The concept of boundary-work, introduced by sociologists, describes how professional groups define and distinguish themselves by establishing clear roles, practices, and language. As paramedics, we operate in a unique environment. This means we need to develop our own code of practice, professional identity, and clinical language.

Yet in Hong Kong, due to systemic differences and historical background, we often find ourselves somewhat disconnected from the broader healthcare system. Despite working closely with emergency departments under the Hospital Authority, there remains a lack of mutual understanding and limited opportunities for integration. One of the few moments we work closely with hospital staff is during patient handover. But instead of bringing us together, it often causes tension. Paramedics sometimes feel that ED staff are overly critical. Conversely, we’ve heard comments from inside the hospital such as, “Paramedics often miss key information,” or “This patient shouldn’t have been brought here.” There is a deeper issue: we don’t truly know each other.

Could we establish a feedback system, or even a shared professional community, between AED staff and ambulance personnel? Is that merely a fantasy — or is it a vision worth pursuing?

While paramedics often seek recognition from doctors and nurses, we’ve come to realize that ED professionals also want to challenge themselves — to understand the complexities of prehospital care. This shared ambition laid the foundation for something greater.

This vision came to life during the 7th Asian EMS Conference and Competition, held from 18 to 20 February 2025. ED doctor, nurse, and paramedics in Hong Kong worked side by side as one unified team — “Happy Loong” — representing HKSEMS on an international stage. But forming that team was as difficult as doing so in real-life emergency settings. Just days before the competition, we had to rearrange team members unexpectedly, and at several moments, we considered withdrawing altogether. The journey was filled with uncertainties and tension. In the end, that hardship only made us more grateful just to be standing on that stage as a team. Thanks to the resilience of every single teammate — new and old — we made it happen.

We are so thankful to have earned the First Runner-Up Award, but the real reward was far deeper. We built bonds. We trained together, debated passionately, and shared plenty of laughs. Have you ever imagined doctor, nurse, and paramedic discussing everything from pathology (mostly lectured by our team leader …) to whether a defibrillator should be placed on the left or right side, and ensuring it's within arm's reach at the scene?

We also struggled with how to clearly present the concepts of ACLS and PHTLS to the judges — and that's where creativity came into play. We incorporated the concept of Pointing and Calling (指差確認), a safety practice widely used in Japan's express industry, to heighten our awareness and minimize preventable errors. This method helped us stay alert and ensure no critical steps were missed.

This experience highlighted how creativity is an essential part of the prehospital environment, where we often have limited information and resources. We’re incredibly proud to have such open-minded, creative, and mature teammates who pushed each other to the limits. This wasn’t just competition training but a shared learning experience.

Not all fantasies come true. But this time, we did something different — even if just within this tiny community.

At the same time, we began another important journey. For years, we had hoped to build stronger feedback mechanisms and academic engagement as a paramedic. With encouragement from our mentor, Dr. Mok Ka Leung, we took our first step into research.

We studied how paramedics in Hong Kong manage anaphylaxis in 2023. At first, the topic seemed simple for us as novice researchers, but as we dug deeper, we realized there was much more to learn. Our findings aligned with international guidelines — showing that prehospital administration of epinephrine significantly reduced the need for in-hospital use of epinephrine. We also found that the diagnostic accuracy of Hong Kong paramedics was commendable.

The research process was challenging but fulfilling. We are so delighted that our study, “Outcome Study on Anaphylaxis Managed by Paramedics in Hong Kong,” was accepted for oral presentation at 7th Asian EMS Conference. It felt like giving birth — not just a project, but a meaningful chapter in our careers.

Boundary-work for us may not always be visible or well-defined. But instead of waiting for recognition, we can create it. Our working environment is full of challenges that deserve to be explored through research, learning, and new ideas. There are many opportunities for paramedics to make a real difference in emergency care in Hong Kong.

We hope our journey, through competition, research, and experience sharing, is a small step toward a more connected emergency care community in Hong Kong.

Sincere thanks to our research mentors, Dr. Mok Ka Leung and Dr. Stephenie Yu, for their invaluable guidance throughout this journey.

Last but not least, special thanks to our teammates and coaches: Dr. Marcus Lo, Mr. Sam Lee, Dr. Irene Lo, Dr. Winnie Lee, and Dr. Stephen Yeung.

And to our training buddies: Andus Chau, and our very own “Best Sixth Man.”