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The Future Role and Education of Paramedic Ambulance Service Personnel (Emerging Concepts)
Publications > The future role... > Introduction
1. Introduction
1.1 Emergency prehospital
care can have a profound influence on morbidity and mortality of those
critically injured. Whilst ambulance paramedics are expected to treat a
wide range of medical, surgical and obstetric emergencies, their
additional training (over and above their basic skills and operational
experience) is relatively modest, with less than 300 hours initially,
followed by a mandatory 16 hour annual refresher course. Moreover,
practical experience is also limited. For example on average each
paramedic may see one case of serious trauma per month [6] and only a few
cases of cardiac arrest each year. Maintaining paramedic skills and
improving their continuing education are therefore recognised as areas
that present significant challenges.
1.2 The question of whether
or not to treat the patient before transporting to hospital can be at
least as important as knowing how to treat the patient. The challenge for
paramedics to gain adequate knowledge for an accurate assessment of the
patient's condition, to acquire the skills for safe management, to
maintain both, and to develop sound clinical judgement is already
considerable. Wider health care developments are likely to make it
increasingly so in the future. Such developments include:-
- Prioritisation and
patient help-line services which would offer support on those occasions
when, after assessment and treatment, transport of the patient to
hospital is deemed to be unnecessary.
- Increased specialisation which often results in longer ambulance
journeys during which more extensive care and more sophisticated
treatment is required.
- The recognition of a place for "immediate transport" policies, especially for trauma when the over-riding priority may be
urgent treatment in hospital. The balance against the need sometimes to
spend time wisely at the scene requires careful assessment and sound
judgement. [7]
- Equity issues especially in relation to remote and rural communities
where conventional emergency services may not be fully effective.
- Changes in the provision of primary care and the diminution in numbers
of home visits by general practitioners associated with the
establishment of out-of-hours cooperatives.
1.3 Incomplete data
sources, problems of isolating the influence of individual components in a
continuum of care, and the short time during which the patient is usually
in the care of ambulance personnel are examples of the factors which make
prehospital research particularly difficult. Thus, national and
international evidence of impact on patient outcome remains inconclusive.
A number of recent UK studies [6,8-10] have failed to show any reduction
in mortality to hospital discharge as a result of paramedic intervention,
at least with regard to trauma. Evidence does exist, however, that
morbidity may be influenced favourably. It is not only outcomes that are
matters of contention: the evidence base for many pre-hospital practices
is generally recognised as seriously deficient. [11]
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