Ambulance delays are by now familiar to anyone working across paramedic practice. While this problem is not a new one, it is one that is steadily worsening (NHS England, 2022). Various impacts of this issue have been identified ranging from the obvious concerns around patient safety incidents and response times (Healthcare Safety Investigation Branch, 2022) to the more nuanced effects on recruitment and retention within ambulance services (Letcher, 2022).
One group that is affected very deeply by this problem and yet receives little attention in relation to it is the paramedic student population. As students, we are in placement within an ambulance service to experience as much paramedic practice as possible, closing the gap between our theoretical education and hands-on learning (Clarke, 2018). This bridging of the practice-theory gap can seem tough at the best of times, let alone when education is based in a world of practice that seems alien in contrast to current realities in some areas of the UK.
As a student, I have had shifts that fit well with how practice is talked about in the university setting: the patient is assessed in the prehospital environment, a treatment plan is created and the patient is transported and handed over to hospital for definitive care. All too often, however, I have also had shifts which start and end in a hospital car park. We arrive to take over an ambulance and patient from a crew who should have gone home half an hour ago. We then might continue this cycle 3–4 times, moving from ambulance to ambulance until we are released for a break.
There is some learning that can be found here for the dedicated student in the re-assessment of the handed-over patient, but it is nowhere near the same experience of elucidating a history first hand in the community. Uncomfortable patients will have already been asked the same questions and subjected to the same assessments, making the line between learning and simply irritating a patient very fine indeed. Similarly, many interventions will already have been carried out, depriving students of opportunities to practice core clinical skills such as cannulation or the administration of medications within the student's scope.
Mentor support here can make or break a student's day. Some of my mentors have assigned me tasks like communication with triage nurses or crew resource management while we wait for a bed (this experiential learning of less clinical or so-called ‘soft’ skills is great to practise where possible). Others have used connections with emergency department (ED) staff to provide learning opportunities, allowing me to shadow advanced clinical practitioners or other crews with different patients. Others still seem not to know what to do with me or themselves, and I cannot say I blame them, even as hours tick by.
Eventually days come to a close and we ourselves are relieved from our parking space by another crew. Student welfare is another area that sometimes lapses here. Should I attend a traumatic cardiac arrest while on placement? I will rightfully be offered a hot debrief and welfare support to safeguard my mental wellbeing. Spending 6 hours in a car park with a scared and confused psychiatric patient, trying to listen and support and best as you can is very different but no less distressing than an arrest—it would be nice to see similar support offered to students for these delay-related incidents.
Going forward, it is these matters in particular that worry me. With preregistration students being exposed to this for 3 years, could they be blamed for looking for opportunities outside the ambulance service on graduation? The staffing problems faced by the ambulance services are nothing new, (Mahase, 2022) but with newly qualified paramedics now having more options than just wearing green once qualified, it is not unforeseeable that recruitment and retention could become even harder in the future. For the sake of students, I feel a more open and honest acknowledgment of these problems and how they affect learning would go a long way to improving morale. More research into the exact scope and progression of the situation is key, so that new evidence-based ways of facilitating learning in difficult circumstance can be trialed and implemented.