When stacking up the history of paramedics against that of other healthcare professions in the UK, we are still the new kids on the block. Despite the fact that paramedic-style work has been undertaken in one form or another since the time of the Romans, it wasn't until the Chamberlain synthesis in 1970 (Chamberlain, 2018) that a distinct professional identity for the paramedic began to emerge in the UK. The idea of ‘mere ambulancemen’ undertaking medical interventions was shocking at the time, and initiated the proud tradition of paramedic practice being a path of positive disruption and new ideas. Today, this same disruptive attitude continues to promote change—not only in prehospital clinical care, but also within the profession that provides it. The concept of retrieval without care is long since gone, but so too is the idea of it being provided solely by those ambulancemen of old.
LGBTQ+ History Month
LGBTQ+ History Month, which takes place every February in the UK, provides an ideal opportunity to reflect on this element of our profession's development. It reminds us of how far we have come in our efforts for better equity in professional opportunity—and also how far we still have left to go, both for ourselves and our patients.
For me, personally, public perceptions of sexuality and gender identity once made my younger self doubt whether I would be suitable for paramedicine, yet I'm now a student paramedic. My confidence in taking the steps to get to this point came from the positivity provided by visible role models in the field who I could look up to, but the difficulties those LGBTQ+ paramedics have faced cannot be understated.
Paramedic practice parallels
There is an interesting symmetry in the developments of paramedic practice and LGBTQ+ equality. Homosexuality was only decriminalised less than a year before the first of Chamberlain's paramedics hit the streets of Brighton UK Parliament. By 1994, heavy campaigning had led to the age of consent for gay couples being lowered from 21 to 18 years (UK Parliament, 2022), just a year before 40 Northumbria Paramedics became the first in the profession to commence undergraduate study in the health sciences (College of Paramedics, 2021). By the time age of consent equality for homosexual couples (16 years old) was achieved in 2001 (UK Parliament, 2022), paramedics had been a registered profession for a year and the first of the degree-trained paramedics graduated. Legal protections for transgender people came in the form of the Equality Act [2010], the same year the College of Paramedics celebrated its 5th birthday. When gay marriage was finally legalised in England in 2014 [Marriage (Same Sex Couples) Act 2013], the curriculum guidance for paramedic education had reached its third edition.
Are we there yet?
All of these victories were hard fought over many years and are the reason that, today, I can sit in a lecture theatre or crew-room and feel safe being honest and open about myself. Yet while I am just beginning in this field as a student paramedic, I find that the parallel nature of these two histories also shares a common contradiction in the public perception of how recent they are. I often hear remarks reflecting the idea that our profession is still shiny, new and making disruptive steps in exciting directions. While I agree, I am still met by surprise when I talk about a hate crime I experienced or discrimination I witnessed in a professional setting. ‘I didn't think that happened anymore’ and ‘at least that stuff is rare now’ are common responses I've received from colleagues. I myself have been guilty in the past of taking for granted the liberty I now enjoy and forgetting just how recently those freedoms were wrought.
These successes should not detract from the present issues seen in care episode data for LGBTQ+ patients. The most recent National LGBT survey from 2017 showed that while accessing healthcare, 16% of respondents experienced discrimination because of sexual orientation and 38% because of their gender identity (Government Equalities Office, 2018). While these data are now more than 4 years old, these are still worrying figures. As of legislative decisions in 2021, I am still legally not recognised as a non-binary person. Meanwhile the government consultation period on banning the practice of so called ‘gay conversion therapy’ has continued to be extended since it started last October and has still not concluded (Government Equalities Office, 2021).
Looking back and ahead
As a clinician and now a student paramedic, I have learned how important reflection is and this LGBTQ+ History Month, I will be looking back at the two histories that are most important to who I am today. One will be familiar to many readers, while the other may be more surprising. I would encourage everyone to actively engage with both, and to consider their implications for the future. To ensure we can continue to provide good quality care in this difficult time, the momentum of development must be maintained. Our history tells us that there is much to be proud of and celebrate—however, if we want to recruit and retain a professional body that reflects the society we serve and continue to make strides, there is still more work to do.