Barriers to Paramedic Professionalisation: A Qualitative Enquiry Across the UK, Canada, Australia, USA and the Republic of Ireland.

Background – Paramedicine is in the midst of a transformative shift, as paramedics move beyond traditional emergency roles toward recognition as healthcare professionals. Central to this evolution is the pursuit of professionalisation—seeking greater autonomy, expanded scope of practice, and formal integration into healthcare systems. However, significant barriers persist. Purpose – This study explores key barriers to paramedic professionalisation across five different developed healthcare systems, both domestically and internationally. Methods – A qualitative study using semi-structured interviews underpinned by a critical theory paradigm. Over five months (Dec 2022–Apr 2023), 15 stakeholders from paramedicine and pre-hospital emergency care across five countries participated. Their backgrounds spanned clinical practice, education, policy, and management. Interviews were conducted via Microsoft Teams, recorded, transcribed verbatim, and thematically analysed. Results – Analysis of fifteen semi-structured interviews revealed four main themes with overlapping but contextually distinct sub-themes: Theme 1: Current Barriers to Expansion – Included outdated legislation, limited funding, staffing challenges, and poor integration into healthcare. Theme 2: Elevating Professional Status – Focused on education, regulation, certification, and professional identity. Theme 3: Impact of COVID-19 – Highlighted lost momentum, shifting policy priorities, and redirected funding. Theme 4: Future Barriers to Change – Included structural/systemic issues, workforce development, collaboration, and entrenched mindsets. Conclusion – Multiple barriers hinder paramedic professional recognition, including fragmented regulation, inconsistent education standards, limited funding, and internal resistance. While COVID-19 briefly raised the profession’s profile, this momentum has since declined. Reinvigorating progress requires political commitment, regulatory reform, educational investment, and workforce development to fully embed paramedics within healthcare systems.