Last month saw the publication of the long overdue and eagerly anticipated updated version of the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Guidelines for use by UK Ambulance Services (JRCALC, 2013), the first major re-write since 2006. Seven years is a long time in terms of clinical care, so it is not surprising that the new guidelines reflect some significant changes and it may take a while for all of these changes to be assimilated and introduced into clinical practice. The main changes have been collated and presented on the Association of Ambulance Chief Executives (AACE) website (AACE, 2013) and are accessible for all to read. The publication of the guidelines is just the first part of what could be a protracted implementation programme where employers decide whether or not they are going to make available all of the drugs that now appear in the guidelines, and whether or not they will embrace all of the recommended changes to practice or adopt them with some local variation such as different timing, dose, sequence or removal of elements of the guideline.
For NHS Ambulance Services a decision also has to be made as to which changes they will allow their practitioners to adopt without the need for further training, and how they are going to address any remaining training needs in a timely manner. The traditional ambulance service approach to change has been to bring all paramedics into the training centre for mandatory ‘one-size-fits-all’ updating, before allowing them to use new skills or drugs, but this is no longer appropriate given the changes that have occurred in the profession over the last decade or so. Paramedics are registered professionals and this means that they must take on the responsibility for keeping up-to-date with changes in practice with the support of their education departments rather than being dependent practitioners who have to be re-programmed following every guideline change.
It is important to remember the role of ambulance technicians and other pre-hospital practitioners as they are also affected by guideline changes. Given that most ambulance services employ several thousand pre-hospital practitioners, including ambulance technicians, nurses, and emergency care assistants, adopting a conventional didactic approach to training could mean that the next update of JRCALC will have been published before everybody has been trained. Not only is this impractical and detrimental to patient care, it could place the paramedic in direct conflict between their employer and their registering body, and it could also be seen as reflecting a lack of trust and confidence in the people who are employed to provide front-line emergency care to the public. It also needs to be recognised that JRCALC is just one guideline group and that other organisations, such as the Resuscitation Council UK, the British Thoracic Society, and the National Institute for Health and Care Excellence, produce guidance that will be relevant to paramedic practice. Patients deserve the best level of care that is available so it is imperative that employers and practitioners work together to ensure that delays in implementing new best practice are kept to a minimum whilst ensuring that any changes are implemented safely.