Paramedic workforce disparities marked by geographical positioning: Comparison of rural and urban regions

Introduction: Effective service delivery and the wellbeing of the paramedic workforce is reliant on confounding factors and is effectuated by geographical positioning. It is important to be aware that there may be several disparities between the rural and urban workforce due to differences in circumstances. However, there is limited litera-ture available examining these. The objective of this review was to investigate where and how these disparities exist to make recommendations in achieving equity in the paramedic workforce and thus achieve patient-centred care universally across rural and urban populations.Methods: The JBI approach was used to perform a scoping review to assess the avail-ability of literature. Key words including paramedic*, EMT, urban OR metro*, rural OR remote and disparit* were inserted into the search engines MEDLINE, CINAHL Plus and Scopus. Titles and abstracts of the 282 results were screened by two authors and inclusion and exclusion criteria applied. The full text of the remaining 77 results were screened to inform the results of the review.Results: The search identified 282 potentially relevant articles, of which 33 informed the results of the review. The included studies identified emerging themes relevant to the objective, including: (1) the skills, training availability, and confidence of the workforce; (2) resourcing of ambulances inclusive of both workload and caseload and access to resources; (3) timings of each group regarding response, scene, and trans-port; and (4) the health status of paramedics in each subset location.Conclusion: This review identified several disparities between rural and urban para-medic locations to the point that it is negatively impacting equitable patient-centred care. Further research is recommended to establish why these disparities exist and the extent to which these disparities are impacting the ability to achieve equity in the paramedic workforce across these two geographical divides.