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The Future Role and Education of Paramedic Ambulance Service Personnel (Emerging Concepts)
Publications > The future role... > Summary of Proposals...
Summary of Proposals and Recommendations
Emergency pre-hospital care
can have a profound influence on morbidity and mortality of those
critically ill or injured.
The ambulance service has
had considerable success in training and deploying paramedics to play a
key role in the provision of pre-hospital care. The objective of having
one such individual with advanced skills on every emergency ambulance has
largely been met. But further developments are now needed to achieve the
full potential of skilled pre-hospital care. In particular, the experience
of paramedics in attending medical and surgical emergencies is limited.
Moreover, present training and professional development do not provide the
underpinning education for sound clinical judgement to be exercised or
indeed expected.
The needs for effective
prioritisation, safe triage, utilisation of new opportunities for
effective immediate care, and judgement to recognise when prompt transport
is the over-riding priority all call for a level of education and
expertise that cannot be provided at present by the established paramedic
courses. This widely perceived requirement has engendered many local
schemes, some involving degree courses. Whilst these offer excellent
opportunities, they are variously targeted, not co-ordinated and offer no
official career structure.
We believe that the needs
of patient care and of the service could best be met by a higher level of
paramedics, perhaps 30% of the total, who are given a three year education
in emergency care leading to a university degree - followed by a further
probationary year of service training. These Practitioners in Emergency
Care (PEC's) would achieve continuing professional development based on
employment both in appropriate pre-hospital and in-hospital environments.
The education would be
modular, and flexible, using some components that are already available.
Ultimately almost all wishing to pursue such a course will be
school-leavers whose ambitions lead them in this direction. But initially
there must also be provision for existing paramedics with the necessary
ability and motivation to make the transition to the new grade, with due
allowance for prior learning.
The scope of the employment
of PEC's in the ambulance service will need to be determined by individual
trusts in conjunction with other partners in the local health economy.
Their advanced skills and increased knowledge are likely to make them
particularly useful for rapid response to life-threatening emergencies and
- importantly - for triage of cases where the need for transport has not
been fully established. Thus, they will not replace existing paramedics
but complement them as advanced practitioners within the discipline. We
anticipate that the knowledge, expertise and judgement will have a
favourable influence on the standard of care provided by all ambulance
personnel.
Many opportunities will
also exist in hospitals (especially within Accident and Emergency
departments) for taking advantage of the experience and skills of PEC's,
where indeed they would be expected to work for a portion of the year.
They could also expect to have valuable roles within primary care.
The cost of the scheme
cannot be calculated in detail at this stage, but the principles and
figures outlined above suggest that it will be relatively modest in
proportion to the needs that are recognised and the gains that are to be
expected. Some savings will accrue and only a proportion of the costs will
be the responsibility of the ambulance service.
We are thus proposing a new
echelon of generic health care worker as part of the Paramedic Profession
with a broad-based University education provided by the nursing, medical
and ambulance personnel - and continuing professional development with
academic and practical components. They will have diverse roles both
within the ambulance service and within wider contexts of primary and
emergency care.
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