Clinical Practice Lens
‘In the first edition of the Journal of Paramedic Practice, Roland Furber promised that the journal would hold relevance to the paramedic profession as a whole, and asked for paramedics to come together to contribute their experiences, opinions and research. We feel the last 10 years of the journal have lived up to this promise, with early clinical practice articles covering pulse oximetry, a feasibility study of pre-hospital arterial blood gas (ABG) analysis and research into ventilation during cardiac arrest. As a profession, we have come a long way in a decade, with specialist paramedics now undertaking thoracostomies, surgical airways and pre-hospital ultrasound, while using drugs to undertake nerve blocks, sedation and paralysis. Furthermore, paramedics are no longer confined to the pre-hospital setting, as their skills become universally recognised in the wider healthcare environment. Most recently, we have seen the roll-out of paramedic prescribing, which will undoubtedly facilitate the progression of paramedics in all domains, and pave the way for further specialist and advanced paramedic roles.’
Research Lens
‘Paramedic practice does not enjoy the long history of many other healthcare professions and has lagged behind in the development of its evidence base. Traditionally we have relied upon other professions—notably the medical profession—to do our research and tell us what to do. When the Journal of Paramedic Practice was established in 2008, it would not have been possible to fill pages with original research by paramedics as so few engaged with research. What a difference a decade makes: paramedics with PhDs, researching in their own field, employed in research roles by NHS ambulance services, and publishing their own work in high-impact, peer-reviewed journals. Paramedics are engaging in both small- and large-scale studies that are informing and transforming practice and patient care. A sure sign of a mature healthcare profession is one that engages in, and generates its own evidence—I would argue that the profession is maturing more rapidly than it has done at any time since professional registration was achieved. Although we are not at full maturity in terms of paramedic research, we are certainly further ahead than I would have expected 10 years ago!’
Leadership and Management Lens
‘In the last 10 years, paramedics have developed new skills needed for leadership and management posts across clinical practice, research and education. New roles have emerged, including consultant and research paramedics. Clinical leadership is key to developing and supporting organisations that deliver quality care. Fewer patients can be transferred to emergency departments, and greater numbers are treated at home. The need for appropriately educated leaders with experience and influence is paramount. Management is closely linked to leadership, including the ability to manage diverse paramedic teams over wider geographical areas, and clinically manage patients, with the introduction of monitoring standards of care for acute myocardial infarctions, stroke, and cardiac arrest among others. Underpinning effective management and leadership is education. The past decade has witnessed the expanding role of the College of Paramedics, with the majority of paramedics now with academic backgrounds, and with practice being further supported by independent prescribing for advanced paramedics—a much awaited asset for paramedics leaders and managers.’
Education Lens
‘Ten years ago, in the first Journal of Paramedic Practice, John Donaghy discussed the steps needed to become a profession and how the education of paramedics would take place in higher education institutions. Kath Start debunked the myth that universities were the domain of doctors and nurses, declaring that paramedic education was entering a new era with greater emphasis on ensuring paramedics could better meet patient needs. This shift has occurred; now an all-graduate profession, the education of paramedics has moved from its traditional approach to an academic route that is developed in association with universities. New modes of education will surface and, inspired by technology and multimedia, education will respond innovatively. Educationalists must provide state-of-the-art 21st Century learning, incorporating professional values, compassion, empathy and emotional intelligence. The rationale for whatever form of education is foisted on the profession must be based on clinical and not fiscal needs. Just as there will always be a role for good patient care, there will always be a role for high quality education and training within the paramedic profession.’
Clinical Practice Lens
‘I expect our clinical development to continue to align with research produced in our profession. Perhaps this will see frontline ambulance services administer antibiotics for severely septic patients prior to emergency admission, or ambulances in-built with sonographic capabilities. I think we'll see a change in the ambulance service model of care too. Many services have added ‘urgent and emergency care’ to their vision statements and as healthcare models develop, clinical skills will too. Education and training need to reflect this changing skill set, further shaping specialist and advanced clinical practice roles. While a core body of paramedics will always be needed in frontline services, many will continue to work across settings. Our generalistic clinical tendencies may perhaps land us into specialist domains of medicine. Advances in technology will also likely be captured in the clinical interface of our profession: we may be a long way from x-ray glasses or hover-stretchers, although the latter may be useful if the retirement age for NHS paramedics remains at 68. The future development of the profession and its clinical capabilities is dependent on us, as paramedics, to shape it now.’
Research Lens
‘Pre-hospital research has experienced significant advances, and its future is likely to advance at an equally rapid pace. There will be more research opportunities for paramedics, resulting in more paramedics pursuing Masters and Doctoral degrees. Approximately 0.1% of the 25 000 registered paramedics in the UK are at Doctoral level—it would be rewarding to see this figure rise over the next 10 years, resulting in more paramedic-led research. The focus on pre-hospital cardiac arrest research is likely to continue, considering its potential impact on patient outcomes. However, the focus may shift towards earlier interventions such as telephony support, community first responders and bystander cardiopulmonary resuscitation and defibrillation, as later interventions have less impact on patient outcomes. With advances in technology, and a focus on point-of-care testing, such as ultrasound and cardiac monitoring, it is likely that new technology will weigh heavily in pre-hospital research over the next 10 years. We need to nurture aspiring research paramedics to build capacity and be open to new ways of working and thinking.’
Leadership and Management Lens
‘Being a good clinician does not mean you'll be a good leader or manager. Clinical and managerial are two specialisms in their own right, just like primary and emergency care. The profession will continue to grow, especially as paramedics are used across a variety of health settings. NHS ambulance services will likely cease being the majority employer and paramedics will have opportunities that currently do not exist. This increase in transferable skills will support the continuous enhancement and development of the profession. Paramedic leadership and management will become its own specialty in organisations and every service that uses paramedics will have a Director of Paramedics (or equivalent) as healthcare organisations recognise the versatility and importance of the profession. The health system will increase the use and advice of paramedics, not only at the frontline but also at the highest level of the system, with paramedics ‘sat at the table’ making decisions; but leadership and management entry will be structured through a regulated council. Empowering leadership and management must start now to see the impact in 10 years' time—the future is closer than we think.’
Education Lens
‘The scope of practice of a paramedic has changed markedly in the last 10 years. Paramedics no longer simply wear green and work on ambulances—many are now found in urgent, primary and advanced care. Paramedicine has gone from a fledgling profession looking to move solely to university education provision to one commenced at BSc level and reaching heights of MSc and independent prescribing. The opportunities that exist for career progression are widespread and extend beyond emergency medicine to roles in the management of the chronically ill, minor injuries and illness within the community, to critical care and advanced practice. Education beyond BSc is varied and should lead to specialist paramedics developing, not only in terms of emergency care and critical care practitioners, but potentially mental health specialists, resuscitation specialists retaining intubation and primary care specialists. Paramedic education must continually evolve to not only facilitate the multi-focused ‘jack of all trades, master of none’ ethos of pre-hospital practice, but also to align with paramedics becoming masters of our field in all areas of primary, urgent and emergency care.’