The services that paramedics provide have changed, and will continue to change and develop, but what remains constant is the fact that the patient is at the centre of all that is done. The role has evolved radically and is developing at a rapid pace, moving from the emphasis on transporting the person to an accident and emergency department to a focus on critical clinical decision-making, treating and managing, and appropriate referral if required.
These changes in service provision are driven by a number of factors within and outside of the profession. Epidemiological data that tells us that the population is ageing, the great technological advances that are occurring, the complexities of illness, changes in skill mix, public expectations and performing under austere economic conditions. The profession itself has also been instrumental as a catalyst for change; for example, the College of Paramedics published its third edition of the Paramedic Curriculum Guidance last year, emphasising the need to equip paramedics for the challenges that health care delivery in the 21st century will present. The third edition of the Paramedic Post-Registration Career Framework is anticipated to be released in May. Paramedic development has the potential to bring opportunity for service development and also benefits for the individual concerning career progression. Development is triumvirate in nature with the patient at the centre, the service, the paramedic, the profession.
Curriculum development is as it says, in a continual state of flux and development, and this is how it should be. It should be flexible enough to respond to the many changes that will occur. Historically, paramedics have seen their education and preparation move into higher education. The ‘extended trained ambulance staff’ role back in the 1970s was the precursor to the current paramedic (this brought with it an extended scope of practice). Degree schemes were introduced in the 1990s and the desire to educate to higher academic levels continued as the profession raised the bar, becoming the 12th group of healthcare workers to be registered as an allied health profession with the then Health Professions Council.
Expanded pre-hospital care roles have to acknowledge and understand that paramedics are the first point of contact for patient care. The role of the paramedic now includes patient assessment, taking the patient history, clinical decision-making, ordering of diagnostic tests, confirmation of differential diagnosis, the administering of medicines, discharging patients, making appropriate referrals, teaching others and offering health promotion.
Advancing academic standards through the provision of a postgraduate degree (for example, Master's level) should be welcomed, but caution must also be applied in ensuring that they are not purely academic standards; they must be firmly rooted in paramedic practice. The role of the paramedic has changed and this must be acknowledged as well as the responsibilities that paramedics accept to undertake when offering a wide range of health care in very unique circumstances.
‘It is essential that the profession is led by paramedics, for the benefit of those who are the recipients of paramedic-delivered care: the public’
It is essential that the profession should be led by paramedics, for the benefit of those who are the recipients of paramedic-delivered health care: the public. However, dialogue is not unilateral and it must engage with a wide range of stakeholders for improvements to be ongoing, ensuring that the paramedic of tomorrow is fit for purpose and fit for practice, this may include preparation at Master's level for some or the provision of ongoing educational opportunity available at a range of academic levels that should include Master's level.
There has been an increase in the breadth of care that is being delivered, the College of Paramedics (2014) emphasises the clinical skills and competencies of the paramedic who is required to assess and manage patients who are very often in need of acute, chronic and specialist services. The scope of practice of paramedics continues to expand post registration, with a focus on patient safety and leadership. Education providers need to ensure that the development of those who wish to, and are also able to, can occur and the profession and the education provider need to work out what level this has to be offered at.
Patient outcomes have to be the metrics that are used to measure the impact of postgraduate education. At the moment, in the sphere of paramedic practice, we simply do not have the answer to determine if ‘postgraduateness’ can enhance outcomes; however, because we do not have the answer, this should not be a barrier to the implementation of postgraduate education, this has to be subject to ongoing review.
Throughout many of the developments within the profession there has been resistance to the changes for a number of reasons, and there will no doubt be resistance as paramedics take up more and more education at postgraduate level. There is an absolute need to offer postgraduate education as paramedic clinical capability expands, along with a change in focus to one that has a greater emphasis on urgent clinical decision-making and more responsibility for appropriately assessing patients, to ensure effective evidence-based decisions regarding where it is best to manage patients or make an appropriate referral.
‘The most important reason or purpose for the paramedic's existence (providing emergency care) must never be lost in the quest to develop the role and the person‘
Recognition of the role and appropriate reward for undertaking all that the advanced roles will bring with them, as well as the added responsibilities, must be considered. This may include remuneration and allowances made for staff to undertake the educational programmes of study; there will be an impact on service provision in many ways.
Consideration to career progression opportunities must also be thought about. Career enhancement strategies should deliberate carefully the progression for all paramedic staff in the service and this includes ways in which to motivate staff.
It is essential to consider the implications if we strive to produce some of the best educated paramedics in the world who will need to be provided with the added knowledge, skills, attitudes, aptitudes and expertise to contribute in the delivery of an integrated 21st century healthcare system.
The most important reason or purpose for the paramedic's existence (providing emergency care) must never be lost in the quest to develop the role and the person. Throwing the baby out with the bath water would be the single most detrimental action to the provision of safe, high quality and effective paramedic care. The second most detrimental action would be failing to seize the opportunity to increase postgraduate education opportunities for those paramedics who wish to progress in this direction.