An exploration of leadership attributes in paramedicine: A scoping review

Paramedicine leadership is critical in high pressure emergencies that require rapid decision-making and effective team coordination. Strong leadership supports governance and improves patient outcomes, however, the specific attributes of leadership relevant to paramedicine remain under studied. This scoping review aims to improve an understanding of leadership and its key attributes within the paramedicine profession.

This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Using the PCC framework, Ovid Medline, Ovid Emcare, Ovid Embase, CINAHL, and Scopus were searched from inception to 7 August 2025. Two reviewers independently screened records in Covidence and extracted data. Peer reviewed studies were thematically synthesised and appraised using JBI critical appraisal tools. Leadership patterns were identified through iterative content analysis and narrative contextualisation.

Twenty studies (nine rated 'good', and eleven 'fair') from 11 countries were included. Four overarching leadership themes were identified: i) interpersonal skills, ii) professionalism, iii) personal attributes, and iv) learning and teaching capabilities. Transformational and situational leadership models highlighted adaptability, resilience, and ethical governance. The synthesis shows how dynamic interactions among these attributes enhance team effectiveness and crisis response in high-pressure medical settings.

Effective paramedic leadership requires structured training in communication, adaptive decision making and ethical governance. This should be supported by system-level reforms that address resource gaps and cultural barriers in emergency care systems.