Do advanced paramedics have a role as independent prescribers?

adobe-spark-3The journey regarding the proposal to introduce independent prescribing by advanced paramedic practitioners has been one focused on patient safety and a strong case for need. The challenge for the profession has been to ensure it’s positioned to respond to any concerns, and that any changes to the law allowing prescribing are made on the basis that patients will benefit.

Ministerial approval to take the proposal forward to the public consultation phase was granted by NHS England on 15 August 2014. The NHS England Allied Health Professions Medicines Project Team, in partnership with the College of Paramedics, developed a case of need for the proposal based on improving quality of care for patients. These improvements related to safety, clinical outcomes and experience, as well as the efficiency of service delivery, and value for money. Approval of the case of need was received from NHS England’s medical and nursing senior management teams in May 2014, and from the Department of Health non-medical prescribing board in July 2014.

Alongside the paramedic proposal, NHS England consulted on proposals to allow three other allied health professions to be able to prescribe or supply and administer medicines, as appropriate for their patients. These proposals were for independent prescribing by radiographers; supplementary prescribing by dietitians; and the use of exemptions within the Human Medicines Regulations 2012 by orthoptists.

At the time, Suzanne Rastrick, Chief Allied Health Professions Officer at NHS England, said:

‘Our proposals will allow patients to get the medicines they need without delay, instead of having to make separate appointments to see their doctor or GP.

‘Breaking down barriers in how care is provided between different parts of the NHS is key to the vision set out in the NHS Five Year Forward View.

‘Extension of prescribing and supply mechanisms for these four professions creates a more flexible workforce, able to innovate to provide services that are more responsive to the needs of patients, and reduce demand in other parts of the healthcare system.’

The public consultation opened on 26 February 2015 and ran for 12 weeks. As well as consulting on proposals for advanced paramedics to become independent prescribers of medicines across the UK, it also proposed that consideration be given to paramedic independent prescribers being allowed to mix licensed medicines prior to administration, and prescribe independently from a restricted list of controlled drugs. Anyone was welcome to respond, and feedback was received from members of the public, patients/patient representative groups, carers, voluntary organisations, health-care providers, commissioners, doctors, pharmacists, allied health professionals, nurses, regulators, non-medical prescribers and the Royal Colleges, as well as other representative bodies.

Why independent prescribing was not recommended

Following the close of the consultation, responses received were collated and analysed. The responses were considered by both the Commission on Human Medicines (CHM) and Medicines and Healthcare Products Regulatory Agency (MHRA), who felt unable to recommend independent prescribing for advanced paramedics at present.

The reasons for this decision were concerns over the wide range of conditions encountered by advanced paramedics and whether they could demonstrate evidence of adequate training and competency to diagnose the conditions that will be prescribed for. Additionally, there were notable concerns over the definition of an advanced paramedic practitioner, as this appears to vary between allied health professionals.

As a result, The CHM felt that independent prescribing might represent a risk to patient safety; for example, and in context with the lack of available evidence of competency at the time, if the wrong diagnosis was made and an inappropriate treatment was prescribed. They also felt that some of the examples cited to demonstrate a need for independent prescribing were not sufficiently robust.

Considering the possibility of independent prescribing

The College of Paramedics expressed disappointment that the CHM was unable to recommend independent prescribing for advanced paramedics at the present time, and has said it will continue its support and commitment to work with the project, and with NHS England this year to address the very legitimate comments made by the CHM. The college also said it would give regular updates to its members on the progress of the work.

Speaking on the possible future for independent prescribing by advanced paramedics, Andy Collen, medicines and prescribing project lead for the College of Paramedics, said:

‘We absolutely think that advanced paramedics have got a role as independent prescribers. The journey for any profession to undertake independent prescribing has to be done so with absolute rigour and consideration for patient safety. We need to provide reassurance that what is being proposed is going to benefit patients completely and that any risks are understood. Although it is disappointing, we absolutely welcome the feedback from CHM and we are continuing to work to answer the concerns the CHM have, and that is being supported by NHS England.’

Gerry Egan, chief executive officer of the College of Paramedics, said:

‘The College has a clear definition of the advanced paramedic role in terms of competencies and education and is working to make this the accepted definition both across the NHS and in the private health sector.

‘The College have no doubts advanced paramedics will deliver a massive benefit to patients in terms of delivering the right care at the right place and at the right time by the use of safe independent prescribing as part of integrated care systems.

‘The College remains totally committed to the proposal to introduce independent prescribing by advanced paramedics and looks forward to continuing supporting NHS England.’

Taken from Nurse Prescribing, published 9 September 2016.

Ambulance staff contemplate suicide due to poor mental health

Project M (1)‘It started to manifest itself after a failed resuscitation attempt on a child several years ago. While there were low-level symptoms over the years, and there were certain calls that would affect me more than others, there was much more severe recurrence after witnessing the aftermath of a plane crash over a year ago.’

Aryeh Myers, 39, is a paramedic for Magen David Adom, Israel’s national ambulance service. Before that he worked for London Ambulance Service NHS Trust for almost 10 years, as both an emergency medical technician (EMT) and paramedic. He was diagnosed with post-traumatic stress disorder (PTSD) just over a year ago.

Myers is one of an alarming number of paramedics whose mental health has suffered directly as a result of working for the ambulance service.

Recent figures published by mental health charity Mind revealed a third of ambulance staff surveyed contemplated taking their own lives due to stress and poor mental health. The results, taken from the responses of 1 600 emergency services staff and volunteers, including 308 in the ambulance service, also showed that 67% of ambulance staff contemplated leaving their job or voluntary role because of stress or poor mental health. A huge 93% reported experiencing stress, low mood and poor mental health at some point while working for the emergency services.

The figures also highlighted how 57% of ambulance staff took time off due to stress, low mood or poor mental health. These results reaffirm those published by The Observer that revealed over 40 000 days were lost by ambulance staff in 2014 due to mental health problems.

For Myers, he recalls how he took a month off work to begin treatment, including several sessions with a counsellor who taught him how to recognise triggers, how to partially ward them off, and particularly how to deal with the thoughts and reactions that those triggers bring.

‘It helped to a certain degree,’ he says. ‘At least I was able to go back to work. But there is, from what I’ve experienced, no way to completely get rid of PTSD, and certainly not if you continue working in the field where it was caused in the first place.’

Blue Light Programme

In October 2014, Mind was awarded LIBOR funding to deliver a programme to provide mental health support for emergency services staff and volunteers from police, fire, ambulance and search and rescue services across England up until 31 March 2016.

The Blue Light Programme focused on five main areas: tackling stigma and discrimination, embedding workplace wellbeing, building resilience of staff, providing information and support, and improving support pathways.

So far the programme has seen 250 000 information resources disseminated, 5 000 managers participate in line manager training, over 400 emergency services staff register to be ‘Blue Light Champions’, and 54 blue light employers and 9 national associations sign the Blue Light Time to Change pledge—a commitment to raising awareness of mental health, tackling stigma and helping enable staff and volunteers to talk more openly about their mental health at work. Currently, all ambulance services in England except East of England Ambulance Service NHS Trust have signed the pledge.

Funds have been allocated for Mind to continue to deliver the programme on a smaller scale throughout 2016/17.

Esmail Rifai, 50, is a clinical safety officer for North West Ambulance Service NHS Trust, who recently returned to work following a long period of work-related anxiety and depression. He lost a work colleague and friend to suicide.

‘My colleague taking his own life had a devastating effect on me at a time when I was coming to terms with my own mental health,’ he says.

‘At work I often take on more than time permits, which inevitably takes its toll and ultimately ends up with my own mental health deteriorating.’

Rifai is a ‘Blue Light Champion’ and has found the experience helpful in coming to terms with his own mental health issues. ‘Being involved with the Blue Light Programme has also given me some solace,’ he says. ‘Knowing that I’m helping others in itself makes me feel good—a sense of achievement.’

Exposure to shocking events

Project M (3)Dan Farnworth is an EMT for North West Ambulance Service NHS Trust who has also suffered from PTSD.

‘My mental health issues started about a year and a half ago,’ he says. ‘We went to a job that involved child abuse. It was awful. We did everything that we could, but unfortunately we weren’t able to save the child.’

While Farnworth understandably felt low after the job, it wasn’t until 24 hours later that he found himself unable to shake the image of the child from his head.

‘At work I wasn’t acting like myself anymore; I wasn’t socialising as much with colleagues, and generally not interacting with people.’

In addition to his work, he found the event had begun to affect his life at home as well.

‘It made me a grumpier person, and my patience was a lot shorter. It even started to affect my sleep, and I found myself having nightmares about it.

‘I’d often find myself just sat there, not really doing anything but thinking about the job, and thinking about whether there was anything else I could have done.’

The nature of work undertaken by ambulance services means there are times when paramedics find themselves turning up at the scene of a shocking or upsetting event.

‘As a paramedic there is no way to avoid seeing sights that are difficult,’ says Myers. ‘It may be one shocking call, or it may be a build up over time, but I believe we are all affected in some way by the things we see, by the emotion we experience but are forced to contain while dealing with our job. Showing any sign of emotion is still perceived as a weakness rather than an outlet, and this is one of the things that needs to change.’

Kevin Sibley is an EMT for East of England Ambulance Service NHS Trust who served 8 years within the army. A year of that time was spent in Northern Ireland where he witnessed a number of harrowing events. He remains unconvinced at the prevalence of mental health problems suffered by ambulance staff.

‘I have known people who have left the ambo service and have come back 6 months later after querying suffering mental problems,’ he says.

‘Unfortunately I think lots of people use the mental health card in the ambo. PTSD in the military is not an excuse, it’s because your mates who will die for you are killed in a horrible situation. Unfortunately I can’t compare this to the ambo service as we join to help people in road traffic collisions (RTC) etc. You [can] walk in to a hanging, RTC or decapitation.’

Sibley is of the opinion that some paramedics are quick to associate distressing events with potential mental health issues, with some reaching for the latest buzz word to explain how they are feeling.

‘I don’t mean to belittle people with issues but we were unwell,’ he says. ‘Not dealing with it, then stress, then depression. People looked for a new thing, a new name, and grabbed PTSD.’

Support for ambulance staff

Currently, ambulance services have internal debriefing support services, and through occupational health staff have access to professional counselling services. Additionally, support is provided to ambulance service staff and their families by The Ambulance Services Charity (TASC).

‘Most people will normally feel some levels of stress throughout their day—the fight or flight model enables us to cope with difficult situations,’ says Jean Hayes, director of support services for TASC. ‘However, prolonged levels of stress can sometimes have a negative impact on health and wellbeing. For some ambulance personnel, constant and increasing exposure to difficult situations may result in poor health.’

Hayes explains how since its launch in March 2015, TASC have been approached by a number of ambulance personnel suffering from low mood, stress-related illness and undiagnosed PTSD, many of whom remain in work providing a dedicated service to the general public.

As a result, the charity is currently developing a programme of support for individuals, working with a leading psychologist, which will enable ambulance personnel to recognise their own symptoms and develop strategies to help manage poor mental health.

‘Subject to funding, TASC aim to roll out this programme of work nationwide,’ says Hayes. ‘Along with other support services, TASC are here to support those working in the UK ambulance services, whenever they are facing unexpected difficulties, crisis or are in need.’

The College of Paramedics has been working closely with Mind over recent months, and is an active participant in the blue light mental health agenda nationally, along with the Association of Ambulance Chief Executives (AACE).

According to David Davis, paramedic and fellow of the College of Paramedics, the College has recognised the importance of the mental health and wellbeing of paramedics and other ambulance and pre-hospital professionals for a number of years. These include significant concerns around what many feel is an unachievable retirement age of 68, significant changes in working practices and increased workloads resulting in increased isolation of practitioners, as well as concerns over violence and aggression towards emergency services workers.

‘The research undertaken by Mind, as part of the Blue Light Programme, has reinforced anecdote with real meaningful data about the level of problems, and importantly revealed that many frontline staff were not keen on being open about mental ill health and stress for fear of either embarrassment or adverse consequences from employers or otherwise,’ says Davis.

‘The most recent data was very worrying indeed,’ he adds. ‘Particularly that 35% of those ambulance staff completing the online survey had contemplated taking their own lives.

‘There is increasing awareness of the risk of suicide among paramedics and other emergency ambulance service personnel that simply cannot be ignored, and the recent data from the Mind survey tells us that actions must be taken now to support and protect this important group of public servants.’

Davis, who is spokesperson on mental health for the College of Paramedics, goes on to highlight that the recent College of Paramedics conference revealed a clearly expressed mandate to make mental health of the membership a priority and to support the Mind programme.

‘A single suicide of one of the brave men or women who I am proud to call my colleagues is a tragedy too many,’ says Davis. ‘We must work together to tackle the issues of mental ill health, whether they be stress, depression, anxiety or post-traumatic stress disorder.’

The AACE is one of the national associations signed up to the Mind Blue Light Time to Change pledge and were fully engaged in the Blue Light Programme throughout its initial duration. According to Anna Parry, national programme manager for the AACE, the association is continuing to benefit from the work undertaken by Mind, with the Time to Change Programme Manager contributing to ongoing work the AACE is overseeing to promote and enhance the mental health and wellbeing of staff. At the national level, the AACE is collating information and data in this area to better understand what more can be done to support ambulance service staff.

‘The sector feels that there is more that could and should be done to fight mental health stigma and discrimination and to enhance the supports that are available to staff in this area,’ says Parry.

‘The mental health and wellbeing of staff subsequently features in the AACEs 2016–17 strategic priorities; these are identified and progressed by ambulance services nationally,’ she adds.

Removing the stigma

Project M (4)Farnworth believes that with ever increasing demand on the ambulance service, there is not as much opportunity for discussion and reflection between jobs anymore.

‘When staff attend a particularly traumatic job, they are offered some “time out” but many staff don’t take this up when they know there are patients out there waiting for our help,’ he says.

‘As much as we look out for each other, there is still a bravado or “stigma” attached with this job; we all like to think we are infallible. We are there to support the public in [their] time of need, but we tend to not ask for help ourselves.’

‘Talking to my peers has also been a massive help,’ says Farnworth. ‘It helps me realise that what I’m going through is normal, and that many people experience things like this from time to time.’

This sentiment is something that Myers finds he can also relate to:

‘The first piece of advice I would give would be “do not be ashamed”. It took me a long time to admit both to myself and to those around me that there was something wrong. There is still a stigma attached to mental health issues, particularly PTSD, in a field where it is expected that you just get on with the job, that prevents people from seeking help. A first-line defence must be to talk, be it to a colleague, a friend or a relative, or, if the need arises, to a medical professional who will be able to give guidance with reference to the right course of treatment if required.

‘Don’t be afraid to seek help. Because the subject up until very recently was taboo, it was not well known how and where to seek help, but I believe that it’s slowly improving.’

Rifai also believes that stigma surrounding mental health should be removed: ‘There is no shame or stigma attached to experiencing mental health problems, it’s just the same as breaking a bone, except no one can see that you are suffering. We are not super humans and we are just as prone to illness as anyone else, if not more.’

Blue Light Walk

To help raise awareness of mental health problems within the blue light community and get emergency service personnel talking, Farnworth has teamed up with Richard Morton, paramedic; Philip Baggaley, senior paramedic; and Gill Despard, paramedic lecturer practitioner, to walk from Scarborough RNLI to Blackpool RNLI stopping at fire, police and ambulance stations along the way. They will be raising money for the Blue Light Programme.

The walk will take place from 26–30 September and they are inviting all emergency services, as well as the general public, to join them on the ‘last leg’ from Broughton ambulance station to Blackpool RNLI. Additionally, they are putting on a Blue Light Walk Charity Ball to celebrate the success of the walk on 1 October. If you would like to support their cause or join them then visit http://www.bluelightwalk.com.

Has your mental health been affected as a result of working for the ambulance service? If so, Journal of Paramedic Practice would like to hear from you. Email jpp@markallengroup.com

Taken from Journal of Paramedic Practice, published 6 May 2016.

The bare necessities: delivering first aid in the Calais ‘Jungle’

Student paramedic, Sam Wheeler, treats treats a Sudanese refugee who burned his hand after the tarpaulin used to make up his tent caught fire. Photo Credit: Rose Oloumi

Student paramedic, Sam Wheeler, treats a Sudanese refugee who burned his hand after the tarpaulin used to make up his tent caught fire. Photo Credit: Rose Oloumi

It’s 11:00 am and a group of 20 people are congregated in a small area between three caravans lined up to form a triangle. Amid the din of Arabic, Farsi and French, snatches of broken English can be heard complaining of sore throats or noses that are ‘closed’. A number of medical volunteers are busily trying to organise a queue, with shouts of ‘one at time’ having to be regularly made. This pandemonium could be any health professional’s idea of a nightmare, but this is just another day in the Calais ‘Jungle’.

These volunteers, made up of doctors, nurses, paramedics and students, have sacrificed their weekend to provide first aid within the refugee and migrant camp located on the outskirts of the city. They form part of the Refugee Support First Aid and Care Team, who since September 2015 have been delivering care from the heart of the ‘Jungle’.

Introducing a first aid team to the Calais ‘Jungle’

One of the first aid caravans situated in the camp. Photo Credit: Rose Oloumi

After hearing about the lack of basic medical care available to refugees and migrants in the ‘Jungle’ over weekends, Liz Gall, a luxury wedding planner and former retail bank manager, set up Refugee Support. Founded on 9 August 2015, the aim of the organisation is to take aid over to refugees and migrants residing in the Calais ‘Jungle’.

‘After living in the jungle at weekends for a month, it became apparent that there were no medical facilities available either at night or on a weekend,’ says Gall.

Current medical aid delivered in the camp is limited. As a result of the ‘Jungle’ not being recognised by French authorities as an official ‘refugee camp’, no large charities or humanitarian groups have a real presence on the ground.

Médecins du Monde (MdM) (Doctors of the World) has provided essential medical help to refugees and migrants living in and around Calais and Dunkirk since 2003, but withdrew from the ‘Jungle’ at the end of 2015 after a theft from their building. Médecins sans Frontières (MsF) (Doctors without Borders) has provided aid since early December and runs a health clinic that is open Monday to Friday. However, it is believed its contract ended on 1 March.

It was because of this that Gall felt the need to set up Refugee Support:

‘Following a conversation with Hassan Chaudry (GP) and Raid Ali (dentist) on return from Calais on 14 September, we decided that as there were UK healthcare professionals wanting to help, we would try and make it happen.

‘Our original aim was to provide care on weekends, when MdM were not in the camp. Refugee Support First Aid and Care Team and Refugee Support Dental Team were borne out of this.’

With help from Caravans for Calais, Gall arranged for a caravan to be sent to the ‘Jungle’ from the UK, with the aim of using it as a mobile clinic for refugees and migrants.

‘On Saturday 26 September we opened our first caravan and treated people on the street in the jungle,’ recalls Gall.

The caravan was funded by a group on Facebook called the Creative Collective for Refugee Relief, who had raised money by selling their artwork online. Two further caravans were sent over in the following 2 months to be used for first aid, as well as an additional caravan for dental care.

Map of Calais ‘Jungle’ highlighting medical care points. Map Data ©2016 Google

Map of Calais ‘Jungle’ highlighting medical care points. Map Data ©2016 Google

Volunteering in the ‘Jungle’

First aid shifts within the camp are coordinated through the Refugee Support First Aid and Care Team Facebook group. Health professionals input their dates of availability, as well as contact information and important details such as their registration number. Registration is then checked against the appropriate regulatory body and dates confirmed. Paramedics currently make up a relatively small percentage of the overall first aid volunteers, with the majority being made up of either doctors, nurses or medical students. So far, over 400 people have volunteered as part of the Refugee Support First Aid and Care Team at the camps located in Calais and Dunkirk.

Dan Evans is a final year medical student at Cardiff University overseeing the first aid caravans as team leader over March. He has been at the camp for 2.5 weeks as part of his medical elective and has another 2 weeks remaining.

‘The vast majority of work is making sure people aren’t unwell, aren’t septic,’ says Evans.

According to Evans, patients are predominantly treated for minor ailments such as colds, flu, sore throats and the nasty variety of chest infections referred to as ‘Jungle lung’. Additionally, broken bones, bruises, sprains and cuts are treated following altercations within the camp or with police, or failed attempts at crossing the border into the UK.

The three caravans used by the first aid team are situated towards the north end of the camp and offer patients a private space for consultations. Where possible, patients are treated there and then. In cases where additional care is needed or follow-up required, patients are referred to the clinic run by MsF. Outside, strepsils, cough medicine and bracelets made from tubigrip and cotton wool soaked in olbas oil are dispensed from a counter made of chipboard.

While the majority who come to visit the caravans receive some medicine and are sent on their way, a small number who turn up are considerably unwell. Notably on this weekend, a young man is seen crouched on the dusty floor, cradling his head in his hands. After an examination by a doctor in one of the caravans, it is recognised he has meningitis and is subsequently rushed to the emergency department in the city.

Among the first aid volunteers at the ‘Jungle’ on the weekend of 12 March are a group of student paramedics from the University of Surrey, who between them raised over £1,000 to go towards medical supplies for the caravans.

They used part of the donations to purchase two paramedic rescue backpacks to enable them to act as a mobile clinic and provide first aid on foot to those in need.

Shadowing the students, it is apparent that being able to bring care to those who may not be aware of the existence of the caravans, or who might fear the implications on their claims for asylum by visiting a clinic and having their details recorded, offers the volunteers access to patients not possible before.

‘We have done something really good with starting an outreach programme which they didn’t have,’ says Javier Garcia-Marcos, a second-year student paramedic. ‘As student paramedics I think we are best placed to do that.’

On this weekend alone, a Sudanese refugee is treated for a burn after the tarpaulin used to make his tent caught fire; an Eritrean refugee who was stabbed in the back following an argument in the camp has his dressing changed; and a Kurdish woman who was afraid to visit the MsF clinic is revealed to be pregnant. Having been trying for a child for 5 years, she thanked the student midwife with tears in her eyes and proceeded to invite her inside her caravan for tea.

The general mood within the camp appears friendly, with many of the refugees and migrants all too happy to offer their seat or extend invitations for a hot drink. Yet despite this, there have been a number of reports of volunteers being attacked or intimidated.

When asked whether he feels safe, Evans pauses for thought:

‘There is a lot of crime as everything is unregulated, but I wouldn’t describe it as dangerous,’ he says. ‘If you are British and not wearing a police uniform, people know you are here to help,’ he adds.

The lack of police within the camp is evident and it is clear their presence is not welcome. Instead they stand in groups around the perimeter of the camp, clad from head to toe in riot gear and ready to intervene should any situation escalate.

Speaking to some of the other volunteers, they agree the overall feeling within the camp appears to be positive:

‘The general mood was quite good. I didn’t find any aggressive people and they were quite accommodating,’ says Omar Yusof, a second-year student paramedic at the University of Surrey.

‘I think people need to remember they are not just refugees, they are people,’ says Jordan Wheeler, a second-year student midwife at the University of Surrey. ‘They are just like us, it is naive to refer to them as locals.’

While the volunteers describe the experience as memorable, it has evidently not been without its difficulties:

‘You feel a bit useless as there is no referral,’ says Wheeler.

‘It is difficult to assess people properly due to very basic equipment, it is also difficult to communicate,’ adds Sam Wheeler, a second-year student paramedic at the University of Surrey. ‘However, it has given me a big boost in confidence. Working in a different environment you have to be inventive.’

When asked what advice the volunteers would give to those considering coming out to Calais, they give out a series of practical steps:

‘Bring your own diagnostics kit,’ says Yusof. ‘It would also be best to have people well trained in minor injuries.’

‘Come in teams as that is the way we are used to working. I think working in twos and threes works really well,’ says Garcia-Marcos. ‘Also, try to learn a few words in Arabic, it opens a lot of doors.’

Student paramedic, Javier Garcia-Marcos, examines an Eritrean refugee complaining of knee pain. Photo Credit: Rose Oloumi

Student paramedic, Javier Garcia-Marcos, examines an Eritrean refugee complaining of knee pain. Photo Credit: Rose Oloumi

Future plans

Refugee Support is currently in the process of registering as an official charity, and according to Gall, the future looks bright:

‘In 6 months what we have achieved is phenomenal. Our original aim was to provide weekend care, yet since December we have covered 7 days a week.’

However, the recent destruction of the southern section of the camp—which left up to 3 500 people without homes—and the proposed demolition of the northern section, has meant things have had to be taken one day at a time:

‘As the requirements within the camp change we must adapt with them,’ says Gall. ‘We were due to have a wooden first aid centre built in Calais, but this is currently on hold until we can be certain that the latest news to maintain the northern part of the camp is happening.’

As a result of regular evictions and demolitions, life in the ‘Jungle’ is constantly forced to change. On 4 March, a re-purposed double decker bus was delivered to the camp to replace the Women and Children’s Centre that disappeared when the southern part of the camp was destroyed. The aim of the bus is to offer a safe living space on the ground floor for women and children, and a dormitory upstairs intended for unaccompanied minors. Additionally, a vaccination clinic set up by Health and Nutrition Development Society (HANDS) International, who have been immunising against influenza and measles, was also forced to move.

However, this constant need for adaptation has not dampened the determination of the volunteers who come to Calais. There is no denying that in the short time since its inception, Refugee Support has gone from strength to strength, yet Gall emphasises it has only been possible because of the people who have dedicated their time to making it a growing concern.

‘We have the most amazing volunteers, and are so grateful to them. Because we are a small group and they are so compassionate, we can adapt at reasonably small notice,’ she concludes.

For more information, or to register your interest in volunteering, visit: www.facebook.com/groups/CRS.UKMEDTEAM/?fref=ts

Taken from Journal of Paramedic Practice, published 1 April 2016.

Final days to provide feedback on the Emergency Care and Treatment Plan (ECTP)

The Resuscitation Council’s (UK) consultation on the Emergency Care and Treatment Plan (ECTP) closes on Monday. The Resuscitation Council (UK) is giving health professionals the opportunity to provide feedback on the concept of the ECTP and its supporting documents via a survey on their website.

The purpose of an ECTP is to record a summary of decisions about what care and treatment a patient would or would not want to receive, if their health deteriorates and they are unable to make those choices at the time.

The decisions recorded on the form can provide immediate information to guide health professionals who are looking after a patient in an emergency. They may not have met the patient before and may not know full details of the patient’s usual state of health or their wishes. Those professionals may include doctors, nurses and ambulance paramedics. They may be looking after the patient at home, in a hospital, in other places such as a nursing home or hospices, or during a journey by ambulance.

The ECTP aims to ensure that patients receive the best possible treatment for their individual situation. It cannot be used to request or demand treatments that will not be beneficial to them.

This consultation offers paramedics and other pre-hospital professionals an excellent opportunity to voice their views on the ECTP and help shape its future direction. I therefore implore you to take a moment over the next few days to fill in the survey.

Report reveals extent of alcohol-fuelled physical assaults on ambulance staff in North East

According to a new survey, almost half of paramedics in the North East of England have been subjected to alcohol-fuelled physical assaults while on duty.

The survey of more than 350 paramedics was carried out by the North East Ambulance Service NHS Foundation Trust (NEAS) and Balance, the North East of England’s alcohol office. Results of the survey were published on 19 August and detail the impact of alcohol misuse on the region’s paramedics.

The report also revealed more than two in five NEAS paramedics have at some point been sexually assaulted/harassed while on duty. Additionally, nine out of ten paramedics agreed that dealing with alcohol-related callouts places an unnecessary burden on their time and resources; and three in five paramedics believed they shouldn’t have to deal with the consequences of excessive consumption of alcohol.

A quarter of paramedics stated that at least 50% of their workload on weekday night times is alcohol related, while two thirds of paramedics stated that alcohol-related incidences account for at least 50% of their workload during weekend shifts.

Between April and December 2014, Balance surveyed 358 paramedics, representing 32% of the NEAS workforce, to establish how they perceive the impact of alcohol misuse on their lives. Throughout the report the term ‘paramedic’ includes the roles of emergency care support workers, technicians and urgent care assistants.

Yvonne Ormston, NEAS chief executive, said: ‘Our crews don’t just deal with drunk weekend revellers; our crews see the effects of alcohol at all times of the day and all times of the week, spread across our region and from patients of all ages and backgrounds.’

She added: ‘We take a zero tolerance approach to assault and support staff every step of the way if they have been abused. All staff also have access to a counselling service and a number of helplines to ensure their mental health is looked after as much as possible.’

In 2013/14, Balance estimated that alcohol-related harm cost the region £911 million, with the NHS paying £242 million.

Colin Shevills, director of Balance, said: ‘ It’s outrageous that paramedics don’t feel safe in their working environment as a result of other people’s alcohol misuse. These are people who are there to help us when we need it most, yet they are living in fear of physical and verbal abuse on a daily basis. How many of us would expect to work like this?

He added: ‘Our relationship with alcohol is out of control. We need to bring it under control by making alcohol less affordable, available and less widely promoted. We need the Government to support a range of targeted, evidence-based measures such as increasing the price of the cheapest, strongest alcohol products, which has been shown to save lives, reduce hospital admissions, cut crime and lessen the financial burden alcohol places on frontline services.’

Taken from Journal of Paramedic Practice, published 19 August 2015.

Rise in number or paramedics leaving NHS ambulance services

The numbers of paramedics leaving NHS ambulance services is increasing, according to figures obtained from ambulance Trusts.

At least 1,015 paramedics left their job in 2013–14, compared with 593 in the same period two years earlier.

This has meant crews are under greater pressure than ever before to meet demand.

As the amount of emergency calls continues to rise each year, there has failed to be an equivalent rise in the number of qualified ambulance staff.

Anthony Marsh, chairman of the Association of Ambulance Chief Executives, says that a surge in 999 calls this year and higher numbers of paramedics leaving some services, means the remaining front-line staff are facing pressures that are ‘greater than they’ve ever been.’

He added: ‘Traditionally, ambulance services receive just over 4% more 999 calls each year, and we have done for the last 10 years—some years a little bit more than that, some a bit less—but this year we’re seeing substantially more 999 calls.’

Dr Fiona Moore, medical director for London Ambulance Service NHS Trust, said:

‘We’ve seen an increase in calls from the 21- to 30-year-old group, and I think that now reflects the sort of supermarket culture we now have, so if you can buy a loaf of bread at 04:00 in the morning, why can’t you access you healthcare when it is convenient to you?’

Taken from Journal of Paramedic Practice, published 20 October 2014.

HCPC publishes new standards of proficiency for paramedics

The Health and Care Professions Council (HCPC) has published revised standards of proficiency for paramedics.

The standards of proficiency are the professional standards that every registrant must meet in order to become registered, and must continue to meet in order to remain on the HCPC Register. The standards set out what professionals should know, understand and be able to do to practise safely and effectively.

The standards of proficiency are divided into generic standards (which apply to all HCPC-regulated professions) and standards specific to each profession.

The HCPC Council approved revised generic standards in March 2011 and the HCPC is now working to update the standards that apply to each individual profession. The revised profession-specific standards for paramedics have been published as part of this process.

Michael Guthrie, Director of Policy and Standards, said:

‘We have worked with the College of Paramedics to review the standards and asked them to make recommendations. We have also considered the feedback we received from our public consultation and are grateful to all those who participated in the process.

‘The changes we have made to the profession-specific standards for paramedics ensure that they reflect current practice and include language that is appropriate to the profession.’

The HCPC will now work with education providers to implement the new standards.

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