I'm an NHS paramedic... AMA

[wherethewestwindblows]

I don't feel that the public have the greatest understanding of the realities of the job in the current climate, so I thought I'd open up the conversation. My answers are obviously my own opinion, however I believe many of them reflect that of a large proportion of my colleagues in the service I work for too (which is about the only question I won't answer for anonymity).

I will answer every question that is posted, however it may not be straight away.

Do you think the job has made you calmer in all other types of situations too? I imagine you are fairly calm and don’t get worked up over things, after what you see and deal with daily.

What is your opinion about rear facing vs forward facing car seats for children? What age would you be happy to put your children in a forward facing seat (roughly)?

How much training do you get? My colleague said her 19yo DD only had 8 week's training before qualifying as a paramedic, which doesn't sound right?

What is your training in ALS/ILS? The vast majority of paramedics I've met do not have this qualification, and fall extremely short I'm sad to say. That's not necessarily their fault, it's a thankless job and has so many pressures, I just don't feel the training is fit for purpose.

Sorry to butt in but I’m pretty sure this is nonsense. I work at a university with a paramedic science course and it’s my understanding that all paramedics are now degree qualified. Especially the young ones. Did she maybe do 8 weeks training before going out in an ambulance for the first time on a placement? Or 8 weeks to do another role? Technician of some sort?

Fellow paramedic here 👋🏻

Its likely the PPs friends daughter has joined a service at entry level - trusts differ on banding and titles but its essentially the same. They are blue light trained but clinically limited, she really shouldn't be calling herself a 'paramedic' as it's misrepresention of a protected title.

Paramedics are now degree educated - either via direct entry to university or via upskill within the service trust and partnered with a university.

I'm 24 years in, an IHCD paramedic so no degree but we have the same level of clinical skills and training. And the luxury of experience.
We also have the opportunity to gain the degree if we wish.
Without the degree we are held back on progression to Band 7+ career opportunities but not all.

Newly qualified paramedics (NQPs) are B5 until 2 years post qualifying then it's Band 6.

In Ireland you’ve needed a 2 year diploma in emergency medical science for a while, and now it’s a BSc degree course, with fees paid by the National Ambulance Service.

(I am not the OP but work in ambulanceland)

Paramedic is now a degree level role, but there are other frontline roles that look exactly the same. You can be on the road at a healthcare assistant level (Emergency Care Attendant or similar title) with 8 weeks’ training + driving training, but you’ll be working with a higher grade of clinician. Paramedic is a protected title.

You can do a degree in Paramedic science, or most trusts now have ways of you working your way up from ECA over a number of years.

@lalalalalullaby really? ALS is pretty core to the role! Where has this been your experience?

Do paramedics have much experience with labour and delivery of babies at home? Are you able to attend these calls quickly and would you say a 'typical' paramedic would be confident/experienced in this situation?

Context: I am in my third trimester with a history of very fast labour, I live over 45 mins from the nearest hospital and have been advised a c section or home birth would be a safer option. Community Midwives advise they will be there within 4 hours so there is chance I will give birth at home alone with toddler. In that case they've said an ambulance would come and assist.

Really interesting thread! I'm a nurse myself and have so little understanding of your role as we never cross paths on the ward.

@AliceS1994
It will all depend on the collective experience of the crew.
We have regular maternity training along with neonate resuscitation training.
But that doesn't replace or even really replicate actual first hand experience.
Personally, I've delivered around 30 babies in 24 years, I find I am more confident since I became a mother myself.
That being said, there are so many variables with maternity calls, it's easy to see why some staff fear them.
We have nothing to monitor a baby still in-utero during a delivery.
We do now have thermo regulators for newborns.

Planned home births on the whole go well, with midwives obviously only calling us if something goes wrong or transportation to a maternity unit is required.

Unplanned home births - again too many variables.

Personally, I would explore all options before you use the ambulance service as a fall back mode.
Demand has gone through the roof again, which was expected. Due to capacity issues, ambulances are often held at EDs meaning there are significant and lengthy delays responding to outstanding calls - which could well be you, delivering on your own with a toddler.
I don't mean to scare you or sound harsh but it's the reality at present.

Every member of road staff is, at the very least, ILS trained.
All Paramedics are ALS trained.
Technicians in my trust can place SGAs, as can Paramedics, older paramedics like myself can perform ET intubation.
Techs are not permitted to cannulate (unless on the paramedic pathway and only under the direction of a registrant)

Could you explain more about why you believe we are not?

As someone who left the ambulance service when I realised that i had started to have a complete lack of empathy for the majority of my patients ( due to years of putting up with abuse and time wasters) do you ever wonder why you are bothering to do the job?

Since about 2021 there was a review which allows paramedics to put end of life care plan in place to reduce the amount of people being admitted to hospital.
Have you had any experience? What sort of training did you get for this? Do you feel it was thrust upon your job and not what you signed up for or do you think it works well?
How does it benefit the public in your opinion? Do you think that it's working for the public or do you think it's just a funding thing that didn't work out well?

@Saytheyhear We don't put EoLC plans into place, but we are able to work autonomously in reference to an EoLC plan that a patient has.

As HCPs we are moving away from the knee-jerk and career defensive stance of taking everyone into hospital.
With specific reference to palliative care, we are able to, under the guidance of our medical directorate and palliative care teams, give non PGD medications - mostly the anticipatory drugs that we do not carry, but will often find in the home.
Our clinical decision making training around palliative care is more robust and our trust also have macmillan nurses and specialist advanced paramedics (B7+) on call to assist.

Attending palliative patients and their families can be emotionally challenging for many reasons.
Usually it's family who want a loved one to receive aggressive treatment (even some who request CPR) that is not always in the patients best interest.
Palliative patients with reversible illnesses such as infection can still be treated in the home setting via referral again negating the need to convey which is often at great distress to the patient. Some are conveyed of course.
One of my colleagues left our trust and is now working as a community EoLC paramedic for a hospice.

@Spencer0220 I've purposely missed your post just so you know as it'll be quite a big answer and I haven't had opportunity to answer it all yet.

We still have the odd responder, but it definitely seems like less than there were historically. Some of them I've come across in my time have been great and genuinely helpful, and then there's the odd one who's... well, the opposite I suppose. The best ones are those who go in, establish what's occurred, commence any treatment within their scope and give a concise handover to the crew that arrive, and then step back and allow us to take it from there. I never mind if they want to stick around to observe/help where possible, but I've experienced one or two who continue to try and lead/tell us what to do, which is inevitably, highly irritating.

@wherethewestwindblows no problem & sorry

I'd say I probably worry about things I've realised I can help control less than I used to, as often times there are patterns between the issue and preceeding the event (i.e. someone with chronic breathing difficulties who has COPD but has smoked all of their life; a risk I can mitigate by not smoking). Repeatedly seeing people in poor states of health with multiple co-morbidities helps keep me on track to live as healthy of a lifestyle as I can.

When it comes to accidents/trauma though, it's mostly just unfortunate accidents. It doesn't put me off riding a motorbike as a good example, but I can imagine if I'd previously been a bit reckless then it may have scared me somewhat into being more careful.

Have the jobs you've been sent to changed your parenting in any way?

BIL is a paramedic and I know he still quarters grapes for 6 year old DN.

Does the higher the number of vehicles = better outcome?

I walked past a house the other day with three emergency response vehicle cars and one ambulance outside it and wondered what they would all be doing in that scenario (for a single person).

My son is currently at uni training to be a paramedic. He is loving it so far and there seems to be lots of different areas he can go into.

Would you recommend it as a career?

You're right that a crazy amount of time is being lost to holding at hospitals these days, but there is no simple answer unfortunately because the problem is massively complex and deeper than most people realise. The answer that I'm almost certain will be proposed by the government though is privatisation. But that won't address the underlying reasons as to why as many people end up in/staying in hospital (and/or requiring health care) as they do.

I could write enough to fill a book on the various factors that feed into the mess we're in now, but that's the shortest answer I can give.

I'm on band 6.

I've said for a long time now: if we're talking relative responsibility, we are massively underpaid (there are people who get paid 2-3x than we are who are responsible for correctly entering numbers into spreadsheets/systems, vs us who can literally be responsible for someone's life). However, for what we actually spend the majority of our time doing, we're actually very well paid.

That said, given (at least in my service) the practically non-existent difference between a band 5 newly qualified paramedic and a band 6 "experienced" paramedic, band 5s in my opinion are by default, underpaid.

I have been in the back of an ambulance twice.

Given morphine and gas and air… I recall saying THE most bizarre and inappropriate things.

Completely out of character and mortifying.

It was like I was listening to a mad woman.

My question is, do you discount, chuckle then not worry about this kind of thing?

I often worry that those poor (fucking AWSOME amazing, kind people doing their job) were in anyway upset by my crazy ramblings.