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The Future Role and Education of Paramedic Ambulance Service Personnel (Emerging Concepts)
Publications > The future role... > A Pattern for the Future
4. A Pattern for the Future.
4.1 For ambulance personnel
to provide optimal care for critical conditions in the important
pre-hospital phase, some better method must be found of providing and
maintaining the necessary skills and developing clinical judgement. The
ability to recognise rapidly severity of any emergency comes mostly from
wide experience - urgency or otherwise may not be immediately obvious to
those not very familiar with some specific conditions. That skill is vital
in deciding the relative priorities of intervention on scene and rapid
transport to hospital. Moreover, paramedics in some rural areas have to
care for critical patients for an appreciable time even if all delays are
minimised.
4.2 There is also an
increasing requirement for the ambulance service to be involved in the
assessment and treatment of "minor conditions" including those
which may not need transport to hospital. Adequate judgement for these
roles cannot come from within the ambulance service alone. The dilution of
experience is necessarily too great - a limitation that is now widely
perceived as weakening paramedics' contribution to safe and effective
care.
4.3 One practical solution
is to establish an additional level of pre-hospital care provider who
would both respond to life-threatening emergencies and attend those cases
in which the need for emergency response had not been determined. Their
potential for helping those most threatened and for providing triage of
those seemingly less threatened is based on real need, and should not be
seen as a paradox. The higher-skilled emergency workers would spend much
more time in these various environments that can provide experience in a
wide range of emergencies and - equally important - exposure to academic
training and disciplines. Regular rotations into the hospital and primary
care would improve and maintain skills and have other practical advantages
for the Health Service.
4.4 In particular, the work
load of Accident and Emergency (A&E) Departments continues to increase
but staffing resources remain limited. There has been an expansion in the
provision of senior medical cover, but a large proportion of medical staff
are Senior House Officers. These trainees have a very steep learning curve
during their six months in post, and then are replaced by less experienced
colleagues. Continuity of experience can be provided by skilled nursing
staff but some A&E Departments have difficulty in recruiting and
retaining sufficient nurses. Better integration and interchange of
ambulance and hospital A&E nursing staff may have the potential for
easing this burden, to the considerable benefit of both.
4.5 Rotation and placements
would provide an increasing resource of skilled practitioners who would
eventually provide experience counted in years rather than months. Such an
arrangement would offer job satisfaction, assist career development, raise
standards of care, make the transition from pre-hospital care to hospital
care increasingly "seamless", avoid unnecessary delays in
repeated triage, and favourably influence other emergency medical
personnel. It would also be entirely in keeping with the current NHS
philosophy of developing a flexible multi-skilled workforce with
opportunities for life long learning.
4.6 A health care
professional with a degree and commitment to long term development of
skills and education by working both in hospital and ambulance
environments would be in a category different from any that exist today.
This should clearly be recognised by an appropriate title. As an interim
measure, we suggest the provisional use of the designation
"Practitioner in Emergency Care" (PEC). The name is deliberately
generic, because we foresee the need to have individuals with appropriate
experience and skill to fill a variety of roles in addition to those
already mentioned.
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