A European paramedic curriculum for geriatric emergency medicine developed via a modified Delphi technique

Background

Older emergency patients currently account for most European emergency medical service dispatches. Due to demographic changes and increasing comorbidities in advanced age, this number is expected to rise substantially in the coming years. Prehospital professionals require specialised training to provide high-quality care for complex, multimorbid patients. The aim of this study is to define minimum competencies for paramedic education in Europe on the management of emergencies in older adults.

Methods

A modified electronic Delphi study was performed from January 2023 to November 2024, comprising two appraisal rounds. A narrative literature review was conducted to identify relevant topics and domains in prehospital geriatric emergency medicine, providing the foundation for an interprofessional core group to establish 58 initial learning objectives. Learning objectives were assigned to competence levels based on a revised Bloom's Taxonomy.

Results

In Round 1, 45 of 58 competence-based learning objectives were accepted (77.6%) with average agreement 83.2% [range: 70.8–93.9%]. 13 declined learning objectives were revised, including merging and splitting of learning objectives, adjusting competence levels, and grouping domains. In Round 2, all 12 adapted learning objectives were accepted with average agreement 87.1% [range: 75–100%]. The final curriculum has 57 learning objectives in 12 domains. This consensus was achieved with contributions from Delphi panellists across 27 European countries. The domains include: risk stratification; indicators of serious health problems; altered mental status; clinical assessment; falls; trauma; medication; communication; medical history; frailty; palliative and end-of-life care; positioning and transport; and social, psychological and legal aspects.

Conclusions

This European curriculum for prehospital geriatric emergency medicine represents a first step towards systematically integrating these geriatric-specific competencies into paramedic education. It can further serve as a foundation for standardised training programs aimed at addressing the complex needs of older emergency patients.