The research paramedic: a new role
Tuesday, October 1, 2013
Fitting the role into the changing face of paramedic practiceThe paramedic profession has changed dramatically over recent years and continues to change. We have moved away from protocol-led treatment and more towards independent clinical decision making supported by higher education (Emms and Armitage, 2010). This change in paradigm has moved us towards the realms of autonomous practice and helped us to develop as a profession. Paramedic training through higher education places more of an emphasis than ever before on understanding the research that underpins our practice.The current focus on evidence-based medicine has highlighted some of the opportunities for research in paramedic practice, which is a natural role for a research paramedic. Some areas of paramedic practice have historically been based on ‘scanty science’ (Callaham, 1997) and recent research-led changes, such as the changing attitude to the use of oxygen, show how much of an effect on day-to-day practice research can eventually lead to. A number of papers have been published which discuss the pressing topics that need to be researched in pre-hospital care (Brace and Cooke, 2010). Paramedics with skills, knowledge and experience in research will prove valuable in future trials. The inclusion of a paramedic, at all stages of a research trial, is thought to be both beneficial and key to overcoming some of the barriers to pre-hospital research (Schmidt et al, 2009; Hargreaves et al, 2013).A personal viewI joined the ambulance service in 2003 as a trainee advanced technician following the Institute of Health Care Development (IHCD) training route. I qualified as an advanced technician after a year or so then worked across the region until I sat my paramedic course in 2007. When I joined the ambulance service I had no inkling of where my career would lead and focused on the goal of learning to be a competent clinician, which to me meant becoming a paramedic. At that time, and until recently, I think the goal that a lot of people aimed for was qualifying as a paramedic. Becoming a paramedic was the end of a long and arduous process for me and at that point I wasn't looking where I would go next.Nowadays being a paramedic is a starting point for many people. Many entrants into the profession start with the expectation of being a qualified and operational paramedic at the end of a university-led course. Opportunities to progress beyond the role of paramedic are appearing in a variety of guises. Some paramedics may work on helicopters, specialise in primary care, some people may lean towards critical care, Hazardous Area Response Team (HART) offers a chance to develop your practice along different lines and most trusts have some form of team leader/station officer role. A different route that is also emerging is to develop a career in research.Once qualified as a paramedic I worked in a busy station until 2009 when I started the training to join the newly created HART. I worked in HART from 2010 until late 2011 when I moved across to take up a secondment in Research and Development (R&D) as a trial coordinator. This initial position was a temporary post which served as a good opportunity to see how a different area of the profession worked and see whether I was interested in pursuing this direction.Since 2011 I have been involved in a number of projects including large trials such as the Head Injury Transportation Straight to Neurosurgery trial (HITS-NS) and the Pre-hospital Randomised Assessment of a Mechanical Compression Device in Cardiac Arrest (PARAMEDIC) as well as other smaller, more localised pieces of research.The research paramedic role is a hybrid role combining clinical and academic elements. One of the ways that I see the research paramedic role developing is by building links between theory and practice, closing the gap between academics and clinicians. Clinical practice and experience informs the development of the next generation of research and allows a researcher to identify the gaps in the knowledge and see the issues that may benefit from research. Academic training and partnerships are necessary to develop the research and conduct robust and efficient trials that generate usable knowledge that is transferrable into real world clinical practice. Partnerships with hospitals and other NHS organisations are important to establishing the impact of most, if not all, pre-hospital interventions. Interventions performed in the pre-hospital environment may require data encompassing the complete patient journey, or their long-term usage of other healthcare services, to show an impact.The regulatory and professional representative bodies for paramedics both acknowledge the role of research in the paramedic profession. The Health and Care Professions Council (HCPC) standards of proficiency for paramedics make explicit mention of the possibility of working in a research setting and various references are made to the research related knowledge expected of all registered paramedics (HCPC, 2007).The new College of Paramedics (CoP) career framework which is due out in late 2013 includes a prominent research strand. This shows how the CoP believes that research is integral to the development of the profession in all the various directions being explored. The CoP career framework shows the scope for paramedics to operate at advanced, specialist and consultant levels and how these roles map against suggested levels of higher education qualifications (College of Paramedics, 2013). The CoP has a dedicated research and development advisory committee (RDAC) that can help and support paramedics pursuing research interests.The nursing profession, which we as paramedics work with on a daily basis and have learnt a great deal from, have the established role of the research nurse (Pick et al, 2011). This role has much to teach the evolving research paramedic and the two roles may work and develop closely in the future. The research nurse role is arguably further along in their evolution than the research paramedic role so there are lessons that can be taken in terms of integrating the dedicated research role into wider practice.
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