Internationally Informed Consensus on Research Priorities in Paramedicine and Emergency Medical Services (EMS)

Prehospital emergency care systems are expanding in scope and complexity, yet research agendas remain disjointed and often nationally focused. An internationally informed set of research priorities is needed to guide strategic investment and evidence generation across emergency medical services (EMS) and paramedicine contexts, while recognizing that local funding environments and needs will continue to shape national research decisions. The objective of this study was to identify and validate internationally informed research priorities for paramedicine and prehospital EMS using a multi-phase, stakeholder-informed consensus and analytic approach.

An observational, three-phase mixed-methods study was conducted. Phase 1 involved an open-ended Delphi survey of international prehospital stakeholders to generate research priorities. Phase 2 asked participants to rate the importance of each priority using a 10-point scale; exploratory factor analysis (EFA) was performed to identify underlying factors. Phase 3 used confirmatory factor analysis (CFA) to test the factor structure. Participants included clinicians, educators, researchers, managers, students, and policy stakeholders from multiple countries to maximize breadth of stakeholder input.

Across the three phases, responses were obtained from 1,299, 717, and 954 participants, respectively, with 703 complete cases included in the final CFA. The final model comprised nine interrelated factors encompassing 40 research priorities. Factors reflected key areas of contemporary prehospital practice, including operations, clinical governance, evidence-based practice, health and well-being, special care (community paramedicine), culture, education and training, trauma care, and clinical care. Confirmatory factor analysis demonstrated acceptable model fit, supporting the robustness of the identified structure.

This study presents an internationally informed framework of research priorities for prehospital emergency care. The findings provide a practical foundation for researchers, funders, EMS organizations, and policy stakeholders to align future research efforts, reduce duplication, and address high-impact gaps across diverse prehospital systems, while remaining responsive to local context.