Implementing the rural advanced care community paramedics in rural and remote British Columbia: A qualitative study

Background: Advanced care paramedics (ACPs) are an important component of the interdisciplinary healthcare team, providing care across diverse acute and community settings. ACPs have competencies extending beyond traditional paramedicine roles, offering advanced patient assessment and management, including cardiac monitoring, endotracheal intubation, and intravenous therapies. Rural and remote communities experience complex healthcare challenges, and the new Rural Advanced Care Community Paramedic (RACCP) role is positioned to provide comprehensive and complementary healthcare. Purpose: This research study explores the implementation and integration of RACCPs in five rural and remote communities in British Columbia, Canada. Methods: A two-phase qualitative descriptive study was conducted, with interviews being performed during early implementation (Phase One) and 1–2 years following integration (Phase Two). Thirty-six interviews were conducted with 31 unique participants, spanning five communities. Participants included health system and emergency services representatives, decision-makers, healthcare providers, and community knowledge users. Data were first coded and analysed thematically, then analysed using the Theoretical Domains Framework with the aim of providing more specific insights relating to the barriers and facilitators of implementation and to frame potential recommendations. Findings: The data from this study offers strong support for the RACCP role, noting the potential to address complex healthcare challenges within rural and remote communities. The RACCP role evolved to allow for care to be provided in place, pre-empting admissions to acute care, and providing services to commonly underserved populations. While all participants were strongly positive about the RACCP role, a lack of role clarity, challenges in integrating within existing healthcare services, and policy/regulatory issues were seen as key barriers. Conclusion: New modes of community paramedic practice are emerging, signalling a shift to new and extended acute care community roles. This study provides a comprehensive examination of the integration of these new RACCP roles, providing insights into key barriers and facilitators of implementation.