What are my expectations and demands from my service:
· All healthcare practitioners are expected to be professional gamblers (taking a gamble that pleuritic chest pain is not cardiac in origin and acting on it after examination, for example). Ambulance staff take some really big gambles and it’s exceptionally rare to get it wrong. I expect my service to value the gambles that pay off because it’s good for the patient, practitioner and health economy but also embrace the learning points when they don’t without unbridled retribution.
· Real clinical leadership from career ambulance staff/paramedics without intentionally damaging manipulation from other professions and staff groups.
· Recognition that `paramedic` is not the same as `ambulance person` anymore. Paramedics are very highly valued commodities away from the traditional ambulance services. If services don’t value and embrace their staff, they can easily leave for something more lucrative. This will only increase when paramedic prescribing becomes a reality and non-ambulance services see paramedics as ways to solve many other healthcare shortages. There is a risk that answering traditional emergency calls is the least `good` place for a paramedic to work and practitioner quality will drop.
What do I like:
· I was 19 when I first worked on an ambulance. I had responsibility, authority, represented a great organisation and became hugely motivated for a role I adored plus confidence in the 4 year degree I was taking leading to a paramedic registration. I don’t think I could have had all this at 19 in any other job, except perhaps in the military.
· I do get an adrenaline rush just as each incident comes in, hoping for something challenging and exciting. People do the job and stick with it for that occasional adrenaline rush.
· I like medical critical care and problem solving in urgent care. I am less excited by trauma care. I like mentoring, I like leading and I get a thrill forcing entry to property where legally and clinically justified.
· “Hello, my name is Matt. I am a paramedic” is a great statement to say to people, professionally and socially. The public really value and take confidence from what they feel that means, which is nice for my ego! Being a paramedic has opened good and fairly paid job opportunities away from ambulance services too.
What don’t I like:
· Not having every tool I need pre-hospitally; my contracted job is to see the sickest, most injured babies, adults and children and to deal with them for up to 2 hours before reaching an appropriate hospital. In critical care, if a few milligrams of morphine, some saline or an non-drug assisted airway don’t work I don’t really have any technical skills left to offer and that means patient suffering and deterioration. In urgent care, I can’t leave patients with a supply of painkillers, comprehensively close a wound or directly book follow-up appointments meaning more taken to the emergency department or becoming an excess burden on alternative care pathways, which is bad for the health economy overall.
· I have worked in environments which do have a racism problem, are clinically neglectful and felt corrupt. The rhetoric is that this is unacceptable but people do seemingly get away with it as there is little appetite to cast light on it.
· The Health and Care Professions Council themselves recognise that going the extra mile for patients is a risk factor for triggering fitness to practise proceedings. The best ambulance staff go the extra mile and shouldn’t need to feel at-risk about it.
· Investment in bespoke technology; Apple, Samsung and other manufacturers have already solved many of the technology issues associated with digital communications, electronic patient reports and access to clinical information yet ambulance services invest heavily in special designs that are always going to be niche and underperform.
· Late finishes and commuting to work during rush hour are incredibly degrading on mental health. I don’t know how ambulance services solve these issues but there needs to be something.
· “I just take everyone to hospital and let them treat them if they want to” is still a viable career plan and equally rewarded than those practitioners who give gold standard care, arrange alternative care pathways and become clinical leaders.
· Feeling like I am playing `second fiddle` to doctors who are part of volunteer and charitable schemes, and therefor inconsistent and can be professionally domineering. Paramedics should be the pre-hospital clinical leaders and should be fully supported to provide gold standard care as part of the statutory response, not the nice-to-have voluntary response.
· Guideline developments which feel outdated when they are released, don’t reflect current gold standards or were written assuming you’re always just a few short minutes from the emergency department, which is not where clinical practise currently is.
What do I miss:
· I celebrated my 20th birthday alone, mopping an ambulance in a car park. The significance of the loneliness hit me and I wondered if I missed out on having a more traditional 20thbirthday.
· I miss colleagues who left, or were pushed out, because their face didn’t fit. There’s a lot of them. During my career, the suicide rate has been substantial and it’s not clear why.
What do I wish for:
· The biggest cause of loss of talented staff is late finishes and lack of serious career progression. I wish there was investment in these issues rather than endless pushes for new staff who burn out quickly.
· I wish for the College of Paramedics to become stronger; it’s the best hope of achieving so much for UK ambulance staff.
· Summing up the costs of my undergraduate degree, postgraduate degree course and continuing professional development activities, I have personally invested somewhere between £40,000-45,000 in my ambulance career and will be in student debt until I am almost 50 years old. The ambulance services are incredibly lucky to have so many staff prepared to take this level of financial risk; for me it means I can’t afford to buy a house. I can’t really afford to think about having a family. There is a real risk I won’t be able to provide for my future. Currently, there is no clear career ladder and it’s hard to objectively justify whether it’s all worth it.
· I wish to work hard and get to my late 30s, 40s, 50s and 60s in a reasonably senior clinically facing job which feels stable, safe and worthwhile which understands I want to work hard but just can’t do as much as I could at age 22.
December 2015
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