An exploration of the role of military advanced practitioners and their potential employability in deployed pre-hospital operations: a mixed- methods study

Abstract

Background prior research and my clinical experience in the UK civilian sector have indicated the potential benefits of incorporating the Advanced Practitioner (AP) role within the UK Defence Medical Services (DMS). This role could benefit Defence Medical Services during Operations, particularly in delivering pre-hospital emergency care (PHEC). The Defence Medical Services has trained a limited number of APs to date, but there is little research to define their operational role, specifically in relation to the contribution to deployed pre-hospital care. The thesis examines the skills required for Level 6 pre-hospital emergency care in military settings, including clinical and non-clinical competencies. It then explores the specific responsibilities of military Advanced Practitioners in their current roles. Lastly, it investigates the opinions of military pre-hospital personnel regarding the current and future significance of the AP role in military PHEC settings. Methods The research study employed a two-phase, mixed-methods design using a Delphi study and a qualitative interview study. Firstly, an in-depth literature review was conducted to synthesise existing knowledge on AP roles and to identify pre- hospital skills relevant to advanced pre-hospital practice. This informed Phase 1 of the study, a Delphi survey. A four-round iterative electronic survey was administered to 26 purposefully sampled Defence subject matter experts. The survey combined open-ended questions, Likert scales, and short answer boxes to determine which Faculty of Pre-Hospital Care competencies should apply to PHEC level 6. Phase 2 consisted of semi-structured interviews which explored the experiences of ten military APs who had deployed in pre-hospital operations. A further 12 interviews were conducted with pre-hospital multidisciplinary team members to examine perceptions of military APs and their potential contributions to military pre-hospital care. Both sets of interviews built on the findings of the Delphi study. Themes from the interviews, combined with Delphi study results, were triangulated in the mixed- methods analysis to provide a comprehensive understanding to answer the research questions. Findings The findings from the Delphi study indicated that APs in PHEC should possess skills such as sedation, independent blood administration, ultrasound, and advanced airway management. However, the Delphi study did not achieve consensus on some skills, including intubation and chest drain insertion. Qualitative interviews explored the experiences of military APs and perceptions of those working in the field. Three main themes emerged: current experiences and support for military APs; working relationships and role understanding within professional groups; and the future of military APs, including challenges, ideas, and concepts for employment. The absence of an employment strategy complicated working relationships, but participants perceived there were benefits of a military AP role. Conclusion Nurses and paramedics are increasingly expanding their scope of practice in emergency and PHEC settings within the NHS. The study provides evidence that introducing APs to military PHEC could offer benefits in the Defence setting. These roles offer personnel with extensive clinical knowledge and experience, enhancing flexibility and resilience for deployed teams.

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Identifiers

ORCID for Jane Prichard: orcid.org/0000-0001-7455-2244

ORCID for Joanne Turnbull: orcid.org/0000-0002-5006-4438

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