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Trade your Crocs for steel toe caps


Emergency nurses and paramedics need to walk in each other’s shoes, says Mike Brady

Paramedicine is a profession that is in its infancy and one that is often shrouded in public misconceptions, similar to that of long-running television programmes. In reality, as emergency nurses know all too well, the delivery of emergency care has changed dramatically over the last decade.

The profession once deemed solely as a transportation arm of the NHS, much in the same way nurses were once seen solely as doctors’ assistants, is expanding both its scope of practice and the education that underpins it. Now predominantly at university level, it aims to match the constantly changing demographics of an ageing and increasing population.

The developing similarities between paramedicine and emergency nursing are perhaps not well known. The two professions that arguably need to approach emergency and unscheduled care in a cohesive manner, need to do so by sharing interprofessional education, and the abolishment of any potential tribalism or professional demarcation. This may only be possible through a better understanding and appreciation of the challenges faced by the other: “A shift in their shoes.”

“I question whether emergency nurses fully appreciate the dynamics in which paramedics work”

By perhaps leaving one’s professional comfort zone and trading proverbial Crocs for steel toe caps and vice versa, we can comprehend both the systematic and political constraints within which each practitioner both works and practices. With a modernising NHS faced with swathing financial constraints and increasing workloads, it is unsurprising that unnecessary accident and emergency admissions by emergency services are met with frustration and fatigue, coupled also with financial implications.

Solutions such as increasing education and interprofessional collaboration have thrown forth the availability of alternative care pathways, and while I recognise that more can be done by individual paramedic practitioners to reduce admissions, I question whether emergency nurses fully appreciate the dynamics in which paramedics work.

Biomedically, without the luxury of fully autonomous professional medical backing, supported by haematology, medical imaging, urinalysis and computerised patient information, paramedics work within the limitations of basically over-the-counter diagnostic equipment.

Psychosocially, often the location and condition in which we respond to our patients coupled with overloaded social and crisis teams, the inability to do anything but admit a patient to an A&E department is unavoidable. While paramedics should have to justify admitting a patient to A&E just as much as one does when providing an alternative pathway, both they and emergency nurses perhaps need to comprehend the limitations and frustrations faced by each other.

Whether it’s through better communication, appreciation, education or even trading places for a shift or two, we as professionals and practitioners need to learn and better comprehend the ways in which we both work, in order to both identify ways in which we can improve but to fundamentally provide joined-up, consistent patient care, in an ever-increasing professionally and economically challenging workplace.

Mike Brady is a graduate paramedic


Readers' comments (4)

  • I fully understand the dynamics of the paramedic role, and mentored many, and appreciate their role. However concern is expressed when persons work outside their parameters of practice. As an ENP I freqently see patients that have been attended to by paramedics on site, wrong advice given, for patients to then re-attend A & E, or return as emergency because the advice / care / vulnerable persons has been incorrect (excluding cardiac and major trauma pathways). Time in university may give practical knowledge but more training is needed in the clinical field. I do not want to go into specifics but I have seen some serious misssed diagnosis. Paramedics are seldom sued and have not the accountability that is required by nurses. Perhaps to enhance the latter paragraph we need to work on accountability to be able to move further on communications, appreciation, education etc.,

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  • michael stone

    Nobody ever 100% 'understands' people whose roles and experiences are different - everybody 'talking properly' is the only way you get anywhere close !

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  • i left the ambulance service 15 years ago, so my comments may be out of date.

    during my nhs td extended skills course (aka paramedic training) i spent several weeks in theatre, icu, ccu and a&e, brushing up my ecg interpretation and getting the required number of cannulations & intubations, among other things. although not required for their training many a&e nurses in my area elected to do shifts as a third person with ambulance crews, inducing incredulity that anyone would attempt cpr in the back of a moving ambuance on their own ("what, no crash team?!")

    at the time two types of joint training were available to ambulance paramedics, nurses and physicians; Pre-Hospital Trauma Life Support which certainly gave hospital staff more insight into ambulancing and some training who's name escapes me (Critical Care something) which although mainly aimed at improving physicians triage skills also gave paramedics more insight into hospital procedures post hand-over. there was also an "obs & gobs" course designed to reduce the need for crash teams to attend unplanned home delivery.

    perhaps naively i assumed more types of training, and particularly joint training, would now be available to ambulance technicians, paramedics, nurses and physicians. if anything, from this article, the situation seems to have gone backwards, despite the introduction of bsc's for paramedics.

    @ Anonymous | 5-Oct-2011 9:29 am
    i can remember cases where even training officers were sued for giving wrong advice regarding chest pain. i myself always followed the algorhythms, for instance where somebody tripped carrying bricks had chest pain, worse on moving their arms above their head, took them to a&e "just in case" as we were supposed to convey ALL chest pains to hospital. the pressure on paramedics not to convey such cases comes not from a lazy attitude but from the look on nurses' faces at hand-over. there will always be that very few ambulance persons who think they know better and try to exceed their training but it's not ambulance crews' jobs to diagnose but to treat for the worse case scenario and convey to hospital for diagnosis.

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  • As a student nurse I have just chosen to do a 4 week elective placement with the ambulance service. I have spent 2 weeks in an ambulance as a 3rd man and 2 weeks in a rapid response vehicle. I felt it was important for me to understand how patients get to hospital. Paramedics are accountable and have procedures to follow and if things aren't done correctly they have to present to the HPA.

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