Prescribing for paramedics?

pqf_non_medical_prescribing_bannerThis month, the Journal of Paramedic Practice contains an article from the College of Paramedics on the recent ministerial approval for the commencement of preparatory work to take paramedic independent prescribing proposals forward to public consultation.

In it, it outlines the work of the Allied Health Professions (AHP) Medicines Project, a joint initiative by NHS England and the Department of Health, which aims to extend prescribing, supply and administration of medicines to allied health professions.

The concept of independent prescribing for paramedics is not a new one—the Department of Health’s (DH) ambulance review Taking Healthcare to the Patient: Transforming NHS Ambulance Services (DH, 2005) recommended that prescribing for paramedics should be actively explored. Since then, the College of Paramedics have been actively campaigning to review the current legislation around non-medical independent prescribing and the case for paramedic independent prescribers.

Under current medicines legislation, paramedics are able to supply and administer a range of medicines, on their own initiative, as part of their normal professional practice for the immediate and necessary treatment of sick or injured persons (DH, 2010). However, it is not currently possible for paramedics to write a prescription for a patient. This is largely because in an emergency situation, it would be unlikely that paramedics would need to write a prescription. Instead, their priority would be to stabilise, treat and transport the patient as necessary. However, the need for paramedics to provide a broader range of treatment in both emergency and urgent (non-emergency) settings has become increasingly apparent.

Paramedics are treating more patients at their homes, thus avoiding the need for many patients to visit A&E. Additionally, paramedics who have undertaken further training, such as emergency care practitioners (ECPs), often work independently in these two types of settings.

The Department of Health’s vision for urgent and emergency care is that ‘patients are provided with 24/7 services which are integrated together, so that patients get the right care wherever they access the health system’ (DH, 2010). The ambulance service plays a key role in allowing for this integration due to the flexibility of the roles that are undertaken by ECPs and other advanced practitioners in delivering care to patients at home and in the community.

The benefit of prescribing for paramedics is clear: not only would it support better integration of urgent and emergency care services, it would enable patients to avoid having to make an additional visit to another healthcare provider. The work that the College of Paramedics is undertaking with NHS England, the Association of Ambulance Chief Executives and Health Education England, therefore, is integral if this is to become a reality.


Department of Health (2005) Taking Healthcare to the Patient: Transforming NHS Ambulance Services. DH, London

Department of Health (2010) Proposals to introduce prescribing responsibilities for paramedics: Stakeholder engagement. DH, London

Taken from Journal of Paramedic Practice, published 5 September 2014

Emergency Services Network: looking at the future of mobile communications

police-fire-ambulanceLast year the Home Office announced that the Emergency Services Mobile Communications Programme (ESMCP) will be replacing services provided by Airwave Solutions Ltd with a new national mobile communication service. The Emergency Services Network (ESN) will feature voice and on-demand data services, including specific public safety features.

The cross-departmental programme began in 2011 and seeks to develop and implement a secure and interoperable mobile communications solution for the three emergency services and other category 1 and 2 responders.

The reason for this change is because contracts with the current supplier, Airwave, and other commercial providers using the next generation commercial network (4G LTE), will start to expire from 2016. According to the ESMCP, it is felt that Airwave is expensive when compared with similar systems more recently deployed in other countries. Additionally, although Airwave was the first national public safety network based on the TETRA technology standard, the technology used by the existing TETRA system is not capable of delivering broadband data services, which users are acquiring directly from the telecoms market.

Key objectives

The key objectives for ESN are to establish a communication system that is:

• Cheaper—to ensure ESN is delivered cost-effectively and able to take advantage of future technological developments
• Better—users are increasingly relying on commercial providers to provide broadband data services. ESN intends to provide this as a core service with appropriate security and availability
• Smarter—Different users will use ESN in different ways so the service will be flexible to allow users to choose only the services relevant to them.

The next phase

On 7 July 2014, the ESMCP released information concerning the next phase of the new communication system, where companies were formally invited to tender for ESN. It was explained that the core procurement for ESN will be divided into four lots:

• Lot 1—ESN Delivery Partner (DP)—transition support, cross-lot integration and user support: a delivery partner to provide programme management services for cross-lot ESN integration in transition; vehicle installation design and assurance; training support services; and delivery support during the implementation of ESN. Companies invited to tender for Lot 1 include Atkins Limited; Kellogg Brown and Root Limited; KPMG LLP; Lockheed Martin UK Ltd; and Mott MacDonald
• Lot 2—ESN User Services (US)—a technical service integrator to provide end-to-end systems integration for the ESN: to develop and operate the public safety applications; the necessary telecommunications infrastructure; mobile device management; customer support; and service management. Companies invited to tender for Lot 2 include Airwave Solutions Ltd, Astrium Limited, CGI IT UK Ltd, HP Enterprise Services UK Ltd; and Motorola Solutions Ltd UK
• Lot 3—ESN Mobile Services (MS)—a resilient mobile network: a network operator to provide an enhanced mobile communications service with highly available full coverage in the defined Lot 3 area (in GB/UK), highly available extended coverage over Lot 4 telecommunications infrastructure, and technical interfaces to Lots 2 and 4. Companies invited to tender for Lot 3 include Airwave Solutions Ltd, EE Limited, Telefonica UK Limited, UK Broadband Networks Limited, Vodafone Ltd
• Lot 4—ESN Extension Services (ES)—coverage beyond the Lot 3 network: a neutral host to provide a highly available telecommunications infrastructure in the defined Lot 4 areas to enable the Lot 3 supplier to extend their coverage, and technical interfaces to the Lot 3 supplier. Companies invited to tender for Lot 4 include Airwave Solutions Ltd, Arqiva, EE Ltd, Telefonica UK Limited, Vodafone Ltd.

Tenders will be submitted in Autumn 2014 and will then be subject to detailed evaluation. Contracts will be awarded in 2015 and the new ESN, designed to help the emergency services protect the public and save lives, will go live from 2016/17.

Minister of State for Policing, Criminal Justice and Victims, Damian Green, said:

‘Interest in providing the new emergency services network and its supporting elements has been strong, with 34 organisations completing in-depth pre-qualification questionnaires. After rigorous evaluation by the Home Office and representatives of the emergency services we are now inviting those organisations we consider to be best suited to tender formally for the work.

‘We remain on track to deliver this key part of our critical national infrastructure by the end of 2016 and today marks another step towards the emergency services having the modern communications network they need to protect the public and save lives.’

Approximately 250 000 operational staff across the three emergency services will use ESN when it is rolled out. Therefore, it is essential that the new communication system offers extensive coverage, high resilience and enhanced security, to ensure public safety can be maintained.


Home Office (2013) Emergency Services Mobile Communication Programme. The Stationery Office, London

Taken from Journal of Paramedic Practice, published 1 August 2014.

Brixton Cycles named Best Small Retailer at London Cycling Awards

WHEELIE GOOD: The team from Brixton Cycles collect their award from Jeremy Vine. Picture: London Cycling Campaign

WHEELIE GOOD: The team from Brixton Cycles collect their award from Jeremy Vine. Picture: London Cycling Campaign

Brixton Cycles has been voted Best Small Retailer at the London Cycling Campaign’s annual London Cycling Awards.

The event, held on Wednesday July 16 in central London, commended organisations, brands and retailers for their promotion of cycling over the last 12 months. Hosted by journalist and keen cyclist Jeremy Vine, the awards were separated into two parts: Consumer Awards, which were nominated by London Cycling Campaign members and voted for by the public; and Project Awards, which were nominated by the public and chosen by a panel of independent cycling experts.

Brixton Cycles was started in 1983 as a workers’ cooperative on Coldharbour Lane, before relocating to its current location next to Stockwell Skatepark in 2001. Opening in the wake of the 1981 riots, it has gained a notable reputation due to its long-standing staff, who ensure a level of experience that is not seen in many other bike shops.

On receiving the award, Lincoln Romain, one of the longest serving co-op directors at Brixton Cycles, said: “We are eternally grateful, it is a great honour and we are ecstatic to win the award. It is because we have put in a lot over the years. There appears to have been a lot of nepotism in the past, but the fact the awards were voted for by actual cyclists throughout London means a lot.”

Speaking on behalf of the local London Cycling Campaign group, Lambeth Cyclists, Luke Evans said: “We congratulate Brixton Cycles, one of the best bike shops in South London, on winning this well deserved award. This recognises the key role that Brixton Cycles have played in keeping Lambeth’s cyclists on the road and promoting cycling over the past 30 years.

“This shop has played a big part in making Lambeth one of the most cycle friendly boroughs in London.”

Brixton Cycles is one of over 125 cycle shops across London which offer discounts to London Cycling Campaign members.

Taken from Brixton Blog/Bugle, published 25 July 2014.

Minister for Civil Society assures air ambulances his ‘door is always open’

L to R Bill Sivewright AAA - Nick Hurd MP Minister for Civil Society - G...

From left to right: Bill Sivewright, NIck Hurd MP, Guy Opperman MP, Clive Dickin

The Minister for Civil Society, Nick Hurd MP, has told members of air ambulance charities that his ‘door is always open’.

Speaking at a reception held by the All Party Parliamentary Group for Air Ambulances (APPGAA) on 9 June on the House of Commons Terrace, Westminster, Mr Hurd MP extended an open invitation to all air ambulance charities:

‘My offer is this, it is a very simple one: my door is always open. Please come and see me. My job is to advocate on behalf of civil society on behalf of the voluntary sector. If you don’t feel you’re getting heard, if you feel you have got an argument that you really want to make, or you have got a brilliant creative idea, please come and see me.’

Mr Hurd MP praised the work being undertaken by air ambulance charities in the UK, who together raised £96.4 million last year through public donations and on average treat 70 patients a day by the 20 charity-funded services.

He expressed his admiration for air ambulance services as a result of the passion and enthusiasm underlying the organisations, as well as their pride and desire to do more to help people. In a sector that relies on public generosity, and people’s willingness and ability to give time and money, Mr Hurd MP said:

‘There is a lot the Government can do to make it easier to give.’

The event, hosted by the chairman of the APPGAA, Guy Opperman MP, allowed local air ambulance charities and ambulance services from the UK to meet with members of Westminster to discuss their operations and key issues affecting the industry.

The APPGAA, a cross-party group of MPs, was set up in 2010 to support air ambulances. Its aim is to raise the quality of care, effectiveness and efficiency of air ambulance services through closer engagement with policy leaders and policy makers. It recently led a successful campaign in the House of Commons on the relief of VAT on air ambulance aviation fuel, and is currently calling on the Government to endorse a policy of recognition of parity for all patients arrival facilities, following a report published by the APPGAA, which highlighted that 60% of air ambulance facilities in the UK are inadequate.

In his opening speech, Mr Opperman MP explained how he had needed an air ambulance following a horse riding accident during his days as a jockey. He went on to explain how the group acts as a champion for air ambulances, ensuring that they have a strong voice in the House of Commons. By bringing members of Westminster together with the various air ambulance charities, Mr Opperman MP said that air ambulances could:

‘Promote innovation, different ideas, and take what I consider to be the fourth emergency service and then say: how can these incredible voluntary organisations harmonise, work together, come up with innovations, look to learn the lessons—whether it is from 7/7 or individual disasters and accidents that take place—so that there is a cohorted body working together and pushing forward the standards, because we are the best in the world?’

Nick Hurd MP addresses the reception

Nick Hurd MP addresses the reception

The Association of Air Ambulances (AAA) supported the reception for the second year, bringing patients, charities, ambulance services and legislators together.

Bill Sivewright, chairman of the AAA, welcomed the Minister’s comments and thanked everyone in attendance, before issuing a challenge to all those present:

‘We must rise to the challenge of ensuring that the patient remains the focus for all our efforts. Air ambulances need to work with their local NHS Trusts, leveraged through the influence of local MPs when appropriate, to ensure that the patient journey from the point of injury or medical incident through to leaving the hospital is as seamless as possible.’

Speaking to the Journal of Paramedic Practice after the event, Graham Hodgkin, chief executive of London’s Air Ambulance, said:

‘As active supporters of the AAA, we’re always appreciative of the opportunity to meet with our sector colleagues, as well as some key supporters. The APPGAA reception is an important event where we can collectively highlight the common issues that impact on our operations and funding to our stakeholders in public office that can positively influence outcomes on our behalf. The APPGAA was instrumental in securing the recent VAT rebate on aviation fuel and it was really encouraging to hear the Minister for Civil Society, Nick Hurd MP, say his door is always open to us as charities.’

Mike Page, emergency care practitioner and critical care paramedic for Great Western Air Ambulance, added:

‘This has been an excellent opportunity for the Great Western Air Ambulance Charity (GWACC) and our team of critical care paramedics to meet with and discuss with our local members of parliament some of the important issues affecting the organisation’s ability to deliver the patient-centred care that is so gratefully funded by the kind donations of members of the public.

‘We in the GWACC area are extremely lucky to have the support of so many of the local MPs, a number of whom have visited the base and provide a good level of support. It is always good to know that they have an open door policy for us and are willing to support our charity when needed.’

Looking to the future for air ambulances, Clive Dickin, national director of the AAA, said:

‘The work on our key issues continues. We are in dialogue with NHS England on the issue of helipads and look for continued support through the members of the All Party Parliamentary Group in delivering appropriate landing facilities within the National Health Service Trusts. On other key issues, we continue to lobby for all VAT, not just that on aviation fuel, to be recoverable for charities, and again, we are working hard with the All Party Parliamentary Group to ensure that that actually materialises. At a local level, we encourage our air ambulance members to be engaging with their local MPs and pressing home those messages and reassuring the fundraisers, the volunteers and the patients that we are constantly improving services.’

Mr Opperman MP, added:

‘I think they [air ambulance charities] need to lobby their MPs more, without a shadow of a doubt. They need to to try to realise they’ve got a great deal more critical mass and force then they have actually exercised previously.

The reception was undoubtedly a success, giving the air ambulance community a rare opportunity to engage with legislators and members of Westminster, and make their issues heard.

Taken from Journal of Paramedic Practice, published 4 July 2014.

The future for the professional body

CoP_Strategic_Plan_2014This issue of the Journal of Paramedic Practice features the College of Paramedics’ Strategic Plan. Developed by the College of Paramedics’ Governing Council and Executive team following consultation with the College’s membership, it serves as the key reference point for the direction of the College over the next two to five years.

As outlined in the document, there are currently more than 19500 paramedics registered with the Health and Care Professions Council (HCPC). Members of the College represent 19% of the present UK paramedic registrants with the HCPC. This marks a substantial growth of membership since the formation of the College of Paramedics (then the British Paramedic Association) in 2003.

This is an important time for the paramedic profession, which has had to evolve and develop to cater for the needs of the acutely ill and injured patients it attends. As the demand for ambulance services has risen, the need for a pre-hospital healthcare professional with enhanced clinical capabilities and clinical decision-making skills has become increasingly evident (Allied Health Solutions, 2013).

The College serves as the voice of the paramedic profession, with representation at higher education institutions, the HCPC, Government agencies and with employers. Its Strategic Plan outlines the strategic activity necessary to meet the intent of its mission, and is separated into three strands: membership and members’ benefits; professional standards; and corporate status and operation.

The first section relates to the College’s engagement with its workforce. As a representative organisation it is there to listen to the needs and aspirations of the paramedic profession. In return for annual subscription to the College, members receive benefits, which include promotion of the paramedic profession and its value to the community, relevant communication to all stakeholders, professional support, and professional indemnity insurance. The Strategic Plan outlines the College’s intention to further develop the benefits for its membership as appropriate for an advancing profession.

The second section concerns the College’s ability to exert influence and apply governance over the content and processes related to the training of future members of the profession through university-based pre-registration programmes. The publication of its Curriculum Guidance and Career and Competency Framework will help ensure best practice for both paramedic education providers and employers.

The final section pays attention to the processes that need to be in place to ensure the College of Paramedics positions itself to effectively function as an organisation with the key challenges of ensuring growth for sustainability.

As a relatively young and growing body, the College of Paramedics is there to support the development of the profession. It relies on engagement with the workforce so that it can recognise what you as paramedics value as important. I urge you to read the document, and if you have not already done so, become a member.

Taken from Journal of Paramedic Practice, published 4 July 2014.


Allied Health Solutions (2013) Paramedics Evidence Based Education Project (PEEP). End of Study Report. Buckinghamshire New University, High Wycombe

Additional training allows paramedics to treat patients at home

van_2846135bThe introduction of specialist paramedic training to the East of England Ambulance Service NHS Trust (EEAST) has allowed for hundreds of patients to be treated at home, avoiding subsequent referral to hospitals and therefore relieving pressure on overburdened A&E departments.

Figures show that in 2013/14, EEAST carried out wound closure treatment in more than 400 patients at their own home.

This comes as welcome news following a report published by NHS Confederation earlier this year, which emphasised the need for more paramedics to be trained to treat at home. The report, entitled Ripping off the sticking plaster: Whole-system solutions for urgent and emergency care, argued for the need of a radical overhaul of emergency care services in order to cope with unsustainable pressures.

Jori Krijgsman, a clinical operation manager for EEAST, said:

‘The treatment ultimately means better care for patients and saves them a journey to hospital. The wound can be treated quickly and effectively through the use of adhesive stitches or dissolvable glue.’

The training has now been introduced to the new student paramedic course, following successful feedback from patients and paramedics. EEAST currently recruits 400 students.

Taken from Journal of Paramedic Practice, published 23 June 2014.

London’s Air Ambulance first to perform roadside balloon surgery

reboaLondon’s Air Ambulance (LAA) has become the first organisation to perform roadside balloon surgery to control internal bleeding. The technique, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), was first used in the UK at The Royal London Hospital, to control haemorrhage in trauma patients.

REBOA works by controlling or preventing further blood loss. The balloon is fed into the bottom end of the aorta, and then inflated, cutting off blood supply to damaged blood vessels. Patients who undergo REBOA by LAA are then transported rapidly to the Royal London Hospital to undergo further vital interventions. The technique can be used on patients suffering severe pelvic haemorrhage, an injury most commonly associated with cycling incidents and falls from height.

Dr Gareth Davies, medical director for LAA, commented on the use of REBOA to treat trauma patients:

‘Our aim is to provide our patients with the world’s most innovative and effective pre-hospital care. Being able to effectively manage blood loss at the scene is a significant advancement in pre-hospital medicine.

‘We believe the use of REBOA can lead to a reduction in the number of patients who quite simply bleed to death before they have the chance to get to hospital where there are highly developed systems for stabilising and preventing blood loss.’

Clinical staff from LAA worked closely with The Royal London Hospital, developing the skills necessary to perform REBOA safely in A&E, before transferring their knowledge to the pre-hospital setting.

Professor Karim Brohi, consultant vascular and trauma surgeon at Barts Health NHS Trust, commented on the partnership between LAA and The Royal London Hospital:

‘We have to stop people bleeding to death— it’s one of the world’s biggest killers. Over 2.5 million people bleed to death from their injuries each year around the world. The Royal London Hospital Major Trauma Centre and London’s Air Ambulance have together led the way in developing new strategies and treatments to reduce this death toll.

‘While it sounds relatively simple it is an extremely difficult technology to deliver in the emergency department in hospital, never mind at the roadside. This successful deployment of REBOA represents nearly two years of development work by our staff. We are excited about the potential for REBOA to reduce death and suffering after trauma and will continue to evaluate and develop the technology into the future.’

Mayor of London, Boris Johnson, said:

‘London’s Air Ambulance delivers a world-class service for a world-class city. It’s astonishing to see how these stunning advances in medical care are helping people survive serious injury in London, injury that they probably wouldn’t survive elsewhere in the world. That change is being pioneered and delivered by an incredible group of men and women—the doctors, paramedics, pilots and support staff of the London Air Ambulance.’

Taken from Journal of Paramedic Practice, published 23 June 2014.


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