National consensus on the capabilities that inform the role of advanced practice paramedics: A Delphi study

Advanced Practice Paramedics (APPs) are highly skilled paramedics who operate in diverse clinical settings both within and outside traditional ambulance services. International evidence demonstrates that APPs enhance patient outcomes in areas such as critical and primary care. In Australia, the expansion of APP roles and responsibilities has gained momentum; however, no nationally recognised framework exists to define their expected capabilities. This gap leads to inconsistencies in education, practice and role clarity. A standardised capability framework is therefore vital to guide the development, implementation and integration of APP roles within the Australian healthcare system. The primary aim of this study was to develop a comprehensive list of APP capabilities tailored to the Australian context through expert consensus. A modified Delphi approach was used across four iterative phases to establish consensus. An expert panel of clinical, academic, organisational and regulatory/governance leaders was identified via the Knowledge Resource Nomination Worksheet. Participants reviewed, rated and refined proposed APP capabilities derived from international frameworks and relevant literature. Consensus was defined as a minimum of 70% agreement among participants. Of the experts invited, 43 consented to participate in the Delphi process. A final set of 33 capabilities, achieving 96% overall consensus, was developed. These capabilities spanned four key domains: Clinical Practice (14), Leadership and Management (10), Education (7) and Research (2). Iterative feedback ensured each capability was clear, relevant and aligned with the Australian healthcare context. The resulting capability framework provides a robust foundation for standardising APP roles within Australia, promoting consistency in education, practice and professional expectations. This framework not only supports the national advancement of APPs but may also serve as a model for international adaptation, contributing to the global development and recognition of advanced practice roles in paramedicine.