Incident.
I was in the barber’s the other day and one of his first conversational gambits was “You’re an ambulance driver, aren’t you?”. I replied “That’s how we roll!”
On Twitter I’ve recently had discussions with @flobach about something he’d observed at the Emergency Services Show at Stoneleigh, Warwickshire. He’s blogged about it as well. This is the use of ‘ambulance’ to define our profession. He wondered, “‘ooo are ya?”
When we called the local out of hours doctor to see our little boy, a doctor arrived (he was easily recogniseable – he had a stethoscope round his neck) with a driver. The driver wears exactly the same uniform as me, except for different eppaulettes. My wife commented that it was great that they sent a doctor and a paramedic. What’s the difference between the driver and a paramedic? What is a paramedic? To quote a question I asked of my audience at a recent Continued Professional Development (CPD) session, “What do we do?”.
Feelings.
I worked extremely hard on my paramedic course and am proud of my and professional title. I feel dissapointed sometimes when all ambulance crew are lumped into one melting pot. I’m a paramedic!
I do recognise that it is hard to recognise one grade of ambulance staff from, especially when we wear virtually identical uniforms throughout the service (emergency and non-emergency, office and road).
It’s fair for the public to expect that a highly qualified member of the ambulance service will turn up soon after 999 is called. I have been trained to assess patients and organise appropriate care pathways according to the HCPC Standards of Proficiency that not all emergency ambulance staff are trained to do. That is a paramedic’s job. I feel uncomfortable when a non clinically trained person is sent to an emergency. The UK’s non-evidence based target of arriving to life threatening events within eight minutes doesn’t help in these instances, as there is pressure for ambulance trusts to send a resource, any resource, to meet these targets. A blog for the future perhaps?!
Evidence.
There are four grades of A and E ambulance staff; Emergency Care Assistants (ECAs), ambulance or emergency medical technicians (techs) paramedics and specialist paramedics, such as primary care and critical care paramedics.
ECAs are not 'clinically' trained. They are taught to assist technicians or paramedics by taking baseline observations, knowing what kit is needed and assisting with procedures to the limits of their training. They shouldn't take any clinical decisions themselves and certainly shouldn't be administering drugs.
However, I work with some extremely competent ECAs who can assess patients better than some paramedics I have worked with and are more than capable of diagnosing a wide range of conditions and working out an appropriate care plan. Sometimes, despite the best efforts of the company, there is no paramedic or technician available to work with an ECA, so they have to respond solo or as a 'double ECA' ambulance crew. This is recognised by Ambulance Trusts as a risk as patient treatment options are severely limited and is mitigated by each occurrence being reported to senior managers. They are generally backed up by the nearest & quickest tech or paramedic. I know of one trust who have a dedicated urgent care team of ECAs who respond to low acuity doctors transfers, leaving 999 vehicle to respond to emergencies.
Techs are traditional 'ambulance crew'. They have a small range of drugs they can administer and should be able to assess patients the same way a paramedic can. They may have the same knowledge a paramedic has, especially if they work with a good paramedic who mentors them. They can work solo on a rapid response vehicle (RRV), although this is limited in some Trusts where they mainly work on ambulances. The technician role is slowly being phased out.
Paramedics are autonomous clinicians who can practice paramedicine. A list of prerequisites can be found on the HCPC website, so I shan’t list them here. We are able to do some quite novel procedures, although, for me, the key skill is the ability to think critically.
There are several specialities including primary care paramedics (including ECPs), critical care paramedics and forensic paramedics. The College of Paramedics is introducing a voluntary register for specialist paramedics and y the curricula for them. They have extra training in a specific area of paramedicine and are often educated to masters level.
The title ‘paramedic’ is legally protected in the UK. You can only identify yourself as a paramedic if you are registered with the Health and Care Professions Council (HCPC) having undertaken their pre-registration requirements. Paramedics must then only practice within the limits of their registration as specified by the HCPC. However, in addition to this, paramedics are paramedics all the time. If we do something that ‘might put the profession into disrepute’ we could be struck off. Because of these stringent requirements, I am a paramedic with the attitude that my job is a way of life. Hence – @Meditude!
The requirement for paramedic education in the UK is certificate level, or equivalent. A level way below what I (and the College of Paramedics as referenced in this article) thinks is suitable. I personally did 4 years as a tech, an accredited prior learning module to use those four years to act as the first year of higher education, followed by a year at university completing my Foundation in Science Degree in Paramedic Science. I never thought I would have the post-nominal letters ‘FdSc’ after my name, when I quit after the first year of a BSc course, 11 years earlier. Now I do and I’m very proud of them.
The other letters I’m proud to have after my name are ‘MCPara’, the post nominals for the College of Paramedics (good CoP, not to be confused with the College of Policing, bad CoP!). This is the professional body for UK paramedics. The national body divides two ways.
Regional groups, who are the voice of the College to operational paramedics and back. They have open channels with Station Champions who can feed information backwards and forwards. The regional groups also organise Continual Professional Development events and provide speakers for events like the Emergency Services Show.
The other strand of the College of Paramedics work is representing the profession to other groups of people, such as other Health Care Professional (HCP) bodies, HE establishments, employers, the government and whichever groups need to be communicated with. It also has a research group and is in the process of setting up specialist groups looking at different areas of practice. My personal area of interest is mental health. I’m really proud of my work with the College, especially within the regional group.
So what do paramedics do? Or more accurately, what could paramedics do? We are a bit of a jack of all trades. We ‘assess, diagnose, treat and dispose’, to quote some of my very early St John training. We also do research, teach, mentor, lead, fly, drive, rescue, go into hazardous areas, work in hospitals, work offshore, do forensic paramedicine. In fact, you name it and there’s probably a paramedic doing it or associated with it. Because we now have this broad basis of knowledge from which to work from, the world’s our oyster! For paramedicine, the future’s bright, the future’s the star of life!
So why get bothered about the title ‘paramedic’? Why should we be properly identified? Why get upset that some ambulance personnel are identified by the vehicle they work from?
This may be historic and may be to do with the legal uses of the word ‘ambulance’. Ambulances have several exemptions to road traffic law, or did until a recent statement from the Crown Prosecution Service (CPS), including driving and parking. If you are not a paramedic you cannot be identified as such, so for simplicity ‘ambulance’ is used as a common denominator, as in ‘ambulance control vehicle’ at major incidents. Identified as being part of the ambulance team, although not paramedics.
Ambulance Control Vehicle.
To sum this difference up, a lot of paramedics (not all) work on ambulances. Not all ambulance staff are paramedics. In official papers and situations we should be recognised as the professionals we are. Identification among our peers is important.
However, if a member of the public calls me an ‘ambulance man’, I don’t care. I’ve got a patient to look after.
Action Plan.
All grades of clinical staff are important for ambulance services to function and good non-clinicians are worth their weight in gold.
The title paramedic is legally protected in the UK and registered paramedics must have a minimum standard of competencies and knowledge.
Paramedics are autonomous practitioners who can go on to specialise in different areas.
There is a professional body for paramedics, which represents the profession’s interests at all levels.
I am a proud paramedic.
Reaction Plan
Encourage paramedics to identify themselves as such to differentiate their advanced knowledge and skill set.
Encourage more paramedics to join their professional body, by continuing to be active in my regional group.
Continue being a proud paramedic!
@meditude
Paramedic with attitude!
