Paramedics in the United Kingdom

In the United Kingdom the term paramedic is protected by law and only applies to ambulance practitioners who are able to achieve and maintain the strict standards established by a statutory body. The Health Professions Council (HPC) requires paramedics to enter a register before being allowed to work autonomously. It sets the profession’s standards of proficiency and expects registrants to work by codes of ethics, conduct and performance.

Paramedics are expected to work utilising their own clinical knowledge to make decisions, many employers utilise clinical guidelines to make this easier. These vary throughout the country but increasingly are being brought into line with national guidelines. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC), a collection of professionals from the UK’s medical, nursing, and ambulance communities, produce these guidelines bi-annually since 2000. This group reviews its advice based on the principles of evidence based medicine and best practice.

Unlike other countries, there is only one legal level of practitioner. However, many paramedics undertake further training or higher educational programmes in order to work as advanced practitioners. Community paramedics, critical care paramedics and emergency care practitioners (ECPs) vary in the scope of their practice throughout the country but can be found offering unscheduled care in the community in lieu of GP visits. [ [http://news.bbc.co.uk/1/hi/health/4634569.stm BBC NEWS | Health | What does a 'super-paramedic' do? ] ] They are also employed to act as forensic medical examiners FMEs within the UK instead of general practitioner (GPs).

Qualifications

Traditionally the only route to becoming a paramedic was to join an National Health Service (NHS) ambulance service and work towards the position from non-emergency patient transport roles through to the emergency division. After qualifying and working as an ambulance technician for a period, it was possible to internally apply for paramedic training. Although offered at ambulance service training departments, the curriculum and certification were awarded by a private company called IHCD. Such paramedic training was usually a 10 week course with some of this time spent in a hospital operating theatre, assisting the anaesthetist and performing airway management techniques. Completion of the course allowed the paramedic to register with the then legislative body (state registration).

It was nearly impossible for non-NHS employees to access such courses, and many private ambulance companies provided their own training. However, lack of recognition by the regulatory body for such training created a problem. This was compounded by paramedical staff leaving the armed forces who found their training unrecognised. Eventually the term paramedic was used by a variety of people with varying levels of ability. After the incorporation of the HPC the paramedic became legally defined and private and military ambulance staff were given an opportunity to have their training and experience reviewed (grandparenting) against the new standards. This allowed many to register.

Eventually the IHCD began to accredit non-NHS training establishments, allowing them to teach their curriculum. In the mid 1990s some universities started to offer para-medicine diplomas and degrees, in association with local Ambulance Trusts. These incorporated the IHCD curriculum and allowed registration. Later, the Health Professions Council (HPC) and British Paramedic Association (BPA) defined the educational standards required to register, removing the requirement for the IHCD material to be the core of such programmes. Only recognized courses will lead to registration however. IHCD is closing down. The College of Paramedics has set the new standards in liaison with the Health Professions Council in London (HPC). The british paramedic association is the only recognized professional body for the paramedic profession in the UK. The higher educational route is still considered controversial, with some more experienced ambulance staff arguing that such a fast track approach misses the experience of PTS where recruits learn vital interpersonal skills, although there is no evidence to support this. However many university educated paramedics are now working for the country's ambulance services in various posts.

Most of the ambulance trusts are no longer accepting trainee ambulance Technicians, instead only accepting graduates and inner-qualified personnel to become Paramedics. The new role of Emergency Care Assistant is becoming the old trainee Technicuan role. Jobs are also now being advertised for 'graduate only' paramedics.

Employment

The NHS employs the majority of paramedics, usually in the role of clinical lead on accident and emergency ambulances. However, some are employed by the NHS in providing other services such as GP practice based roles, community unscheduled care provision, and within minor injury units. Private sector paramedics are often found providing medical services at large public events, at remote industrial sites, as lecturers and trainers, or increasingly as contractors working on behalf of the NHS in accident and emergency work. Increasingly paramedics are being tasked to work on fast response cars to respond to accidents and emergencies.

A number of private ambulance services also employ paramedics, with many of these moving into specific disciplines to allow them to compete with the NHS. Critical care transfer is one such niche in which private companies are flourishing.

Professional Organizations

The British Paramedic Association (BPA) is the paramedic's professional body within the UK It was formed relatively soon after the HPC's incorporation but due to government pressure rather than peer demand. It was the only profession regulated by the HPC without such a body and this situation was deemed unallowable. It was important the profession could maintain self regulation responsibilities for standards and education. At the time paramedics were still struggling with what it means to be a professional rather than a vocational worker and the BPA was eyed with some suspicion. The membership is increasing with ever starting Degree course. The Courses following the Curriculum of the BPA/CoP.Members can consult the Councilors to all issues regarding education and standards. All Stakeholder, such as Military, Unions etc. are members of the BPA/CoP Council. The BPA/CoP consults Universities, Hospitals and Ambulance Services. Some Council Members are HPC Officers. The BPA/CoP holds the stake role in the Continuing Professional Development (CPD). Every Registrar has to proof every 2 years the fitness to practice, by providing the CPD files to the HPC. The CoP Council is representing the Paramedics in England, Wales, Scotland and since 2008 Northern Ireland.

Scope of Practice

PARAMEDIC DRUGS

Atropine ,Adrenaline ,Aspirin ,Chlorphenamine ,Diazemuls ,Dicobalt Edetate. ,Entonox ,Frusemide ,Glyceryl Trinitrate ,Glucagon ,Glucose 5% ,Glucose 10%, Heparin ,Hydrocortisone ,Hypostop ,Lidocaine ,Metoclopramide ,Morphine Sulphate ,Nalbuphine Hydrochloride ,Naloxone Hydrochloride ,Oxygen ,Salbutamol ,Sodium Chloride ,Sodium Lactate ,Sodium Thiosulphate ,Stesolid ,Syntometrine ,Tenecteplase ,Tramadol

PARAMEDIC INTERVENTION

Manual defibrillation ,automated bi-phasic defibrillation ,trans thoracic pacing (local agreement) ,laryngoscopy / removal of foreign bodies ,endotracheal intubation ,eschmann Intubation ,nasoparyngeal airways ,laryngeal masks ,cannulation ,valsalva manoeuvre ,carotid sinus massage ,phlebotomy ,ECG monitoring acquire and interpret 12 Lead ECG ,pulse oximetry ,Capnography ,Intraosseous access ,needle cricothyroidotomy ,needle thoracostomy pulmonary ventilation by intubation ,IPPV using BVM or mechanical ventilator ,'T' piece ventilation for asthmatics ,Combat Arterial Tourniquets ,SMART CLIP drug testing

Drug administration routes via

intravenous ,intramuscular ,subcutaneous ,nebulisers ,intraosseous ,sublingual ,endotracheal ,rectal ,buccal ,oral.

References

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