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The evolution of the

Article · September 2015

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5 authors, including:

Alan M Batt Jason E Buick Fanshawe College St. Michael's

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Available from: Alan M Batt Retrieved on: 12 May 2016 Jessica Morton1,7, Klint Kloepping2,7, Jason E. Buick,3,4 Jamie Todd5,7 & Alan Batt 6,7,8 1. Student Australasia, NSW, Australia, 2. Lifelink Critical Care Transport, NC, USA, 3. Rescu, St. Michael’s Hospital, Toronto, Canada, 4. York Region ; Halton Region, Ontario, Canada, 5. Pre-Hospital Care Consultancy, United Kingdom, 6. National LLC, Abu Dhabi, UAE, 7. Prehospital Research Support Site, prehospitalresearch.eu, 8. Centre for Prehospital Research, University of Limerick, Ireland

Introduction ised plans for treatment, further care and in for their students? Yes. Education implies The role of the paramedic is one that some areas even discharge plans their patients knowledge development of broad, core princi- is rapidly evolving, across many countries. (1). The requirement for paramedics to expand ples. Training is a narrow spectrum, focused Demands placed on health services, offload their clinical capabilities has been noted for on application rather than principles. Educa- delays, cuts to budgets, increased expecta- over a decade. In 2005, the United Kingdom tion of paramedics focuses on the ability of tions from the general public and an increas- Department of Health stated: the student to think about what they’re doing, ing older population all place the paramedic “Ambulance clinicians should be equipped with and more importantly, why they’re doing it, profession at a crossroads in its development. a greater range of competencies that enable them to while training emphasises the actual skill and has yet to figure out where it assess, treat, refer or discharge patients” (2) [note the technique. belongs. Does it belong in public safety? Does referral to clinicians at this stage] The paramedic however needs to be a versa- it belong in healthcare? The road less travelled The eventual move towards full profession- tile clinician, especially in the face of their requires the paramedic profession to be pursue alisation of the paramedic requires a paradigm expanding role. A paramedic who has education identity as a healthcare profession and not shift from (i) training to education; (ii) trade regarding , but no train- as emergency responders, EMS workers, or representation to professional representation ing in the application of airway management ambulance drivers, which we are so commonly and (iii) a change in mind-set and attitude from techniques will be of little use to the patient identified with. technician to clinician. who requires life-saving airway interventions. Increasingly seen as a true healthcare Neither is the paramedic who has training in professional, the paramedic is now required Training to Education the administration of a medication, but no to perform a detailed and through examina- education regarding its effects, side-effects, tion and history gathering, have knowledge Is there really a difference between train- indications etc. of evidence-based treatment guidelines and ing and education? Yes. Is this important for Therefore if a paramedic requires both therapy options, and formulate individual- paramedic educators, and more importantly, education and training, then educators also 2222 need to be trainers (and vice versa). Paramedic Education, Leadership and Research. This encourage the further education and develop- educational programmes at all levels need to educational model would encompass a ment of the EMT, which contributes to the ensure an integrated training component, while common educational grounding in emergency overall progression of the paramedic profes- also developing the student academically. As response for all paramedics at the college or sion. The authors propose the consideration of paramedicine transitions to higher education, a undergraduate level followed by selection adopting a higher education model for EMT move important for the evolution of the profes- of a specialty stream, at either undergradu- education, with options to transition into sion, the hands-on training cannot simply be ate or postgraduate level. Completion of a paramedicine in the future. A new professional replaced with with academic knowledge. The “residency” in this specialised stream would title should also be adopted, and regulation move to higher education has played an import- then lead to a specialty qualification. Similar of these individuals should be investigated. ant part in the evolution of other professions in to medicine, and therapy colleagues, Efforts to standardise levels of practice, and the health care disciplines, such as nursing and this would allow for career progression, poten- professional terminology of out-of-hospital the therapy professions (3). tial for sub-specialisation, and the continuous care providers internationally should also be Traditional paramedicine education development of a unique body of knowledge. pursued. programs, whether in the UK, Ireland, Austra- The question surrounding the education, lia, Canada or the USA, tend to focus on regulation and professionalisation of other Trade to profession emergency response and resuscitation, with prehospital care staff also plays an important limited (if any) education in patient safety, role, and one that has been forgotten until now. Merriam-Webster defines a profession as “a chronic condition management, care of the The terms we use to describe ourselves and our calling requiring specialized knowledge and often elderly or health promotion (4). The move to practice (6), and how we present ourselves (7), play long and intensive academic preparation” (8) higher education presents an opportunity to an important role in our image as professionals. Paramedics possess specialized knowledge change the curriculum of paramedic education. Emergency Medical Technicians (EMTs) are which requires academic preparation. However, In Australia the field of paramedic educa- common in many services worldwide (although this isn’t all that is required to be a ‘profession’. tion has evolved from vocational education not in Canada), and their training generally Transitioning towards a professional model and training, to university-based education consists of 160-200 hours of classroom educa- requires a number of steps to be undertaken, (5) with the majority of paramedic educa- tion plus clinical placement time. The use of such as professional regulation, the establish- tion at Bachelor’s degree level. In the United the term ‘technician’ implies the profession is a ment of professional representative bodies, the Kingdom, paramedic education has evolved technical undertaking. development of peer-reviewed journals, the from technician training of approximately 400 The EMT is an associate to the paramedic introduction of advanced roles and increased hours plus placements, to a Foundation Degree profession, and thus paramedics should scope and the advancement of discipline-spe- (equivalent to a Diploma), with proposed plans to increase this to a minimum education level of a Bachelor’s degree for registration as WE SUPPORT OUR FIRST RESPONDERS a paramedic. In Ireland, current paramedic training consists of a two year University Diploma. The first post-registration Bachelor Devry Smith Frank LLP is there to help our brave paramedics, police officers, and of Science in Paramedic Studies in Ireland firefighters. Our First Responders Group is headed by John Schuman who is both began in January 2015, again with proposals to an active Ontario paramedic and a Certified Specialist in Family Law. Our knowl- make Bachelor degree education the entry to edge of what you go through gives us the expertise to help with the particular legal practice standard in the future. problems first responders face in: Paramedic education in Canada differs • Business and Corporate Law • Family Law • Professional Standards slightly, as it is generally a one to two year • Consent, Capacity and • Insurance claims and Discipline college diploma. Some paramedics complete a Mental Health Issues • Litigation • Real Estate* Bachelor’s degree in a non-paramedic discipline • Education Law • Personal Injury* • Wills and Powers of Attorney* prior to entering paramedic college. There are • Employment Law some Bachelor of Science programs available, We are proud to provide a 20% discount to our first responders although the majority of paramedics complete for all of the above areas of practice. *Discount not available. their initial technical education, then pursue further education afterwards. For most of the last forty plus years, paramedicine has also been regarded as a technical profession in the United States and is normally delivered through certificate programmes at community colleges. There is a move by many paramedics towards complet- ing an Associate’s Degree, but the incentive to complete further study is missing, as increases in pay are not guaranteed with more advanced education. So how do we move forward? The authors propose the concept of integrated paramedic CALL US! education for specialty disciplines such as 416-446-5080 Community, Remote and Rural, Advanced Practice, Critical Care/Flight, Industrial, 23 AugustSeptember 2015 cific research. These aspects of professionalisa- tion face challenges in many ambulance services around the world. Large variations in the deliv- ery of paramedic-led care internationally make a unified approach to these challenges nearly impossible. Nursing and therapy professions achieved their professional standing through a combi- nation of registration and regulation, curric- ulum development, and scope of practice guidance. A key marker of professional status is professional regulation (9). Paramedics are currently regulated (self or direct) in the United Kingdom, Republic of Ireland, South Africa, and a number of Canadian provinces (including New Brunswick, Alberta, Saskatchewan). Paramedics in these jurisdic- tions have a licence to practice paramedicine, albeit with certain provisions or requisites (in good standing, working for an approved service etc.). They agree to codes of conduct and professionalism, and are held to transpar- ent clinical standards set forth by the regula- tory body. In the unfortunate event of breach of those clinical or professional standards of the regulatory body, the individual paramed- ics can be held to account through fitness to practice proceedings. Unfortunately, not all paramedics worldwide enjoy this objectively structured process. The Health Professions RegulatoryFigure 1. College of Paramedics Post Registration Career Framework (2015) Used with permission. Advisory Council in Ontario recently recommended against the self-regulation of sentative bodies comprised of paramedics with administer a medication. A technician can be paramedics in Ontario based on an application a common, united vision that are needed to lead taught how identify the signs and symptoms of submitted by the Ontario Paramedic Associa- the paramedic profession. cardiac ischemia and administer that medica- tion (10). This was a major setback to establish- Paramedics also need to define their educa- tion. A clinician can formulate a working ing a true paramedic profession in Ontario, for tional curriculum, and develop the paramedicine diagnosis and decide when to treat, and when paramedics, led by paramedics. Elsewhere, it body of knowledge. This can only be achieved not to treat. A good clinician knows when to appears that the pursuit of national registra- through paramedics becoming involved in, apply their clinical therapy options...but a great tion and regulation of paramedics in Australia and leading, the research in prehospital and clinician knows when to withhold treatment. and New Zealand will have a positive outcome out-of-hospital care. The U.S. Department of A recent proposal by the Ontario Profes- in the coming months, due largely to work Transportation issued a statement in 2002 to all sional Fire Fighters Association proposed a being carried out by Paramedics Australasia. involved in the prehospital profession indicat- role of “Fire Medic” which would grant fire This will ultimately lead to improved patient ing that a lack of EMS research was the imped- fighters a similar scope of practice (with regards safety, and as an added benefit, Australian iment to progress of emergency medical services to symptom relief medication administration) paramedics will reap the benefits of regulation, (12). Canada and the Republic of Ireland have as a Primary Care Paramedic in Ontario (15). including improved professional standing, the published national research agendas in response The education required to administer symptom ability to develop national standards, easier to the lack of coordinated published prehospi- relief medications would be delivered in 20 inter-state and international labour mobility tal research (13,14). Unfortunately, there still hours. Efforts such as this serve to continuously and more. remains a need for more high-quality evidence undermine the paramedic profession, reduc- Although the College of Paramedics in the to validate many aspects of paramedic practice ing it to technical skills that can be taught in UK only represent approximately 25% of regis- (1). Until we begin to validate what we do, and a manner of hours, and are unfortunately not tered Paramedics in the UK, their influence on why we do it, we can never hope to build our unique to Ontario or indeed Canada. This is the future of the paramedic profession cannot unique body of knowledge. This can only be again where professional representative bodies be understated. Their proposed post-registra- achieved by increased undertaking of higher can inform the public and other services, tion career framework (Figure 1) for paramed- research degrees by paramedics, including advocate for the profession and represent the ics, encompassing clinical practice, education, masters and doctoral level studies. views of their membership. management and research is something which In the UK, Canada, the USA and Australia, should be replicated by all countries that utilise Technician to Clinician community paramedicine and mobile integrated paramedics (11). The Irish College of Paramed- healthcare initiatives are seeing paramedics take ics is pursuing similar influence on the profes- Physicians practice medicine. Nurses on a broader clinician role with great success. sion in Ireland, and holds a representative seat practice nursing. Paramedics need to practice Key to this success, as identified by O’Meara is on the regulatory body. It is professional repre- paramedicine. Anyone can be taught how to if “paramedic education provides graduates with 2424 References suitable breadth and depth of capabilities that move to assess the impact and outcomes of beyond the traditional paramedic emergency response fire fighter symptom relief training and competencies” (16). The NHTSA stated in “EMS of 1. Ball L. Setting the scene for the intervention in Ontario. Intrepid Mag the future will be community-based health manage- paramedic in primary care: a review [Internet]. 2015;(Summer):18–20. 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A National Prehospital nationalambulance.ae necessarily reflect the official policy or position of Research Strategy. 2008. Twitter: @alan_batt their employers or organizations. 15. Ontario Professional Fire Fighter Association. Proposal for pilot projects 25 AugustSeptember 2015