Back again!

After a short absence with technical difficulties, I should be back to posting new blogs!

 

Regards,

Tj

“That’s how We Roll!” Or “Who are ya?”

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!

I read, I learn, I blog.

Incident.

Those of you who know me on Twitter (@meditude), will know that I am a UK Paramedic (with attitude!).

I have read blogs for more than a year, especially after the Journal of Paramedic Practice started highlighting online paramedics in its pages. I have been reading them since then and have been fortunate to have learnt a lot from them. I started using Twitter last year after thinking I was missing part of the conversation, and the discussions I have had with paramedics worldwide have been another opportunity to learn and laugh. I have also ‘met’ other professionals who’s paths cross ours and have had an impact on my practice. Now, 140 characters on twitter isn’t enough and I want to continue my discussions in more depth.

I’ve read, I’ve learnt, now I blog.

Feelings

Some of the blogs I read are like being at work. They are descriptions of what happens on a shift. I empathise with the writers, that’s not what I want my blog to be. Some are full of the moans and groans of work and some are inspirational. Some are very personal and the writers bare their souls to the world, some don’t hesitate to display their political feelings. Some are exclusively about paramedicine and some combine a range of issues.

This blog will be aimed at discussing professional issues of interest to the paramedic profession. I am an active member of my regional group of my professional body, the College of Paramedics and I am passionate about the development of my profession. Having a Foundation Degree in Paramedic Science has given me a good insight into academic writing and I hope to link to my sources and be as objective as possible. I hope to discuss clinical and operational issues, or indeed any issue that relates to paramedicine.

If you want a description of working jobs I’ve been to and the lives I’ve saved/changed… Not here.

If you want to hear about how bad my day’s been and how unfair it is to work as a state funded paramedic… Not here.

If you want to read about my personal life and how it affects my working life… Not here.

However. I am a family man. I work and volunteer as a paramedic. I have other interests. Sometimes I might be wrong. Sometimes the opinions I put on here might conflict with the readers view. In short, I am human. I would love people to comment about my writing.

I read, I learn, now I blog.

Evidence

My first duty is to my family. Posts might be sporadic as I fit them round family and work life. I am registered with the Health & Care Professions Council, who determine my professional practice and ensure the public is kept safe by my practice. My professional guidelines (the Joint Royal Colleges Ambulance Liaison Committee, JRCALC) also set out what my level of autonomy is as a paramedic. To this end my patients confidentiality is paramount. Any case studies written on here are examples of what might be found in paramedic practice, although are not based on any individual, job or incident that I have attended. If you recognise yourself, you don’t. The scenario is an example of what could/might/may happen if a particular set of circumstances arises.

Those of you familiar with reflective practice will recognise the template I am using. Gibbs reflective tool, adapted by Smart to ‘IFEAR‘, is a very powerful tool to reflect with. This is how my posts will be written. Thank you Gary.

I will be blogging from my phone. I have the HTC one X, which is an awesome bit of kit. However, there are limitations which I will no doubt discover one day.

I am using wordpress for the blog software. Free hosting…awesome!

Lastly, I am writing for you. Please comment on posts or contact me if you have anything to say. Please be polite, you don’t know who may read your comments! I will respect sources anonymity if requested, by not publishing names or employer details, however, I make myself a target here, if I don’t want to publish… I dont!

Action plan.

Blogging is a powerful tool and can be abused easily due to the speed of communication round the world.

It can also be used for great good as ideas can be disseminated quickly and easily.

There are personal and professional risks to blogging.

Reaction Plan

I will post when the time is right personally.

I will post as objectively as I can, whilst developing my own style.

My personal & professional life will be impacted as little as possible.

Tj.