paramedics need degrees
TRANSCRIPT
Paramedics need degrees
@MLG1611
Matt Green BSc (Hons) PGDip MCPara
“Time of death 1854 hours.” There. You said it. You ended someone’s life. You’re 21 years old, still
living with your parents and barely an adult in many eyes but you’ve just welded one of the biggest
emotional swords available. They are dead and it’s because you said so.
You recently registered as a paramedic and completed a few preceptor shifts before going it alone.
That was the first real test; the first time without a mentor to depend on and when you’re expected
to take the lead and make every decision without error. As if to prove the point, the first job was a
34 year old male in cardiac arrest.
There he was, laid in the gym beside the treadmill still whirring away. It was looking bad from the
start; despite good bystander CPR, there was asystole from the moment you put the pads on. Your
ECA crewmate did some sterling CPR while you tried various interventions. A second crew arrived; a
technician and an ECA you knew well as a student but were now clinically commanding to save this
patient’s life.
You were there 40 minutes; you really did try everything until the sweat beads poured from your
bodies. Nothing worked and you pressed on until it was time to stop. You were a long way from
hospital, so copping out and conveying there was not an option. “Give it 10 more minutes” you said,
reluctant to let it end like this but knowing the literature afforded this patient almost no hope of
survival.
The gym emptied save for two earnest police officers who’d arrived in grim anticipation of the
outcome. You knelt back and glanced around, thanked everyone for the efforts and stopped.
The formalities swallowed up the next few hours and you felt a conflicting pride that you did your
duty, with a vague shaky feeling about what you’d done. You know while directly not your fault;
something beyond you must have happened to make the patient die, yet you also know that his
friends and family will always know he died at that time, at that place and in the conditions you bare
responsibility for. Perhaps they will get to ask you about it at a coroner’s inquest.
When all was said and done, you know you did your best. Later on plenty of more experienced, more
qualified paramedic colleagues reassured that you did well and your managers supported you.
The rest of the shift was less life and death; a grizzly child who needed assessing and referral to a GP
who wanted lots of detailed information and based on your diagnosis decides they don’t need a
follow up appointment today and can be seen in their regular surgery tomorrow. This felt a great
outcome; other professionals value your assessment skills, the child’s family had minimal disruption
and didn’t need to go to the paediatric emergency department miles away, there is less demand on
scarce emergency resources which is good news for the NHS and it’s an overall great use of your
professional autonomy.
However, you’re plagued by lucid thoughts; what if you made a mistake; what if you missed
photophobia, bulging fontanelles and a non-blanching rash. You absolutely know you didn’t but it
plays on your mind…what if you did?
The final patient was being transferred between hospitals; despite being fairly young, the next day
her foot was being amputated after a string of complications meant an ulcer never healed and her
necrosed foot was unsalvageable. She had fluids running and on 6 different antibiotics and
painkillers; you’d been trusted with diamorphine to give PRN during the transfer by the dispatching
hospital who had no escort to send with the patient. The patient wanted to talk and mourn her foot.
She liked having two feet that worked; she liked the freedom, the independence and the
spontaneity they afforded. She is stoic about how she will cope but is coming to terms with how it
will affect her life, her perception of herself and she openly says she thinks she will become
depressed or have post-traumatic stress disorder or both. She casually asks you about the
differences between the two and what you recommend to help her cope with it. “You do know,
don’t you?” she says while you tried to reflect confidence and competence beyond your years “you
will have studied this” she follows up.
The shift ended; it was ok. It was fun, it was challenging. It was what you thought being a paramedic
was all about when you applied.
On the way home you reflect that had you studied medicine you’d still be at university, looking
forward to years of supported learning and structured mentorship. In nursing you’d need to build up
many years of post-registration nursing study and experience before autonomously practicing like
you’ve done today.
But as a paramedic, the autonomy was there on the first day. Expected to give high doses of
morphine, diazepam and amiodarone here, delivering a baby there and actively trying to discharge
as many patients as possible on scene. It feels like it only takes one person to disagree with one
decision once and the HCPC Fitness to Practice process could bare down on you and ultimately strike
you off. That’s frightening.
Looking forward, one day you’d like to focus on one area of practice. Specialist Paramedic in Critical
Care is an option. Perhaps you’ll become a Resuscitation Officer in hospital or a researcher at a
university. Maybe you’ll sail the seven seas as a paramedic on a cruise ship or move to a third world
country to develop an ambulance service there. Perhaps when you’re ready to put down some roots,
working in a GP surgery might be a great work/life balance in a beautiful part of the country. So, so
much feels open to you – and it all starts as a registered paramedic.
Just one newly qualified paramedic in just one day assesses, manages, discharges and refers patients
with significant clinical risk. They deal with polypharmacy, mental health, life changing moments and
wrestle their own aspirations to enjoy a fulfilling career. There are hundreds of new paramedics
seeing tens of thousands of patients making millions of risky decisions every year.
It is clear that all paramedics needs to be highly qualified and competent individuals to give them the
skills and knowledge to make the most of their experience in practice. Able paramedics give the
public confidence and strengthen our professional case for more drugs and techniques to be added
to our scope of practice, to provide an even better service to our patients and be a greater asset to
the health service.
It is simply not appropriate nor plausible for future paramedics to practice at this level and beyond
with anything less than a bachelor’s degree in paramedic science/practice in addition to the
experience and mentorship afforded them by well-designed placements with good ambulance
clinicians within trusts. This is the right basis for a career of post-registration study and continuing
professional development.
The HCPC are currently proposing to maintain a Certificate in Higher Education as the minimum
education standard for registering as a paramedic.
If you agree or disagree with this blog post and the standards of education for paramedics to
become registered, tell the HCPC’s consultation at http://www.hcpc-
uk.org/aboutus/consultations/index.asp?id=220
@MLG1611