The discipline of paramedicine is rooted in a working culture, having evolved from transporting patients to hospital, to carrying out a broad range of clinical skills in the out-of-hospital setting. However, while current paramedic practice continues to require clinical and soft skills, it is embedded in higher education and integrated with a growing culture of research and leadership.
One of the main factors that distinguishes the historical ‘ambulance man’ from the present-day paramedic is the ability to think critically, often under pressure. Today's paramedic is not simply carrying out a task or even a skill—he or she is required to apply a sophisticated set of cognitive abilities, problem solve and make competent clinical decisions rapidly. Contemporary paramedics are applying an evolving evidence base to day-to-day practice, and are required to be somewhat experimental, despite being systematic, asking themselves in a given situation whether a particular intervention is in fact the right one based on his or her clinical observations and gut intuition.
In this month's issue of the Journal of Paramedic Practice, Beavan et al highlight that needle decompression of the chest is sometimes inappropriately carried out in the absence of tension pneumothorax, despite the fact that most chest trauma patients can be safely managed without it (p. 330). They importantly note that a level of clinical suspicion and critical thinking is required before needle decompression is carried out in this particular patient group.
In a similar vein, newly qualified paramedic, Abbygail Elsey, shares her reflections on the importance of being able to follow your gut and how having your eyes glued to the screen rather than looking at your patient can actually lead you away from discovering your patient's true needs (p. 359). She further notes that the ‘soft skill’ of listening is perhaps one of the most valuable despite the common misconception that soft skills are less important than clinical skills.
In this month's Consultant Column (p. 361), Daniel Smith shines a light on just how outdated a definition is used to describe today's paramedic, and how it doesn't even begin to paint a picture of the range of abilities, competencies and specialties currently carried out by modern-day paramedics. While it is an incredibly exciting time in paramedicine and our current paramedics are surely pioneers, there is a clear need to know precisely who these paramedics are and what specalised skills they are undertaking in order to provide them with the necessary support.
On p. 335, Anderson demonstrates further the gap for support required for paramedics on account of both the complex and emotionally taxing nature of the work, and the shift work that can take its toll on the practising clinician as well as his or her family members, who should also be supported in some way.
The perception that the jobbing paramedic at a patient's bedside somehow becomes less compassionate as soon as his or her attention is turned to practice guidelines, research, clinical reasoning and critical thinking in order to make appropriate decisions couldn't be further from the truth—it's because of this very compassion that a patient's care should be underpinned by evidence, coupled with a paramedic's valuable experience and trusted gut intuition.