There was always a desire in me to opt for a profession in which I could contribute to the society and help the people in need. What better way to do this than to be a paramedic who tirelessly works to aid people in distress. On joining this profession, one must learn to apply theoretical knowledge that to clinical and field situations. One must also learn many procedures and constantly update those skills. No day is a routine day. Every day, the shifts are different, the locations changed and clinical scenarios unique.
The work pertains to attending calls such as trauma, cardiac and respiratory emergencies, substance overdose and many other situations and every call teaches some lesson. Apart from providing clinical help, paramedics have to act as efficient organisers and counsellors. Paramedics are often relied upon to control and direct emergency situations, this responsibility and challenging tasks is what draws me to become a practicing paramedic. The areas of effective learning are clinical basics, assessment of clinical scenarios, decision making and execution, and patient care.
Theoretical knowledge about the field of emergency medicine is the foundation on which other aspects of knowledge are built. Physiological, pharmacological, pathological and diagnostic knowledge are imparted as a part of the course. Apart from medical and clinical knowledge, soft skills are also a part of learning. My experiences shadowing and researching this field has taught me teamwork, leadership, time management, resilience, empathy, lifestyle management, organisational and prioritising skills. All these qualities are inherent in this science and are inevitably acquired in some time.
However, these skills are also influenced by the willingness of the individual to learn and the mentor to teach. There is always a potential to grow no matter how intensive the training has been and the same is true of paramedic science. Given the evolution of this science into an entity of its own and crossover in to the domains of other health care professionals like physicians and nurses, there is a need to upgrade our skills and deliver high quality of care and in turn build up a rewarding practice.
Clinical learning is an important part of paramedic curriculum. It involves practical application of the theoretical knowledge in real life context. It can be provided on-site in the real clinical setting with real patients. Budding paramedics observe and learn to perform procedures such as airway management, intravenous access, cardiopulmonary resuscitation, manual handling procedures and drug administration in difficult and uncontrolled environments. Students learn to cope with the limitation of resources and infrastructure, and emotional demands of the patients.
This experience is important to develop the qualities of critical thinking, analysis, judgement, decision making and implementation, and public dealing. Apart from the field experience, another way of imparting clinical experience is through simulation equipment and techniques, and creating the clinical scenario in the class room. Problem solving approach is applied to different situations in different ways and algorithms and actions are performed repetitively. Thus, class room based teaching is conducted in the clinical context.
Also, clinical case studies may be taught using the virtual means. This enables the patients to test their knowledge before applying it to real persons so that learning curve doesn’t harm the patients. Thus, a combination of actual authentic experiences and fictitious case studies provides the clinical learning experience to the paramedics. Paramedics very rarely work alone. There is always a person who drives the vehicle, ambulance technician and usually another ‘partner’ paramedic unless the call is very low priority.
Apart from the vehicle members, there is interaction and communication with the physician who is in charge of the emergency and pre-hospital care services. Thus, the work involves many professional relationships with juniors, colleagues and seniors, and calls for efficient and cordial team work. It is natural that in responding to calls in highly stressful and emergency situation, there may be difference of opinion over many issues. It is important that these differences do not jeopardise patient care and all efforts should be made to resolve any disputes.
In case of an emotional turmoil or loss of a patient, co-workers can provide psychological support. Work place bonding also decrease psychological stress and increases the sense of well being (Ozaki et al 2012). Paramedic practice involves administration of medical care in out –of-hospital and emergency settings. However, the scope of the practice is expanding and some paramedics are also working at the hospitals akin to a ‘nurse practitioner’. The kind of aid provided includes immediate response to distress and emergency calls in coordination with a telephone dispatch system.
On reaching the venue, paramedics proceed systematically by assessing scene safety, quick assessment of the situation and calling for more help, if required. The patient is assessed and lives saving measures are administered if required. These include but are not limited to oxygen administration, fluid resuscitation, cardiopulmonary resuscitation, defibrillation and drugs. If time and situations permits, history, physical examination and diagnostic tests such as ECG, peak expiratory flow rate and arterial blood gases measurement can be done, more so on the way to the hospital.
Concomitantly, arrangements are made to shift the patient to the nearest or most appropriate medical facility. Accurate assessment of the patient allows the transport and referral to an appropriate facility such as specialising in burns, stroke, spine or other trauma, cardiac facility etc. Although the skills formally imparted to and expected from paramedics may vary from region to region, certain core skills are always a part of the paramedic work profile.
A paramedic can perform a basic assessment of the patient with components of history taking, relevant examination and determination of positive clinical findings and a few diagnostic tests. Assessment of scene safety is also a part of the work. After the assessment is over, next set of clinical management skills take over such as skills pertaining to management of trauma patients such as fractures, haemorrhage, chest trauma, airway injuries, wounds and penetrating injuries, and head, neck and spinal injuries.
Paramedics are proficient in splints, tractions, immobilisation, fluid resuscitation, protection of open injuries, supplemental oxygen administration and airway management. Other clinical areas with relevant skills required are medical emergencies such as cardiac (angina or cardiovascular collapse) in which the skills of cardioversion, administration of narcotic and other drugs, recording and interpretation of ECG are included.
Other skills which are as important as those mentioned earlier are those of intuition, anticipation, triage and emergency airway management in trauma patients, organisational skills, maintenance of records and findings. Necessary skills are familiarity with latest and routinely used medical equipments such as defibrillators, oxygen cylinders, suction machines, nebulisers etc and basic troubleshooting of these equipments. Ability to man the emergency vehicle and operate the communication equipment is also desired.
Given the possibility of inadequate assessment, diagnosis and treatment of certain conditions and to standardise the level of care, much emphasis is being placed on the development of uniform guidelines to manage clinical conditions. Also, these guidelines are evidence based so that practices based on rituals, traditions and anecdotal evidence is eliminated. However, researchers studying the usefulness of these guidelines as well as the compliance by the paramedics to these guidelines have found them impractical and misapplied in clinical settings (Snooks et al 2004).
This led to inaccurate diagnosis and treatment of the conditions (Figgis, Slevin & Cunningham 2010). Moreover, research in the field of paramedic science has produced inconsistent results and low quality of evidence resulting in poor outcomes with these guidelines. Additionally, these guidelines have proved counterproductive in the sense that they have caused suppression of independent thinking, questioning ability and autonomous decision making amongst the paramedics.
They limit the role of paramedics as care providers being dictated by the physicians. There is no doubt that evidence based guidelines are required and should be used by the paramedics equivalent to any other health care practitioner. However, there must be some margin and space within these guidelines for the paramedics who are often faced with unusual and exceptional circumstances so that they can adapt and apply the guidelines in that particular situation. Biggest benefit of paramedic practice is job satisfaction.
It is altruistic and immensely satisfying to bring relief to those in distress and also gives the feeling of contributing to the society. Paramedics serve the nation by maintaining the health of its citizens. Another benefit is varied nature of the job. The work is far from monotonous and provides new challenges every day. It’s a job where one has to keep himself updated. There are regular encounters with newer drugs and equipment. This provides opportunity for growth and self development. Learning quotient of this job is very high.
With newer recommendations calling in for overhauling and upgrading of the ambulance and pre-hospital care services in many countries, there is going to be no dearth of opportunities, promotions and remuneration in this field. There are many risks and hazards associated with this profession. A paramedic is usually the first person to respond to disaster situations like natural calamities, infectious disease outbreaks and terrorism and warfare related medical emergencies (Smith et al 2009). It is inevitable then that in all these situations, paramedics are exposed to life threatening situations and infections (Leiss 2009).
In addition, there have been so many cases of physical assault and violence against paramedics that administrators are planning to introduce anti stab vests for their protection (Summers 2005). Infact, it has been shown that sometimes the threat perceived by paramedics to themselves or their families is so great that they may not report to work (Smith et al 2009). For managing this aspect of profession, that is, occupational hazards the paramedics should adopt the best possible safety and self protection rules and follow them diligently. These risks also call for stringent regulations for paramedic safety.