The impact of interdisciplinary cardiac arrest teams on paramedic practise: an interpretive qualitative study using reflexive thematic analysis

Objectives: This study examined paramedics' perceptions of the influence of a specialist out-of-hospital cardiac arrest (OHCA) extracorporeal cardiopulmonary resuscitation (ECPR) team on their resuscitation practise and professional development. Methods: An interpretive qualitative methodology was employed. A purposive sample of 379 NSW Ambulance paramedics who attended an OHCA alongside the PRECARE team was invited to complete an anonymous online survey, of whom 67 participated. The survey included demographic questions for sample context and open-ended, non-leading questions designed to capture in-depth insights. Reflexive thematic analysis was conducted collaboratively by multiple authors, guided by the principle of theoretical sufficiency. Results: Five themes were identified: Mentorship, Empowerment, Understanding and Development, Cause-Directed Care and Collaborative Care. Participants frequently described PRECARE's real-time mentoring and post-event debriefs as influential in shaping their clinical confidence and skill development. Working alongside PRECARE teams was reported to enhance participants' understanding of OHCA physiology and pathophysiology, evidence-based interventions, and the importance of cause-directed and individualised care. Paramedics also described changes in motivation, accountability, and non-technical skills such as leadership and communication. Alongside these perspectives, some participants described challenges related to role clarity, leadership dynamics, and operational priorities. Conclusions: The integration of specialist interdisciplinary OHCA teams was perceived to influence paramedics' clinical practise and professional development by contributing to a psychologically safe working environment and providing experiential learning opportunities, including real-time mentorship and reflective post-event debriefing. This interdisciplinary collaboration was associated with increased confidence, perceived strengthening of non-technical skills, and a shift toward more nuanced, cause-directed care, while also highlighting the importance of clear role delineation and alignment of operational priorities when integrating specialist teams into established EMS systems.