As a ‘vintage’ paramedic in the UK my learning journey is quite extensive. As the saying goes ‘every day is a school day’ this is very true for all of us who work in emergency care. I have been asked a few times about how the education for a paramedic has changed over the years so here goes.
In the distant past when I joined the ambulance service, all the training was in-house. I had a six week residential course at the training centre. On that course we covered the basics of anatomy and physiology, an introduction to most types of medical emergency and the basics of trauma (trauma in our context = physical injury). The training was a mixture of classroom work and practical sessions. Once we had learned the basics we then went on to learn the basic treatments options which we as an ambulance service could provide. These all entailed transport to an Emergency Department (ED) of a local hospital with some intervention en route. At the end of the six week course we had a two week driving course to learn to drive the ambulance safely. Surprisingly, we weren’t taught ‘blue light drives’ on this course. At the time, UK law wouldn’t allow a blue light drive unless on a medical emergency, we picked up the blue light driving skills ‘on the job’ when we were unleashed onto the public roads. After these eight weeks, we were unleashed on the public as a trainee ambulance technician. The trainee status lasted a year and during that year we worked with a wide range of paramedics as part of the crew. At four points in that year we were scheduled to work with a work based trainer paramedic who assessed our progress and pointed out areas to improve. At the end of the year, assuming we passed all the assessments, we were qualified ambulance technicians.
A year after qualifying as a technician we were eligible to take the paramedic entrance exam. Paramedic training was only offered according to the demand for paramedics in the service. If it was deemed that we had enough paramedics it could be several years between courses. After having passed the exam I was invited back to training school for a further four weeks of slightly more advanced Anatomy and Physiology, and the ‘paramedic skills’ of cannulation (inserting a needle into a patient’s vein which has a plastic tube around it. The needle is then withdrawn leaving the plastic tube in the vein allowing us to introduce a range of lifesaving drugs and fluids directly into the bloodstream) and Intubation (inserting a plastic tube into an unconscious patients mouth and through the vocal chords into the trachea (airway tube leading to the lungs), once in place a balloon on the outside of the tube is inflated and so the airway is protected from blood and other nasty secretions entering the lungs while still allowing air in and out). In training school we have plastic dummies to practice on, similar to the ones you can practice CPR on but more lifelike to allow intubation and cannulation. After successfully completing the four week course we had a four week placement in a hospital, spending time in the ED, critical care units and operating theatres. This was where we got to try out cannulation and intubation on real people, supervised by doctors. Once the departmental consultants (senior doctors) deemed us competent we were signed off to practice independently. After the four weeks we were released in public as qualified paramedics. We were recalled to the training centre every 3 years to re-qualify – a scary two days of exams and practical assessments.
That education was enough to enable us to fulfil the job as a paramedic back then. We were essentially a transport system to hospital with the ability to stabilise en-route. Our area of specialisation was resuscitation; that was where we did basically everything that the hospital can do, and then transport to hospital.
What about the modern day UK paramedic?
The requirements on the ambulance service in general and paramedics in particular have changed a lot.
The modern idea of care is to provide ‘the right care in the right place at the right time’. It acknowledges that the ED of the local hospital is not always the ‘right place’ to provide the ‘right care’. To carry this out requires paramedics who respond to the call for help to be able to quickly assess where the right place is. We needed to improve our diagnostic skills, we need to quickly assess and diagnose what the basic problem is and then establish a safe and appropriate care plan for the patient. Sometimes this is still a trip to the ED, sometimes making them an appointment to see a doctor, sometimes passing details on to social services for review of social needs, sometimes nothing needs to be done other than offer reassurance. To be able to do all this safely and without risk to the patient needed more education.
The current system for paramedics is university based: a two year diploma course, much more in-depth and intensive than the old in-house training. During the two years at university a series of placements are planned at various hospital departments and out on the road with paramedic crews. Existing paramedics like me were offered the education on a part time basis while continuing to work full time. I completed my diploma with a series of five modules over five years. It was hard work but I enjoyed the learning and found it awoke a new interest and level of enthusiasm for my job.
The role of the paramedic is evolving all the time and I wouldn’t like to guess what direction the education will take in the future. It’s exciting to be part of an evolving profession.