title: A Culture in Transition: Paramedic Experiences with Community Referral Programs.
abstract: OBJECTIVE
  As an aging population continues to place strain on the health care system, many older adults are living with unmet social and medical needs. In response, Emergency Medical Services (EMS) have initiated programs that encourage paramedics to refer patients in need to community based support services. This qualitative study explores frontline paramedic experiences with referral programs to identify opportunities and challenges in their practice.
  
  
  METHODS
  This study used an intepretivist qualitative study design involving interviews of frontline paramedics employed in a region where referral programs were in place. Interviews were semi-structured and one-on-one. Data were transcribed verbatim and analyzed using inductive open coding throughout, then grouped to identify themes. Data collection and analysis were conducted simultaneously and flexibly until saturation.
  
  
  RESULTS
  Twenty-three interviews were conducted representing 6 regions. When participating with referral programs the data revealed that frontline paramedics appear to experience (a) role confusion, (b) an inadequate knowledge base, (c) inadequate feedback, (d) undefined accountability, and (e) strong patient advocacy.
  
  
  CONCLUSIONS
  In a strained health care system, EMS and paramedics have an opportunity to better serve patients by initiating referrals for patients they encounter with unmet social and medical needs. However, referral programs face a number of challenges that, if left poorly addressed, may threaten the success of such programs.
authors.affiliation: *McMaster University,Hamilton,ON.
authors.forename: Madison
authors.initials: M
authors.lastname: Brydges
authors.affiliation: †York Region EMS,East Gwillimbury,ON.
authors.forename: Chris
authors.initials: C
authors.lastname: Spearen
authors.affiliation: ‡University of Toronto Wilson Center,Toronto,ON.
authors.forename: Arija
authors.initials: A
authors.lastname: Birze
authors.affiliation: *McMaster University,Hamilton,ON.
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education* / Q000592:standards; D004517:Education, Professional / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000193:education / Q000592:standards*; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008297:Male; D036301:Qualitative Research
keywords: community paramedicine; culture; paramedic; qualitative; referral