The future for the professional body

This 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.

References:

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

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Getting more AEDs in public places

Sudden cardiac arrest (SCA) is a leading cause of premature death. In the UK alone, approximately 30 000 people sustain cardiac arrest outside hospital and are treated by emergency medical services (EMS) each year (Pell et al, 2003). However, many SCA victims can be saved by bystanders who recognise what has happened, summon the ambulance service as soon as possible, perform basic CPR and use an AED to provide a high-energy electric shock to restore the heart’s normal rhythm (Resuscitation Council (UK) and British Heart Foundation, 2013).

It has been shown that a strong predictor of SCA survival is the interval from collapse of the patient to defibrillation (Valenzuela et al, 1997). While this generally applies to defibrillation as carried out by healthcare professionals—from emergency physicians, to paramedics, to first responders—it also extends to defibrillation carried out by the layperson (Rea and Page, 2010). The introduction of public access defibrillation (PAD) programmes has produced positive results. One US study, which looked at a prospective series of cases of SCA in casinos, attended to by security officers instructed in the use of AEDs, recorded survival rates as high as 74% (Valenzuela et al, 2000).

In April, the Department for Education announced a plan to allow schools to purchase defibrillators at a lower cost. As a result, the Government is currently working to identify a supplier who will offer defibrillators at a competitive price, affirming that the deal will be sealed in time for the autumn term. Around 270 cardiac arrests occur in schools in the UK each year, highlighting the evident need to have AEDs on hand.

Ambulance services have played their part in encouraging PAD as well as the number of defibrillators in the community. On 1 May 2014, London Ambulance Service NHS Trust launched a campaign to get 1 000 defibrillators in shops, businesses and gyms across the capital, while South Central Ambulance Service NHS Foundation Trust have launched an app that uses GPS functionality to show where the nearest AED is, as well as a list of other AEDs in the area, as part of its ‘Start a Heart’ campaign.

Undoubtedly, there are considerations to take into account with regards to PAD, such as the investment to purchase AEDs and maintain layperson responder proficiency (Rea and Page, 2010). However, given that AEDs are designed to be used by laypersons, with the machine guiding the operator through the defibrillation process by verbal instructions and visual prompts (Resuscitation Council (UK) and British Heart Foundation, 2013), there is plenty of argument in favour of PAD.

References:

Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM (2003) Presentation, management, and outcome of out of hospital cardiopulmonary arrest: comparison by underlying aetiology. Heart 89(8): 839–42

Rea T, Page RL (2010) Community approaches to improve resuscitation after out-of-hospital sudden cardiac arrest. Circulation 121(9): 1134–40

Resuscitation Council (UK) And British Heart Foundation (2013) A Guide to Automated External Defibrillators (AEDS). Resuscitation Council (UK), London

Valenzuela TD, Roe DJ, Cretin S, Spaite DW, Larsen MP (1997) Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 96(10): 3308–13

Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG (2000) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 343(17): 1206–9

Taken from Journal of Paramedic Practice, published 6 June 2014.

Expanding the role of paramedics

As populations worldwide continue to grow and life expectancy rises, there has been a corresponding demand placed on health care services. Emergency medical services (EMS) in particular have found themselves under increasing pressure, with some ambulance services experiencing a rise in the number of emergency calls received by as much as 8% annually (Department of Health, 2004).

Traditionally, EMS systems have focused on providing patient care for acute illnesses and emergencies. However, studies have suggested that 10–40% of EMS responses are for non-emergent situations (Joint Committee on Rural Emergency Care and National Association of State EMS Officials (JCREC and NASEMSO), 2010). The need for an EMS role, which can improve individual and community health, reduce unnecessary hospitalisations and emergency department visits, and reduce health care costs, has led to the introduction of community paramedic programmes in the United States, Canada, Australia and New Zealand. In the United Kingdom, similar work has been carried out by paramedic practitioners and/or emergency care practitioners, although without the same level of community engagement found in the community paramedic role.

The inaugural meeting of the International Roundtable on Community Paramedicine (IRCP) in 2005 gave the opportunity for the international exchange of ideas on integrating rural EMS providers into rural health care delivery systems (IRCP, 2014). The IRCP has continued to meet annually, promoting the international exchange of information and experience related to the provision of flexible and reliable health care services to residents of rural and remote areas using novel health care delivery models, and acting as a resource to Government agencies, emergency service providers, and others (IRCP, 2014).

In this issue of International Paramedic Practice, O’Meara conducts a scoping review of the emergence of community paramedics and their potential impact. His findings illustrate that although there are few empirical studies on community paramedics, with much of the literature consisting of commentaries and opinion papers, there is still an emerging research literature that is contributing to the development of community paramedicine programme models and the evaluation tools that will contribute to the future evolution of the model.

Also in this issue, Raynovich et al present the findings of a survey of community course offerings and planned offerings sent to every recipient of a standardised community paramedic curriculum. The responses indicated that many community paramedic courses were in the planning stages by programmes that had received the standardised curriculum, both in the United States and Internationally.

Both these papers illustrate the need for further research to examine the impact of community paramedicine, but also highlight the potential of extended scope of practice of paramedics who are based in the community.

References:

Department of Health (2004) Statistical Bulletin Ambulance Services, England 2003–04. DH, London, UK

International Roundtable on Community Paramedicine (2014) IRCP History. http://www.ircp. info (accessed 20 May 2014)

Joint Committee on Rural Emergency Care, National Association of State EMS Officials (2010) Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders. National Conference of State Legislators December 2010

Taken from International Paramedic Practice, published 21 May 2014.

Supporting ambulance service development

Following mounting pressures on England’s emergency care services, the NHS Confederation’s Urgent and Emergency Care Forum has brought together organisations from across the whole health and care system to debate, develop and share ideas for improving urgent and emergency care. The resulting briefing published by the NHS Confederation, which incorporated findings from a survey of 125 senior NHS leaders and an analysis of national data, highlighted a concern that only ‘sticking plaster’ solutions were being offered to overcome pressures placed on A&E departments, rather than solutions which focus on the long-term challenges ahead (NHS Confederation, 2013).

This was followed by a report published on 10 March, which proposed the fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients (NHS Confederation, 2014).

One of the key recommendations from the report is the importance of getting the best from the urgent and emergency care system and workforce. Ways in which this could be achieved include improving the education, information, engagement and support available to staff.

In Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care, he emphasised that fewer patients attended by ambulance crews should be taken to hospital so that pressures on A&E departments are reduced (NHS England, 2013). In order for this to be made possible, the NHS must improve training and investment in its staff. The development of more community-based ambulance services, through enhancing paramedic practitioner roles, is just one of the ways this could be achieved.

This would enable paramedics to take more responsibility for decisions to treat patients on scene and therefore equip them with the necessary skills to establish when it is appropriate to convey patients to emergency departments.

Given that life-threatening emergencies represent approximately 10% of the overall workload for paramedics (Turner et al, 2006), the expectations, behaviours and skills of the workforce need to change. Confidence is dependent on good training and the availability of services to enable efficient referrals where necessary. The development of ambulance services as out-of-hospital providers, in combination with a whole-system approach to urgent and emergency care, will help reduce pressures placed on A&E departments and ensure the needs of patients now and in the future are met.

References:

NHS Confederation (2013) Emergency care: an accident waiting to happen? NHS Confederation, London

NHS Confederation (2014) Ripping off the sticking plaster: Whole-systems solutions for urgent and emergency care. NHS Confederation, London

NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England—Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

Turner J, O’Keeffe C, Dixon S, Warren K, Nicholl J (2006) The costs and benefits of changing ambulance service response time performance standards: Final report to the Department of Health. Medical Care Research Unit, University of Sheffield

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

Self-injury awareness for paramedics

On 1 March, people across the globe took part in the annual Self-Injury Awareness Day. Introduced around 15 years ago, its aim is to encourage people to be more open about their own self-harm, with mental health organisations making special efforts to raise awareness about self-harm and self-injury (LifeSIGNS, 2014a).

The self-injury guidance and network support charity LifeSIGNS defines self injury as: ‘any deliberate, non-suicidal behaviour that inflicts physical harm on your body and is aimed at relieving emotional distress’ (LifeSIGNS, 2014c).

The majority of people who self-harm are aged between 11 and 25 years, and it is estimated that between 1 in 12 and 1 in 15 young people self-harm in the UK (Mental Health Foundation, 2014).

For the majority of people, self-injury is a coping mechanism rather than a genuine attempt at suicide (LifeSIGNS, 2014b). It is therefore not overly common for paramedics to be called out to life-threatening cases involving self-injury. However, this does not mean that paramedics should not be adequately prepared for situations where this may be the case, as the nature of their work means it is likely that they would find themselves the first point of contact for these patients.

Each ambulance service should have a formal process or protocol for establishing the capacity of patients to consent to assessment and to being transported for further care (Joint Royal Colleges Ambulance Liaison Committee (JRCALC), 2013). While the JRCALC guidelines cover transportation of a person subject to detention under the Mental Health Act 2007 (c.12); capacity in relation to consent to treatment and/or conveyance under the Mental Capacity Act 2005 (c.9); and assessing risk in relation to self-harm and or/suicide, there are no other paramedic approved directives or guidance statements that practitioners can refer to in order to support their clinical decision making when presented with a person with mental health needs (Elliott and Brown, 2013). It is therefore arguable that there is a developmental need for a paramedic pathway to mental health (Elliott and Brown, 2013).

As ambulance staff have an increasingly important role in the assessment and early treatment of self-injury, it is important that they receive appropriate training to equip them to understand and care for people who have self-injured (National Institute for Health and Care Excellence, 2004). This begins with the proper awareness and understanding of self-injury, encouraged by events such as Self-Injury Awareness Day.

References:

Elliot R, Brown P (2013) Exploring the develomental need for a paramedic pathway to mental health. Journal of Paramedic Practice 5(5): 264–70

Joint Royal Colleges Ambulance Liaison Committee (2013) UK Ambulance Services Clinical Practice Guidelines 2013. Class Professional Publishing, Bridgwater

LifeSIGNS (2014a) Self-Injury Awareness Day 2014. http://www.lifesigns.org.uk/siad/ (accessed 3 March 2014)

LifeSIGNS (2014b) Self-injury myths. http://www.lifesigns.org.uk/what/self-injury-myths (accessed 3 March 2014)

LifeSIGNS (2014c) What self injury is. http://www.lifesigns.org.uk/what/ (accessed 3 March 2014)

Mental Health Foundation (2014) Self-Harm. http://www.mentalhealth.org.uk/help-information/mental-health-a-z/S/self-harm/ (accessed 3 March 2014)

National Institute for Health and Care Excellence (2004) Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. CG16. NICE, London

Taken from Journal of Paramedic Practice, published 7 March 2014.

Student paramedic recruitment drives

Last month it was announced that the East of England Ambulance Service NHS Trust (EEAST) was aiming to recruit 400 student paramedics as part of the service’s turnaround plan which was issued in April last year (EEAST, 2013). The plan was brought about following criticism directed at the service as a result of poor response times, where it was felt that people could not be assured they would receive care in a timely and effective manner (Care Quality Commission, 2013).

Within the plan, the Trust acknowledges: ‘We are not delivering our 999 service, which is our core business well enough’ (EEAST, 2013). It outlines some of the challenges faced by the Trust, which it groups into the headings: leadership, our people, clinical operational delivery, and systems and processes.

The recruitment drive comes as a result of the realisation that there are not enough front-line resources available to deliver the required levels of service in both urban and rural areas. This includes not enough staff or double staffed ambulances.

Response to the new student paramedic programme has been overwhelming, with the number of applications exceeding 1200 in the week it was launched (EEAST, 2014). It is undoubted that this is largely due to the ability for students to learn while on the job. The increasing prevalence of higher education institution qualifications in paramedic science as a means to achieve HCPC registration, and corresponding reduction in student paramedic positions with ambulance service Trusts, has meant that many people wishing to pursue a career as a paramedic have been unable to do so due to factors such as cost.

Currently, paramedic education favours those who are able to financially support themselves, yet this does not promote fair or widened access to the profession (Allied Health Solutions, 2013).

The student training programme offered by EEAST will include a recognised qualification via a partner higher education institution that leads to eligibility to apply for registration with the HCPC, yet it is unclear how this will be delivered. Qualification from the programme takes two and a half years.

The initiative from EEAST is just one of a number that combine an apprenticeship model with learning from higher education institutions. Another notable example would be the Scottish model of the Ambulance Service sponsoring an Academy linked to Glasgow Caledonian University (Allied Health Solutions, 2013).

It is hoped that the EEAST recruitment drive will help with the recovery of the organisation, and so allow for the delivery of high-quality services for patients, not to mention it will also offer a considerable number of career opportunities for people in the east of England.

References:

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

Care Quality Commission (2013) East of England Ambulance Service NHS Trust HQ. Inspection Report, March 2013. http://tinyurl.com/omftynq (accessed 31 January 2014)

East of England Ambulance Service NHS Trust (2013) Delivering better services for our patients: The turnaround plan for the East of England NHS Trust.

East of England Ambulance Service NHS Trust (2014) More than a thousand application—and rising! http://tinyurl.com/og9mnmo (accessed 31 January 2014)

Taken from Journal of Paramedic Practice, published 7 February 2014.

2013: the year in review

As paramedics across the country are recovering from the busiest shift of the year, the Journal of Paramedic Practice thought it would look back over 2013 and consider some of the notable events that occurred, both good and bad.

The beginning of 2013 will be remembered by most for the tragic loss of Roland Furber, President of the College of Paramedics, who passed away on 4 February. Roland and his late wife Carol were known for the huge contribution they made to the paramedic profession and the establishment of the professional body, which was then the British Paramedic Association (BPA). As the inaugural chief executive of the BPA, Roland made an enormous impact on the founding of the profession.

February also saw the release of the final report of the Mid Staffordshire NHS Foundation Trust Inquiry chaired by Robert Francis QC, which though not directly affecting paramedics, raised a number of important questions concerning the care of those who are older and more vulnerable. Perhaps more than anything it highlighted the need for a cultural change within the NHS, where patients are placed at the centre.

One of the most notable events of the past year was the long-awaited publication of the UK Ambulance Services Clinical Practice Guidelines 2013, which was issued following lengthy development with JRCALC and National Ambulance Service Medical Directors. The first major re-write since 2006, it features a number of significant changes in terms of guidance for clinical care. Work is already underway scoping future editions and updates, as can be seen in the obstetrics and gynaecology update published in this issue.

April saw the new health and care system in England become fully operational, with its ambitious aims to deliver the content laid out in the Health and Social Care Act 2012.

August saw the publication of the end of study report for the Paramedic Evidence Based Project (PEEP). Commissioned as a result of the growing interest in the delivery of paramedic education and training, the project called for the introduction of a national education and training framework for paramedics.

Perhaps the biggest piece of news came with Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care, published 13 November, which presented a significant step in the progression of the paramedic profession. Sir Bruce’s call for the development of 999 ambulance services so that they become mobile urgent treatment services, illustrated an appreciation of the skillset of paramedics and their potential in the delivery of pre-hospital care.

Finally, 2013 marked the five-year anniversary of the Journal of Paramedic Practice, which was launched in October 2008. On behalf of the journal I would like to thank the editorial board, the consultant editors, all those who have contributed to the journal, helping to make it an informative learning resource, and most of all, you the readers, without which this publication would not be possible. I look forward to another exciting year and wish you all the best for 2014.

Taken from Journal of Paramedic Practice, published 10 January 2014.