Before the pandemic, I had been looking forward to this summer when I was supposed to complete my degree, graduate as a paramedic, and have a short break before starting work. Instead, I have received my first-class honours degree virtually, my graduation ceremony will likely now take place next summer, and I've started working as a temporary newly qualified paramedic (TNQP) with South Central Ambulance Service. I am currently midway through my induction and I'm a fortnight away from my preceptorship shifts before I begin working as an independent clinician.
As paramedicine is still a relatively ‘new’ profession in relation to other areas of healthcare, research in the prehospital environment is still lacking and there are so many variations in practice. Policies within ambulance service trusts and even practice from clinician to clinician within the same trust can differ in terms of everything from their techniques, to paperwork completion, to the tools they use to assess patients. Even for events as common as a stroke, there are many different instruments for assessment such as the FAST test, the MEND checklist and the ROSIER scale. During my last year as a student paramedic, I have come to accept that I need to be flexible in my approach and always be open to learning from updated research and from colleagues—particularly as I enter the ambulance service at a time where guidelines on personal protective equipment (PPE) and policies are changing on an almost daily basis.
COVID-19 has affected us all in so many ways—some more unexpected than others—and the pandemic has really got me thinking about the effect that unnecessary conveyance to hospital can have on our more vulnerable patients. At the beginning of lockdown, I was trying my best to avoid taking patients into hospital because even if they were going to the ‘clean’ (or ‘green’, depending on the hospital) side of accident and emergency (A&E), there was still a risk of contracting the virus that we know so little about.
Throughout my degree, I've always thought that when I start work, I'd err on the side of caution as an NQP and take patients in if I had the slightest concern. However, COVID-19 has emphasised the fact that paramedics really should manage patients in the community where possible. Even without a global pandemic, hospital admission can have disastrous long-term effects for our patients. Pressure ulcers, hospital-acquired infection and reduced mobility are unfortunately common consequences of being admitted and they can have a serious effect on the patient's quality of life, sometimes even becoming fatal.
If there's a positive to come from this outbreak, it's that I know I'll do my absolute best not to convey patients ‘just in case’ so that those who can safely be managed at home, have the right care and safety-netting advice in place to stay in the community.