Health systems across the world face remarkably similar challenges. Workforce shortages, rising demand, ageing populations, climate-related emergencies, pandemics and widening health inequalities are no longer local problems. They are global ones.
In response, healthcare leaders are increasingly looking beyond national borders for solutions. We share evidence internationally. We benchmark outcomes globally. We collaborate on research, education and workforce development. Organisations such as the World Health Organization (WHO) have rightly emphasised the importance of strengthening the global health workforce as a critical enabler of universal health coverage, emergency preparedness and sustainable health systems.
Yet one profession remains largely organised within national boundaries: paramedicine. That is increasingly difficult to reconcile with the role paramedics now play in modern healthcare.
Around the world, paramedics have evolved significantly over the past two decades. In many health systems they are no longer solely providers of emergency transport. They have become autonomous clinicians, delivering assessment, diagnosis, treatment, referral and care navigation across urgent, emergency, community and primary care settings. They are increasingly at the front door of healthcare systems, making complex decisions in patients' homes, workplaces and communities.
At the same time, many countries are investing in the development of emergency care systems for the first time. Others are seeking to modernise existing models to better meet the needs of their populations. Despite these shared ambitions, there remains no globally recognised framework describing what modern paramedic practice should look like or what capabilities health systems should expect from their pre-hospital workforce.
This is not an argument for uniformity. Healthcare is delivered within different cultures, economies, geographies and regulatory environments. The needs of a rural community in sub-Saharan Africa may differ significantly from those of a major city in Europe. Effective healthcare leadership recognises and respects those differences.
Medicine has internationally recognised educational and professional principles. Nursing has established global competency frameworks. Public health operates through internationally accepted standards and collaborative networks. These approaches do not prescribe identical systems. Rather, they provide a common language that enables countries to learn from one another, benchmark progress and accelerate development.
The WHO's Workforce 2030 agenda recognises that workforce capability, competency development and lifelong learning are fundamental to achieving broader health objectives. Similarly, emerging international strategies focused on integrated emergency care and emergency preparedness increasingly require workforces that are capable, adaptable and able to work effectively across complex systems.
Paramedics are uniquely positioned within this agenda.
They operate at the interface between communities and healthcare systems. They are often the first clinical contact during emergencies. Increasingly, they support prevention, early intervention and the management of urgent health needs outside traditional hospital settings. During disasters and major incidents, they provide a critical component of surge capacity and emergency response.
Yet despite this growing contribution, there remains wide variation in education, professional recognition, regulation and scope of practice across the world. For health leaders, this creates challenges.
It limits opportunities to share best practice systematically. It makes workforce comparison and mobility more difficult. It can create uncertainty for countries seeking to develop new services. Most importantly, it risks slowing the development of a profession that could make a substantial contribution to improving health outcomes and access to care.
A globally informed framework would not seek to create identical paramedics. Instead, it could establish a shared set of principles, competencies and professional expectations that countries could adapt according to local need.
Done well, such an approach could support educational development, strengthen workforce planning, improve professional recognition and contribute to safer, more consistent patient care. It could also help emerging services avoid having to develop solutions in isolation when experience and expertise already exist elsewhere.
That is why a growing number of paramedic leaders, educators and professional organisations are beginning to explore the creation of a World Paramedic Alliance (WPA).
The ambition is straightforward but significant: to create a forum through which the profession can collectively define its future, strengthen international collaboration and explore the development of globally relevant standards that support both professional growth and health system improvement.
The global conversation around health workforce development has never been stronger. WHO priorities relating to workforce capability, emergency care systems, universal health coverage and emergency preparedness all point towards the need for a competent, adaptable and internationally connected healthcare workforce. Paramedicine should be part of that conversation and, increasingly, part of the solution.
The development of global paramedic standards will not happen overnight. It will require dialogue, partnership and trust. There will be legitimate debate about scope, governance and implementation.
The future of paramedicine should not be defined by geography alone. It should be shaped by a collective commitment to excellence, collaboration and better care for the communities we serve.
Author biography
Kerry Robertshaw is the President of the Royal College of Paramedics in the UK and member of the Commonwealth Leadership Institute (CLI). She is also a Consultant Paramedic in Urgent Care within the Welsh Ambulance Services NHS Trust. She is leading international exploratory work to establish a World Paramedic Alliance and develop a Global Paramedic Standards Initiative aimed at supporting workforce development, education and health system improvement across diverse healthcare settings.
Competing interests: The author is involved in the development of the World Paramedic Alliance and Global Paramedic Standards Initiative discussed in this article