With Great Trust Comes Great Responsibility: Advocacy in Paramedicine

Being a paramedic is a privilege with great public trust

“We’re given the honour of laying our hands on them… [there’s] just an implied trust, because of the uniform that we wear, and the role that we have.”

– Anonymous Research Participant¹

Paramedics inherit an innate trust from the public simply by virtue of being a part of the paramedic profession. While there is a sense of trust associated with almost all health professions, the immediacy and location of paramedic practice create a sense of immensity in the trust afforded to paramedics. Strangers allow paramedics into their homes, often at their most vulnerable, with no prior relationship, no background check, and no hesitation. At its very core, that trust exists because the public expect an unwavering commitment to place the public interest above all else.¹

As a paramedic, I find this privilege humbling, and I am not alone. Although many paramedics are quick to shrug off claims of heroism and frequently downplay such assertions (so much so that this trait is highlighted as a defining part of the professional culture of paramedicine), when asked about their work, paramedics will inevitably discuss the privilege or honour that comes with being part of this profession, as seen by the opening quote above. There is also an acute awareness that, as an individual, that trust was not earned; rather, it was earned by the profession as a whole. Despite this, as an individual, there is a great sense of responsibility to ‘live up’ to and protect that trust.

Trust grants influence and influence carries responsibility

I have explored the intersection of public trust and professional responsibilities in previous work, but the relevant point here is that public trust in the professions, including paramedicine, extends beyond clinical practice. This results in professionals holding increased social status and influence within our communities, including outside of work.² This is why, for example, the social media activity of professionals outside of work must still fall within the standards expected by their respective professional board if it has potential to influence public health or trust in the health professions.³

Consequently, trust is not simply an accolade enjoyed by paramedicine. It creates influence, and influence carries responsibilities concerning how, and for whose benefit, it is used. A wise uncle once said, “with great power comes great responsibility” and advocacy is one way to live up to that responsibility.

As alluded to above, professional regulators highlight an underlying connection between community trust and professional responsibilities that extend beyond direct clinical practice. Advocacy for patient and community health is one of these broader responsibilities (Australian paramedics can find this in the Shared Code of Conduct, Section 6.2).

To be clear, I am not trying to imply that the Paramedicine Board obliges every Australian paramedic to campaign publicly or protest the lawns of government. It is my interpretation that the obligation is more encompassing and nuanced than that.

What does advocacy look like in paramedicine?

The role of advocacy in paramedic practice falls within the range of professional practice topics that I have taught for several years. Between this teaching and discussions with fellow clinicians, I am often surprised to hear how many paramedics believe they aren’t an advocate, because they aren’t directly involved in shaping policy. This is, in part at least, sometimes due to a narrow view on what advocacy actually is and what it looks like in action.

Advocacy is not only about public campaigning or policy influence (and not all campaigning is advocacy). Merriam-Webster defines an advocate as “one who supports or promotes the interests of a cause or group”.⁴ By this definition, and I would argue by the language used in professional expectations laid out by regulators, professional advocacy is best interpreted as a continuum spanning from clinical advocacy for an individual patient through to health system and community advocacy.

Advocacy can look like policy influence, research, professional association activity, consultation, organisational advice and public communication.⁵ But equally, it can also look like small acts of positive health-influence in our communities, schools and sporting organisations, the attitudes we foster in students, and health-related conversations at the dinner table with family and friends. Importantly, it includes something, that in my opinion, paramedics are excellent at doing every day – clinical advocacy for our patients.

As well as being a strong voice for our patients, the profession and its leaders have already shown the ability to organise, participate in policy processes and advocate on issues directly affecting paramedicine. Most recently, we see this in public discourse supporting the increasing integration of paramedics in primary and urgent care settings and the recent discussion regarding the proposed Advanced Practice Paramedic endorsement proposal.

Acknowledging the political aspect of healthcare and advocacy

A counterargument I have received in the past, especially when advocacy involves politics, is that there is a need for healthcare to remain politically neutral and separate from the political process – i.e., that healthcare should be apolitical.

In response to this I would highlight the position above, that advocacy does not require every clinician to become a public activist. Additionally, and perhaps more importantly, healthcare is intrinsically shaped by political decisions about funding, regulation, access and service design, so influencing political and policy processes is an integral component of improving health within our communities.

Health is also shaped by a range of factors that sit beyond healthcare. Access to safe and affordable housing, income, education, geography, environmental conditions, discrimination and access to other resources (i.e., the social determinants of health)⁶ all impact health outcomes. They are also commonly political issues. This is also why we often see national and international professional organisations involved in political lobbying and exerting their public influence in support of political causes that affect public health. My point is not that as individuals, or even as a profession, that we need to be experts in all these areas. Rather, it is to highlight that as a profession concerned with improving health outcomes, we cannot disregard them simply because they fall outside direct clinical care.

Given the influence of professional voices, it is important though, that we recognise the need for responsible professional advocacy. Advocacy should be informed by evidence, transparent about values and uncertainty, proportionate to expertise and attentive to differing views within the profession. Most importantly though, it should always be undertaken with affected communities rather than merely on their behalf – else we risk returning to a healthcare system underpinned by clinician paternalism.

As paramedicine matures, so should its advocacy efforts

Conversations about the paramedicine’s growth are commonplace of late (at least within Australasia) and the role of paramedic practice expansion is a large part of these conversations. However, practice expansion is only one aspect of growth. I would suggest that professional maturity refers to growth beyond clinical practice and encompasses a deeper development of identity and professional responsibility. Specific to advocacy, professional maturity means increasing paramedicine’s confidence and capacity to use the profession’s knowledge and influence for purposes extending beyond its own advancement.

I would note here that am neither alone, nor first in making this argument. For example, Bolster and Batt⁸ have previously called for paramedics to move ‘upstream’ from implementing policy to helping shape it and Morrison⁹ argued that professional maturity requires paramedicine to look beyond advancing its own role and contribute to the wider health system.

As stated above, it is my view that everyday clinical advocacy is already a prominent and often well-executed part of paramedicine. Additionally, both paramedic professional bodies (such as the Australasian College of Paramedicine and the Royal College of Paramedics) and individuals are already involved in advocacy, particularly as it pertains to the paramedic role in the health system. The next step is not to abandon advocacy for patients or the profession, but to further develop that capability to influence the wider systems and social determinants shaping the health of the communities we serve.

Final thoughts

Not every paramedic needs to become a policy expert, public campaigner or political activist. But collectively, we should be prepared to use the trust and influence afforded to our profession beyond our own immediate interests.

If paramedicine wants to demonstrate its maturity, we must advocate not only for our place within the health system, but for a healthier and more equitable system for the communities that place their trust in.

As always, stay curious and be excellent to each other.

References

Show References (9)

1.            Collings-Hughes D, Townsend R, Williams B. Paramedic use and understanding of their professional code of conduct. Nurs Ethics. 2023 Mar;30(2):258–75. https://doi.org/10.1177/09697330221130607

2.            McCann Leo. The Paramedic at Work : A Sociology of a New Profession. Oxford: Oxford University Press, Incorporated, 2022.

3.            Greenwood E. Attributes of a Profession. Greenwood E, editor. Soc Work. 1957;2(3):45–55. https://doi.org/10.1093/sw/2.3.45

4.            Social media: How to meet your obligations under the National Law [Internet]. Available from: https://www.ahpra.gov.au/Resources/Social-media-guidance.aspx

5.            Definition of ADVOCATE [Internet]. 2026. Available from: https://www.merriam-webster.com/dictionary/advocate

6.            Earnest M, Wong SL, Federico S, Cervantes L. A Model of Advocacy to Inform Action. J Gen Intern Med. 2023 Jan;38(1):208–12. https://doi.org/10.1007/s11606-022-07866-x

7.            Closing the gap in a generation: health equity through action on the social determinants of health – Final report of the commission on social determinants of health [Internet]. Available from: https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1

8.            Bolster JL, Batt AM. Building bridges and moving upstream: Paramedics as policy architects. Paramedicine. 2025 Jul 1;22(4):192–201. https://doi.org/10.1177/27536386251336008

9.            Morrison A. Transcending identity politics in paramedicine: Start shaping the health system. Paramedicine. 2025 Jul 1;22(4):202–4. https://doi.org/10.1177/27536386251346980