References

Ahl C, Nyström M, Jansson L Making up one's mind—patients’ experiences of calling an ambulance. Accid Emerg Nurs. 2006; 14:(1)11-9 https://doi.org/10.1016/j.aaen.2005.10.002

Edwards T Association of Ambulance Chief Executives.London: Association of Ambulance Chief Executives; 2014

Association of Ambulance Chief Executives. Taking healthcare to the patient 2. 2011. http//aace.org.uk/wp-content/uploads/2011/11/Taking-Healthcare-to-the-Patient-2-REPORT.pdf (accessed 29 March 2020)

Banks T Ambulance services: could the UK learn from the French?. Accid Emerg Nurs. 1999; 7:(2)79-82 https://doi.org/10.1016/S0965-2302(99)80026-5

Barker R 2030—the future of medicine: avoiding a medical meltdown.Oxford: Oxford University Press Press; 2010

Beaulieu PFM, Vilain LB The emergency medical assistance service in France. Br J Intens Care. 1992; 2:260-267

Baskett PJ, Diamond AW, Cochrane DF Urban mobile resuscitation: training and service. Br J Anaesth. 1976; 48:(4)377-385 https://doi.org/10.1093/bja/48.4.377

Baskett PJF, Irving M, McKibbin B Saving lives: the NHS accident and emergency service and how to improve it.London: Institute of Economic Affairs Health and Welfare Unit; 1991

Black N Is hospital mortality higher at weekends? If so, why?. Lancet. 2016; 388:(10040)108-111 https://doi.org/10.1016/S0140-6736(16)30505-0

Bower JL, Christensen CM Disruptive technologies: catching the wave. Harvard Business Review. 1995; 73:(1)43-53

Brewis J, Godfrey R From Extreme to Mundane? The Changing Face of Paramedicine in the UK Ambulance Service.New York (NY): Routledge; 2019 https://doi.org/10.4324/9781315104447-11

Briggs RS, Brown PM, Crabb ME The Brighton resuscitation ambulances: a continuing experiment in prehospital care by ambulance staff. Br Med J. 1976; 2:(6045)1161-1165 https://doi.org/10.1136/bmj.2.6045.1161

British Medical Association. Staffing crisis in NHS laid bare, as new BMA analysis shows that three quarters of medical specialities face shortage of doctors. 2017. https//tinyurl.com/ybqc4m8s (accessed 9 March 2020)

British Heart Foundation. Heart statistics. 2011. https//www.bhf.org.uk/what-we-do/our-research/heart-statistics (accessed 24 March 2020)

Charlin B, Tardif J, Boshuizen HP Scripts and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Acad Med. 2000; 75:(2)182-190 https://doi.org/10.1097/00001888-200002000-00020

Christensen CM The innovator's prescription.New York (NY): McGraw Hill; 2009

College of Paramedics. Paramedic curriculum guidance. 2014. https//tinyurl.com/hbwghec

College of Paramedics. Paramedic post-graduate curriculum guidance. 2017a. https//tinyurl.com/s9k2eqr (accessed 9 March 2020)

College of Paramedics. Independent prescribing by paramedics to be recommended for implementation. 2017b. https//tinyurl.com/s7o5w7n (accessed 9 March 2020)

College of Paramedics. Paramedic career framework. 2017c. https//www.collegeofparamedics.co.uk/downloads/DigitalCareerFramework2017v2.pdf (accessed 27 March 2020)

Taking Healthcare to the Patient. Transforming NHS Ambulance Services. 2005;

Department of Transport. Reported road casualties in Great Britain: 2016 annual report. 2017. https//tinyurl.com/ts3oyho (accessed 9 March 2020)

Dick WF Anglo-American vs Franco-German emergency medical services system. Prehosp Disaster Med. 2003; 18:(1)29-37 https://doi.org/10.1017/S1049023X00000650

Easton KC Road accidents and the family doctor. Medical organization. Br Med J. 1969; 4:(5676)150-151 https://doi.org/10.1136/bmj.4.5676.150

Squeezing out the doctor. Bangalore Framingham. The Economist. 2012;

Flodgren G, Gonçalves-Bradley DC, Pomey MP External inspection of compliance with standards for improved healthcare outcomes. Cochr Database Syst Rev. 2016; 12:(12) https://doi.org/10.1002/14651858.CD008992.pub3

Gilhooly KJ Cognitive psychology and medical diagnosis. Appl Cogn Psychol. 1990; 4:261-272 https://doi.org/10.1002/acp.2350040404

Giround B Le Service d'Aide Médicale Urgente (SAMU). Portail des Secours du Grand-Duché de Luxembourg. 2012;

Granter E, McCann L, Boyle M Extreme work/normal work: Intensification, storytelling and hypermediation I the (re) construction of the ‘New Normal’, Organization. 2005; 22:(4)443-456 https://doi.org/10.1177/1350508415573881

Granter E, Wankhade P, McCann L, Hasard J, Hyde P Multiple dimension of work intensitiy: ambulance work as edgework. Work Employ Soc. 2018; https://doi.org/10.1177/0950017018759207

Health and Care Professions Council. HCPC decision on threshold level of qualification for paramedics. 2018. https//tinyurl.com/yxkaa6xj (accessed 26 March 2020)

Health Education England. An evaluation of early stage development of rotating paramedic model pilot sites. 2018. https//tinyurl.com/uforbqp (accessed 9 March 2020)

Hines K BASICS comes of age 1977-1998. A short history of immediate care.Ipswich: BASICS; 1998

Hwang J, Christensen CM Disruptive innovation in health care delivery: a framework for business-model innovation. Health Aff (Millwood). 2008; 27:(5)1329-1335 https://doi.org/10.1377/hlthaff.27.5.1329

Jashapara A Clinical innovation in pre-hospital care: an introduction to critical care paramedics in the United Kingdom.London: Royal Holloway, University of London; 2011

Keep M Report road accident statistics. Standard note: SN/SG/2198.London: House of Commons Library; 2013

Lewis D Bullying & harassment at South East Coast Ambulance Service NHS Foundation Trust. Plymouth University and Longbow Associates; 2017. 2017;

Paramedic evidence based education project (PEEP). End of study report. 2013. https//tinyurl.com/yay32sqy (accessed 26 March 2020)

Medical Commission on Accident Prevention; extended training for ambulance attendants. In: Lucas B (ed). Bristol: Stonebridge Press; 1979

Mackenzie R, Steel A, French J Views regarding the provision of prehospital critical care in the UK. Emerg Med J. 2009; 26:(5)365-370 https://doi.org/10.1136/emj.2008.062588

McCann L, Granter E, Hyde P, Hassard J Still blue-collar after all these years? An ethnography of the professionalizatin of emergency ambulance work. Journal of Management Studies. 2012; https://doi.org/10.1111/joms.12009

Millar ELM Report by the Working Party on Ambulance Training and Equipment. Part 1—Training. Ministry of Health, Scottish and Home Department.London: HMSO; 1966

Transforming NHS ambulance services.London: National Audit Office;

National Audit Office. NHS ambulance services. 2017. https//tinyurl.com/y8q82huc (accessed 9 March 2020)

New B Too many cooks? Response of The health-related services to major incidents in London (research report). The King's Fund. 1992;

Newton A Quo vadis: eight possible scenarios for change in the ambulance services. In: Wankhade P, Mackway-Jones K (eds). New York (NY): Routledge; 2019

Newton A, Harris G Leadership and system thinking in the modern ambulance service.Cham: Springer International; 2015 https://doi.org/10.1007/978-3-319-18642-9_7

Newton A, Hodge D The ambulance service: the past, present and future. J Paramedic Pract. 2012; 4:(5)303-305 https://doi.org/10.12968/jpar.2012.4.5.303

NHS Employers. NHS terms and conditions (AfC) pay scales—annual. 2019. https//tinyurl.com/vtwhrca

NHS England. Transforming urgent and emergency care services in England. 2015. https//tinyurl.com/ybwqgro3 (accessed 9 March 2020)

NHS England. Improving access: Paramedic practitioner service in the South Kent Coast. 2020. https//tinyurl.com/wvvufqp (accessed 9 March 2020)

NHS England and BMA. Investment and evolution: a five-year framework for GP contract reform to implement the NHS Long Term Plan. 2019. https//www.england.nhs.uk/wp-content/uploads/2019/01/gp-contract-2019.pdf (accessed 9 March 2020)

NHS Improvement. Operational performance and productivity in the ambulance service; unacceptable variations. 2018. https//tinyurl.com/y6v937ap (accessed 9 March 2020)

O'Cathain A, Knowles E, Bishop-Edwards L Understanding variation in ambulance service non-conveyance rates: a mixed methods study. Health Serv Deliv Res. 2018; 6 https://doi.org/10.3310/hsdr06190

Office of the Strategic Health Authorities. Emergency Services Review - A comparative review of international ambulance service best practice. 2009. https//www.sheffield.ac.uk/polopoly_fs/1.43654!/file/OSHA-Report.pdf (accessed 29 March 2020)

Page C, Sbat M, Vazquez K, Zeynep DY Analysis of emergency medical systems across the World. BSc project submitted to Worcester Polytechnic Institute. 2013;

Peacock PJ, Peacock JL, Victor CR, Chazot C Changes in the emergency workload of the London Ambulance Service between 1989 and 1999. Emerg Med J. 2005; 22:(1)56-59 https://doi.org/10.1136/emj.2004.016741

Palazzo FF, Warner OJ, Harron M, Sadana A Misuse of the London ambulance service: How much and why?. J Accid Emerg Med. 1998; 15:(6)368-370 https://doi.org/10.1136/emj.15.6.368

Implications of the changing role of the Ambulance Paramedic for the interpretation of inappropriate calls: a review of the literature. 2010. https//tinyurl.com/vubrctz (accessed 9 March 2020)

Rawlins M Michael Rawlins on innovation. Health Serv J. 2012; 122:(6298)

Royal College of Emergency Medicine. Emergency care in crisis. 2017. https//tinyurl.com/v59d2yy (accessed 9 March 2020)

Skills for Health and College of Paramedics. Paramedic specialist in primary and urgent care core capabilities framework. 2019. https//tinyurl.com/yxpevzer (accessed 9 March 2020)

Snooks H, Wrigley H, George S, Thomas E, Smith H, Glasper A Appropriateness of use of emergency ambulances. J Accid Emerg Med. 1998; 15:(4)212-215 https://doi.org/10.1136/emj.15.4.212

London Ambulance Service bullying and harassment review. 2015. https//www.thisislocallondon.co.uk/resources/files/34721 (accessed 28 March 2020)

Turner J, Coster J, Chambers D What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res. 2015; 3:(43) https://doi.org/10.3310/hsdr03430

Ambulance response programme. Evaluation of phase 1 and phase 2. Final report. 2017. https//tinyurl.com/vvp6cto (accessed 9 March 2020)

van der Gaag A, Jago R, Austin Z Why do paramedics have a high rate of self-referral?. J Para Pract. 2018; 10:(5) https://doi.org/10.12968/jpar.2018.10.5.205

Victor CR, Peacock JL, Chazot C, Walsh S, Holmes D Who calls 999 and why? A survey of the emergency workload of the London Ambulance Service. J Accid Emerg Med. 1999; 16:(3)174-178 https://doi.org/10.1136/emj.16.3.174

Von Vopelius-Feldt J, Wood J, Benger J Critical care paramedics: where is the evidence?. Emerg Med J. 2014; 31:(12)1016-1024 https://doi.org/10.1136/emermed-2013-202721

Revealed: why paramedics are fleeing the NHS. 2014b. https//www.spectator.co.uk/article/revealed-why-paramedics-are-fleeing-the-nhs (accessed 29 March 2020)

Wankhade P Different cultures of managements and their relationship with organisation performance: evidence from the UK ambulance service. Public Money & Management. 2012; 32:381-388 https://doi.org/10.1080/09540962.2012.676312

Woollard M, O'Meara P, Munro G What price 90 seconds: is ‘call connect’ a disservice to 999 callers?. Emerg Med J. 2010; 27:(10)729-730 https://doi.org/10.1136/emj.2010.102277

Wright K Extended training of ambulance staff.York: Institute for Research in the Social Sciences Centre for Health Economics, University of York; 1984

Wrigley H, George S, Smith H, Snooks H, Glasper A, Thomas E Trends in demand for emergency ambulance services in Wiltshire over nine years: observational study. BMJ. 2002; 324:(7338)646-647 https://doi.org/10.1136/bmj.324.7338.646

The paramedic profession: disruptive innovation and barriers to further progress

02 April 2020
Volume 12 · Issue 4

Abstract

The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity and became fully professionally recognised and regulated as allied health professionals, becoming an example of the phenomenon termed ‘disruptive Innovation’; this is something that creates a new market and value network while disrupting existing ones. The steep developmental trajectory of paramedics has not been mirrored by a comparable pace of reform and modernisation in NHS ambulance services which, in comparison, have lagged behind and also failed to adapt to significant changes in the pattern, quantity and epidemiological characteristics of patient demand. This has led to a mismatch between the capabilities offered by paramedics and the professional opportunities available to them in ambulance services, and hampered these practitioners' ability to make full use of their skills. The consequence of this has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover. Parallel developments in medical personnel deployment have increased the quantity of medical labour available to patients with serious or life-threatening injuries, with medical staff added to helicopter emergency medical crews. While many patients with urgent conditions would have benefited from general practitioners being available out of hours, proportionally fewer doctors are available to fulfil this role today and those that are attracted to working with the ambulance service often prefer to respond to cases involving major injury. For these reasons and given the reality that the ambulance service is morphing into primarily an urgent care organisation, de-emphasising the transport aspect of the service, changes are needed to its model of operation and to staff management and support.

Some inventions can be viewed as ‘disruptive innovations’—a concept that started to enter the managerial lexicon after being devised by Joseph Bower and Clayton Christensen in the Harvard Business Review in 1995 (Bower and Christensen, 1995). These innovations create a new market and value network, disrupting existing ones. This designation is normally applied to new technologies, such as microcomputers, digital cameras, mobile phones and small home photocopiers.

One important feature of this phenomenon is that the new product is initially inferior to established products but, over time, becomes progressively more capable and relatively less expensive. The relationship of film and digital cameras demonstrates this reality.

Disruptive innovation has been applied to many service industries, as exemplified by low-cost airlines or specific groups of workers, particularly if they offer technical capabilities that are broadly equal and effective as those offered by traditional providers but at a lower cost.

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed