What is a Paramedic?
Paramedics are autonomous Allied Health Professionals (AHPs) who have traditionally been employed by NHS ambulance services (84% in 2012). They are trained in all aspects of prehospital emergency care, ranging from acute problems such as cardiac arrest, strokes, spinal injuries and major trauma, to urgent problems such as minor illness and injury. In recent years, the paramedic profession has evolved from being a provider of treatment and transportation to a provider of mobile healthcare. As a result of this evolution, paramedics can now be found working in multiple settings including general practice, minor injury units, urgent care centres, walk-in centres and accident and emergency (A&E) departments, telehealth, and telecare services and in the armed forces and remote and offshore sectors.
Paramedics undertake full clinical assessments and make decisions regarding the care provided to patients. Changing demands have required the paramedic workforce to be flexible, to develop the skills and competencies required to treat and manage increasingly complex patients, while continuing to provide excellent and safe patient care. However, the development of these roles has not occurred consistently, with a variety of different programmes, job titles and scopes of practice for paramedics working in these areas.
As a result of the delivery of the Urgent and Emergency Care Review, the Five Year Forward View and the recommendations made in the Primary Care Workforce Commission’s report The Future of Primary Care: Creating teams for tomorrow, around the importance of developing multidisciplinary teams, it is expected that the unique skill set of paramedics will be increasingly utilised within these teams and help to contribute to the development of effective multidisciplinary clinical centres for primary, urgent and unscheduled care provision, both in the community and wider healthcare settings.
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What do Paramedics do?
A paramedic is usually the senior member of a two-person ambulance crew, supported by an emergency care assistant or technician. A paramedic is typically one of the first healthcare professionals to arrive at the scene of an emergency. Typical duties of the job include:
- • driving and staffing ambulances and other emergency vehicles
- • responding to emergency 999 calls
- • assessing patients, providing emergency treatment and making diagnoses
- • monitoring and administering medication, pain relief and intravenous infusions
- • dressing wounds/injuries
- • using specialist equipment including ventilators and defibrillators
- • transporting patients to hospital and continuing to provide treatment while in transit
- • providing hospital staff with patient information including condition and treatment • helping provide patient care in hospitals and other medical facilities
- • communicating effectively with patients and their relatives/friends
- • teaching and training members of the public to use first aid techniques correctly
Paramedics working in primary and urgent care can undertake a variety of roles including:
- • competently use the medical/biopsychosocial model to assess, examine, treat and manage patients of all age ranges with a variety of acute undifferentiated and chronic conditions
- • triage patients, carry out telephone consultations, undertake face-to-face consultations, carry out home visits (including residential and nursing homes)
- • request, review, and act on laboratory results
- • paramedics can refer to specialist services or certain investigations as appropriate
- • paramedics can see patients presenting with acute or urgent (same-day) problems, as well as offering pre-booked and routine appointments
- • paramedics are also able to mentor and supervise students from a range of health and social care backgrounds.
The level of competence at which the paramedic in primary and urgent care can work will depend on their skills and experience, and the skills and experience of the practice team. Paramedics in primary and urgent care should be aware of their level of clinical competency, and their areas for development, working within their limits and scope of practice. As each general practice and urgent care provider is run differently, a paramedic’s role in primary and urgent care may differ across each practice or urgent care setting.
Health Education England commissioned the development of the Paramedic (Specialist in Primary and Urgent Care) core capabilities framework to support those paramedics working in primary and urgent care and the transformation of services that employ these clinicians in new environments. The capabilities set out what a paramedic can do, recognising that the paramedic working in primary and urgent care must be adaptable and not constrained by protocols or prescriptions for practice. The framework describes the knowledge, skills and behaviours that must be acquired, developed and demonstrated in order to safely and effectively manage service users across the lifespan and in often quite challenging conditions.
What training and qualifications do paramedics have?
To practice as a paramedic, an approved degree in paramedic science is required or an equivalent apprenticeship degree. Application to an ambulance service as a qualified paramedic and registration with the Health and Care Professions Council (HCPC) is then required. Regulations as with all other allied health professions, the term ‘paramedic’ is a protected title by law. All paramedics, whether working in the NHS, private or voluntary sectors must be registered with the Health and Care Professions Council (HCPC). To remain on the HCPC register, registrants must demonstrate that they continue to meet these standards as this is how their fitness to practice is determined. All paramedics are required to renew their registration with the HCPC every two years, to continue to practice as a paramedic.
As registered health professionals, there are also expectations for paramedics to undertake activities relating to leadership and management, and research and education (which include the role of a practice educator). Paramedic science courses usually take between three or four years full time and include a mixture of theory and practical work including placements with the ambulance services. Entry requirements for an undergraduate course are typically:
- • two or three A levels, including a science, along with five GCSEs (grades 9-4/A-C), including English language, maths and science or equivalent qualifications
- • a BTEC, HND or HNC, including science
- • a relevant NVQ
- • a science- or health-based access course
- • equivalent Scottish or Irish qualifications.