose deaths are often attributed to comorbidities such as overdose rather than exposure. Wildfire smoke emerged as a chronic threat that rarely triggers a 911 call on its own but saturates emergency departments with patients in respiratory distress, degrading capacity for the entire system. Flooding and relentless rain were linked to hypothermia and skin breakdown resembling trench foot, conditions one interviewee summarized by observing that things have gotten soggier in the last five or six years.

Paramedics themselves are far from immune. One described working the heat dome by taping bags of hospital ice to their neck and head between calls. Uniform and personal protective equipment requirements make heat harder to escape than cold, and wildfire smoke degrades respirator filters faster, raising costs and exposure. Responders described colleagues rushing from one cardiac arrest to the next during the dome, and the physical demands of the job continue regardless of air quality warnings, because, as the study puts it, no one chooses where their patient arrests. Extreme weather also severs the logistics of response: flooded roads, fallen trees and closed highways delay ambulances, strand commuting paramedics and force patients who cannot self-transport to depend entirely on ambulance service.

Perhaps the most striking statistical finding concerns politics. Consistent with earlier research, self-reported political orientation correlated with climate views in the survey. But when multiple linear regression was applied, perceived impacts on the respondents’ own jobs emerged as by far the strongest predictor of support for involving health care professionals in climate policy, with a standardized coefficient of 0.492, exceeding the next strongest variable by a margin of 0.3 and remaining significant at p less than 0.01. In other words, paramedics across the political spectrum translated lived experience of climate impacts at work into a desire for institutional action. Only five of 109 respondents rejected climate action outright.

The qualitative data exposed a workforce starved of planning. One 20-year paramedic, writing after three minor earthquakes struck in March 2025, described having no idea what the plan is for a catastrophic disaster, asking what is expected of staff on or off shift, how crews would be relieved, fed or deployed, and pleading for classroom-led rather than online training. Interviewees described management as reactionary rather than proactive, and noted that existing mental health supports rely on self-referral, leaving chronic, cumulative stress from repeated environmental emergencies unaddressed at a time when the service is already grappling with a documented mental health crisis. Interviewees also described how the decline of primary care has pushed sicker patients toward 911, compounding the load.

From these findings, the study distills a disaster-risk framework, hazard multiplied by vulnerability and exposure, divided by capacity, and derives four recommendations: commit to an organizational culture of proactivity that treats disasters as a matter of when, not if; develop region-specific hazard education and planning; integrate weather modelling and forecasting into operational management with early warnings pushed to frontline staff; and build recovery programs designed for multi-incident and chronic stress rather than single traumatic events. The author acknowledges limitations, including the self-selecting sample, the absence of a pilot phase and a scope that excluded climate mitigation topics such as electrifying the ambulance fleet. But the conclusion is pointed: for most paramedics surveyed, climate change is already harming the public, and the emergency health system absorbs that harm. Having triaged the problem, the paper suggests, the pre-hospital system can now move to treatment.

Subject of Research: British Columbia paramedics' perspectives on climate change impacts and adaptation measures for pre-hospital emergency care

Article Title: Triaging the climate crisis: An investigation into British Columbia paramedics’ perspectives on climate change impacts and evidence-based adaptation measures

Article References: Triaging the climate crisis: An investigation into British Columbia paramedics’ perspectives on climate change impacts and evidence-based adaptation measures. (n.d.). https://doi.org/10.1007/s44467-026-00015-y

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00015-y

Keywords: climate change, paramedics, emergency medical services, British Columbia, extreme heat, wildfire smoke, flooding, disaster management, pre-hospital care, climate adaptation, public health, occupational stress