How does paramedicine conceptualise and implement person-centredness in the reality of practice: A hybrid scoping/methodological review

Background Paramedics operate in diverse, unpredictable environments where they encounter people requiring not just clinical intervention but compassionate, dignified care. Currently, paramedicine has no conceptual framework specific to their profession. Person-centredness is the global standard for healthcare delivery, offering an appropriate philosophical foundation for emergency practice contexts. Aim This hybrid scoping/methodological review examined international literature on person-centredness in paramedicine, specifically its conceptualisation and implementation in emergency settings, and paramedics’ understanding and delivery of person-centred approaches in practice. Method Systematic searches across five databases identified relevant studies. Critical realist analysis employed the Person-Centred Practice Framework as analytical infrastructure, maintaining appropriate epistemological boundaries for secondary literature. The JBI checklists assessed methodological quality, and thematic synthesis examined conceptual patterns, research approaches and structural mechanisms shaping practice. Results Seventeen studies were included: 13 qualitative studies, 2 quantitative studies, and 2 systematic reviews. Geographic concentration was striking; 76% originated from Sweden, where ambulance personnel are nurse-trained rather than paramedic-trained, representing fundamentally different professional preparation for scopes of practice. Analysis revealed systematic tensions across three domains. Conceptually, paramedics lack shared understanding of what person-centredness means for emergency practice. Relationally, they navigate emotional regulation, power asymmetries and temporal constraints that challenge person-centred ideals. Ethically, they face conflicts between autonomy principles and risk management demands. A fundamental paradox defines current practice: paramedics demonstrate excellence in relational care yet reject person-centred language, citing poor conceptual clarity and lack of profession-specific guidance. Conclusion The articulation of person-centredness is largely absent from paramedic-specific evidence. Systematic tensions expose gaps between theoretical ideals and practice realities shaped by structural constraints, organisational cultures and professional hierarchies. Without paramedic-led research and context-specific frameworks, person-centredness risks remaining borrowed rhetoric rather than authentic professional identity. Future research must develop profession-specific conceptualisations that bridge policy frameworks, educational programmes and practice cultures to embed person-centredness within paramedic professional identity.