An Introduction To Specialist Paramedics

Author: Craig Brackenridge @craigdot1

Specialist Paramedic in Urgent & Emergency Care, Scottish Ambulance Service

11/4/18


WAIT A MINUTE – ISN’T IT THE G.P.’S JOB TO DO THAT?

Specialist Paramedic, Paramedic Practitioner, Community Paramedic, Emergency Care Practitioner, Intermediate Care Practitioner, Urgent Care Practitioner, Primary Care Practitioner. That which we call a rose, etc. In this part of the world the Sunday name is Specialist Paramedic (Urgent & Emergency Care).

It’s a bit of a mouthful but what does it mean?

As far back as 2004 a number of unconnected Paramedic Practitioner schemes began to develop in Scotland. Most were run in conjunction with “Hospital At Home” type schemes led by the local health board. Additional training and education for the Paramedics involved was widely varied with some attending an FE college and some with simple on-the-job training sessions. Perception among colleagues was equally as varied with some schemes being seen as a comfort blanket for uninjured falls patients and others being seen as a means of “fobbing-off” the minor unwell, especially the elderly. In 2012 a new BSc program was developed with Glasgow Caledonian University which shared undergraduate modules with both pre and post-registration nursing and other allied health professions. In 2016 the decision was taken that all new Specialist Paramedics should be qualified to postgraduate certificate level.

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Additional education & training includes research, advanced clinical assessment and decision making, minor injuries (includes local anaesthetic, suturing and special dressings) and supporting anticipatory care.

Specialist Paramedics can be found in a variety of places depending on local arrangements. Most commonly they are working on Paramedic Response Units responding to 999 and NHS24 emergency calls as usual, but also in Minor Injury Units, as part of a multi-disciplinary Community Care Team or a Primary Care practice including out-of-hours.

So what do these people do to keep patients out of my already-full E.D.?

Well it’s not quite as simple as that, but the Scottish Ambulance Service’s “Towards 2020” wants to “Take the care to the patient”. It’s about getting the right response to the right patient in the right place at the right time. Blah blah blah. I’m sure that all means something to someone, but what is the reality? Yes the reality is that many patients attended to by Specialist Paramedics will still end up in the ED; but let’s first focus on those who won’t:

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Some patients will be referred to a receiving / assessment unit or intermediate care, depending on local arrangements. Some patients will be actively treated at the locus of the call with:

  • Wound exploration, cleansing and closure (including suturing);
  • Oral and topical antimicrobial medications;
  • Oral and topical steroids;
  • Oral and parenteral analgesia;
  • Oral and parenteral anti-emetics;
  • Or indeed just a thorough assessment and no actual treatment.

Those who do still end up in the ED may have been treated with some of the above too.

 

What’s coming next then?

Last year the Commission on Human Medicines and the Medicines and Healthcare Products Regulatory Agency recommended adding suitably-qualified Paramedics to the list of non-medical prescribers. In April it will be written into law as an amendment to the Human Medicines Regulations 2012 allowing advanced-level Paramedics to independently prescribe after attaining the appropriate qualification. Other future developments are likely to include taking bloods, cultures and urine for lab analysis, catheter care and palliative care. The advent of independent prescribing will certainly lead to more collaborative working with Primary Care services, and no doubt to Specialist Paramedics employed directly in health centres, out-of-hours centres and working alongside ENPs in Minor Injury Units.

 

Well, what does it mean to me?

As an Ambulance Technician or Paramedic you may find that you’re transporting one of these patients into the ED or AAU, or you may attend to an acute unwell / minor injured patient who you think may be suitable for a Specialist Paramedic to attend to. As an ED nurse, medical student or FY doc you could be triaging or initiating assessment and a treatment plan for one of them. Generally speaking it will be virtually identical to a patient who has been assessed and (partially) treated by their GP before referral. In any of these roles you should be aware of the additional pre-hospital treatments that the patient may have received over and above the Paramedic scope of practice. In short – read the PRF and / or referral letter.

Hannah Bell