Or maybe not, who knows….
It appears that one of the constants in the EMS world wide is the question of what is the best skill set for responders to a 999/911 call? Along with this comes the whole ALS/BLS discussion, and as far as I can tell there has never been a definitive answer either way, although many of us have our own thoughts.
When I started in the Ambulance service in 2000, there had been a particularily long drought as far as paramedic training in my service area. It was far more common to have an advanced technician crew (EMT – I) than have a paramedic crew. In fact, it got to the point that the wording on the side of the Ambulances changed from ‘Paramedic Ambulance’ to ‘Emergency Ambulance’ as when a ‘Paramedic Ambulance’ turned up on scene, the patient and their family quite rightly expected a paramedic.
Times have moved on however, and skill sets and grades of staff have also changed. We no longer train ‘Advanced Technicians’. We still have some on front line duties, but that rank of staff has now been changed to our ‘Emergency Care Support Worker’ colleagues who are as far as I can tell are the equivalent of an EMT Basic.
When the role was first developed, there was alot of opposition to it. So much so that I would have hated to have been one of the poor souls that were in the first few cohorts of training. There were shouts of the role not being fit for purpose and there were objections from many paramedics that this new role would result in them having to be in the back with the patient for every job instead of doing ‘job and job about’ with their advanced technician or paramedic partner.
There were other, more legitimate concerns though, and these are the ones that I also agreed with, but over time (the last 2-3 years), the role has become imbedded in the service and the amount of experience our ECSWs have now had, makes them more than capable of providing great support to the paramedic that they are working with.
There are moves afoot, to increase their level of training to have them almost at the level of what the advanced technician used to be, and we are all waiting with baited breath to see what the outcome of all the consultations are on that one.
But all of this is just a pre-amble and a bit of history before I get to the main question that I want to ask….
Does every ambulance need a paramedic on it?
I would suggest no, and here is my rationale:
I don’t think that every patient needs a paramedic staffed ambulance. I do, however believe that every patient deserves an assessment from a paramedic.
That may sound a bit of a contradiction but there is a suggestion that the UK ambulance services could adopt a formula of response which could actually achieve this.
Think of this scenario:
If you are a paramedic, then you will be working on a car, by yourself. The ambulances will be staffed by a double ECSW crew, or an ECSW and a ‘new grade technician (if that rule becomes a reality). The paramedics on the car will be sent to all 999 calls, and depending on the severity of the patient’s condition at telephone triage, a crew will also be sent, or will be allocated once the paramedic has arrived on scene and has assessed the patient and determined the most appropriate response. That may be no response, travel by own car, travel in the Rapid Response Car, travel in Ambulance or refer onto an alternative pathway of care. If the patient then requires medical interventions or a level of care higher than that of the responding BLS ambulance crew, then the paramedic will travel with the patient to hospital whilst one of the other members of the team drives the RR car.
I do this already, and it works.
If I am sent to a patient who requires transport to A&E but does not require a paramedic level of care, then I will ask for an ‘urgent crew’ to transport the patient. If however, I am with a poorly patient and the only backup available to me is an urgent crew or a double ECSW crew, then I will just jump in the back. Im sure there are many others around the country and world who also already do this too.
Then there is the question of the amount of ‘emergencies’ that we actually attend which require the advanced skills of a paramedic. As we all know, these are by far the rarest of the incidents that we attend, and the most common are the ones which don’t require an emergency response and usually don’t even really need a trip to hospital.
If that’s the case, then why not keep the paramedics for the jobs that they are really needed for?
This is where the understanding and the change in focus for modern day paramedics comes in. I have written previously about if intervention or assessment is the most important skill set for a paramedic to work with. (here and here) Both are essential, but in the every decreasing percentage volume of genuine medical emergencies, our primary route for assisting the patient is rapidly becoming the appropriate assessment/advice and referral onwards.
It then follows, that this is the reason that paramedics need to attend ALL categories of emergencies. A service would be leaving its litigation doors wide open if it allowed its lesser trained members of the healthcare team to assess and advise the public about their minor illnesses or ailments. The only alternative would be the default position of all patients who are seen by a member of ambulance staff who isn’t a paramedic, get transported to hospital, which is precisely what we are trying to avoid.
I give you this picture, as I want to have a bit of a discussion. This is only one suggestion of many that seems to be doing the rounds of the rumour mill.
In this time of cost efficiency savings and having to really pull in the purse strings, could we not take it as an opportunity to become both more cost effective and provide a better service for our patients. That may sound like an oxymoron, but I can see the potential. What about you??