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Paramedics- more than an ambulance driver?

Paramedics are often the first contact for patients in emergency scenarios, and are responsible for getting them stable and safely to hospital. But there is a lot more to their role, as student paramedic Jakob Schopen explains.

What do paramedics do?

Paramedics are registered healthcare professionals that provide emergency and urgent care to patients in a variety of clinical settings. Traditionally, paramedics only provided emergency care and transport to hospital but with the increasing pressure on emergency departments and the shift towards alternative care pathways the scope of practice for paramedics has drastically changed.

Not all patients treated by paramedics require care at emergency departments. In the South West 60% of all patients treated by the ambulance service aren’t conveyed to hospital. Instead they are either treated at home or referred to alternative care services. Paramedics are able to refer patients to out of hours doctors, general practices, district nurses, minor injuries units and community mental health services to name a few. To be able to discharge patients or make referrals paramedics need to take detailed clinical histories and perform systemic examinations in order to form their own clinical impression.

Paramedics working within the NHS practice in accordance with clinical guidelines that are set out by the 17 NHS ambulance trusts. They are able to deviate from clinical guidelines where ‘deviation permissible’ is stated- on the provision that they can justify their actions and have not exceeded their competency. Of course, all paramedics are able to perform advanced life support, and other interventions that paramedics can carry out vary on a national and trust level.

How did the role of paramedics come about?

The first training schemes for paramedics began to emerge in the 1970s, national training schemes were formed in the 1980s and it wasn’t until 2000 that paramedics became registered healthcare professionals. Training schemes often involved hospital placements and brief talks from doctors, nurses and other healthcare professionals. At the turn of the century higher education programs were formed, training schemes ran by ambulance services were faded out and paramedics are now required to undergo three years of regulated academic study. The switch to higher education has given paramedics more professional recognition and has enabled them to guide their own profession by developing education and research. Paramedics are regulated by the Health and Care Professions Council (HCPC).

Where do paramedics work?

Paramedics work in a variety of roles outside of the ambulance service. Those include: Air ambulance services, GP surgeries, Minor injury units, Emergency Departments, Foreign Aid organisations, prisons, offshore oil rigs and the armed forces.

How do paramedics interact with hospital staff?

For paramedics there is a lot of focus on providing detailed and direct handovers. The style of handover that paramedics will give will change depending on the situation, time critical patients will usually be handed over in an ATMIST (Age, Time, Mechanism, Investigation, Signs, Treatment) style. Less time critical patients may be handed over using the SBAR (Situation, Background, Assessment, Recommendations) style which is more commonly used in hospital. Paramedic handovers contain a lot of key information and are a vital communication point before hospital teams begin examination. For trauma cases, asking paramedics questions about the mechanism of injury will be incredibly beneficial as they have had the opportunity to visualise the scene.

Paramedics perform a huge variety of acute procedures, from airway management to jugular vein cannulation. Although most paramedics do not prescribe, they routinely administer drugs for common acute conditions. The role of the paramedic is changing rapidly, with involvement in clinical trials, independent prescribing and primary care paramedics. As healthcare becomes every more multidisciplinary, medical students can look forward to benefitting from the huge wealth of experience paramedics bring.

Useful resources:

College of Paramedics website

Journal of Paramedic Practice

JRCALC Guidelines

Demonstration of Pre-hospital cardiac arrest management

Guest Blog: , 04.08.2018


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