On the 13th of November we had the pleasure of attending Nottingham Trent university to deliver the 3rd pilot of our practice educator support package to a group of Paramedics, educators, and placement managers from East Midlands ambulance service. Thank you for EMAS for your warm and engaging hospitality throughout the day, your enthusiasm was very welcomed, and we appreciate all your feedback!
Based on the feedback from our LAS pilot, we delivered the face-to-face element slightly differently, we split the group into two and gave them different case studies to talk through. This created less repetitive discussion which we felt as co-academic leads worked well. The feedback from EMAS highlighted that all participants felt the discussion was the best delivery method for the case studies and one person stated “loved the NQP scenario as it highlights the different pressures they are under and the transition”. Interestingly, one person stated that the session could be improved through some role play, which as academic leads we feel could be an interesting part to incorporate. 
Although the majority of participants stated that the E-learning was the right length and informative for the face-to-face element, a common piece of feedback throughout the group was around the lack of quizzes and activities in the E-learning, we are going to look into this and hopefully implement it going forward!
We have now completed three pilot sessions in SWAST, LAS & EMAS, we are still having discussions with other ambulance trusts to hopefully deliver this to further areas, however, we are now going to spend the next couple of months evaluating the pilot and developing the training materials so that this education package can start to be disseminated within these trusts.
Thank you again to the three trusts that have welcomed this training package, and for your valuable feedback.

Emma Geis and Katie Pavoni, co-academic leads for the Future Workforce Mental Health Project recently attended the University of Cumbria’s 2023 Education Conference, to run a practical workshop exploring how the pre-registration wellbeing curriculum framework could be embedded within their BSc Paramedic Science. 



The session revisited the core aspects of the curriculum and best practice examples but focused on how specific learning outcomes may be implemented across diverse learning and teaching content and within the unique context of a multicentred apprenticeship programme.

The session was attended by approximately 50 members of the academic administrative faculty who engaged in small group discussion to explore how the framework could be applied within their own education practice, such as at sessional module, or at programme leadership level. Attendees then considered personal action points, and next steps for actualising the guidance. 

The workshop received positive feedback, with many educators remarking on how the session had altered their perspective on how wellbeing could be incorporated into educational content in a meaningful way, without becoming tokenistic, or a ‘bolt on’ with their only constructive comment being and that they would have liked longer!

Thank you to the University of Cumbria and in particular Tom Davidson and Gemma Howlett for inviting us to take part in your important event, and for Herdy the Sheep of course! 

Katie and Emma are keen to support other universities in adopting the curriculum For more information please contact Emma Geis emma.geis@collegeofparamedics.co.uk or Katie Pavoni kpavoni@sgul.ac.uk. 

Josh is a 3rd year paramedic and is the East of England’s student rep. Nova is paramedic in the south of England and is the Disability Strand Lead for the College’s Diversity Steering Group. 

N: So Josh, before the conference, when you thought about the term “inclusion” within the paramedic profession, what came to mind?
J: When considering diversity, my mind conjures up an image of a university campus with various people from different backgrounds sitting on a hill together for a brief photo moment. 

N: So it seemed like it was just a tick-box thing, not something actively pursued or paid attention to?
J: Yes, exactly. But how can we make this fictitious image a reality within the ambulance service? How can we shift our focus from mere box-ticking and appearing inclusive to actively working towards true inclusivity? 
N: It’s a difficult task, certainly. But having these difficult discussions where everyone who has a hand in recruitment directly or indirectly, like Directors, lecturers, front and back-room staff can come together and voice their lived experiences and ideas on how to improve things, its a good start.

J: Were there any speakers or topics that stood out to you?
N: The presentation by Anton Emmanuel discussing the WRES data. I knew the ambulance sector doesn’t perform super well when it comes to hitting national targets [for employment of non-white-British people] but I did not realise how low it was. However, the data showed improvements year on year, and some decent improvements in management and higher positions.
J: Yeah, only 7%, that number struck me hard. It raises the question of what steps can we take to effect meaningful change? Dawn Whelan in her presentation emphasised that whatever we do, the “on-size-fits-all” approach won’t work at all. Everyone is unique, and we should embrace and celebrate our profession's rich diversity. We can better serve our diverse communities if we encourage and support diversity in our profession.

N: So, from the perspective of a student, do you think this kind of conference is necessary? Do you think your perspective on inclusivity within the profession has changed?
J: The statistics from the speakers paint a bleak picture of diversity within our paramedic profession. Nevertheless, the workshops were an essential aspect of this conference and highlighted good practice. It allowed representatives from various fields, such as ambulance directors and associate directors, senior university lecturers, and recruitment staff, to come together and discuss diversity and inclusion. Through these discussions, we learned how different sectors are working to become more diverse and inclusive. Attending this conference made me realise that we are on the right track. Having so many people from CEOs to front-line staff gathered to discuss ways to foster a more inclusive and diverse environment. It's encouraging to see everyone working together to achieve genuine inclusivity.

N: The statistics are less than ideal to be sure, although interestingly I learnt that LGBT+ representation within the ambulance service is higher than the reported national average! You mentioned the afternoon workshops (where I had the pleasure to co-host one with Anna Perry [AACE]) it was fascinating to learn things from so many perspectives. Knowing that there are currently positive actions happening, such as London Ambulance Service having a successful mentoring programme specifically for people from a BAME background to progress and thrive in upper management was a highlight of the day. As was watching people get out their diaries to book time in to share these successful concepts within Trusts and across organisations.
J: Do you have any final thoughts or feelings about the conference?
N: It’s difficult to see the light at the end of the tunnel when you are someone who reads things like the WDES, WRES, and actively seeks discrimination and inequity so that it can be improved. However, events like this give me genuine hope for the future of the profession. And to paraphrase my colleague and friend, Dawn Whelan, it all starts with a snowflake to make an avalanche of progress.
J: The Paramedic Inclusive Recruitment Conference highlighted our progress in starting these critical conversations and working together to address this issue of diversity and inclusion. It also paints a clear picture of where we can go from here. Bringing together people from various backgrounds, such as the university paramedic senior lectures, to the ambulance service and other work settings where paramedics find themselves has made me realise that achieving this change and changing the culture of our Ambulance Service and other clinician settings will require a collaborative effort. However, it is possible, and this conference is the first step towards a genuinely inclusive and diverse workforce that embraces and celebrates individualism.

Written by Emma Geis
The co-academic leads had the pleasure of attending dockside education centre to deliver this pilot train the trainer to a diverse group of curriculum designers, education managers, link tutors, associate and clinical tutors including trainers for the preceptorship programmes for NQPs. Thank you to the London ambulance service for being very welcoming and engaged throughout the day, supporting us in our delivery of the education package developed for practice educators to support students with their mental health and wellbeing.

Following the initial feedback from the SWAST pilot we removed one of the case studies so that the face-to-face element was shorter, we also moved the structure around of the delivery of the session which the academic leads felt worked better.
There was some excellent discussion developed not just through the case studies but also some of the common concerns around supporting student mental health and wellbeing that we feel we can take away and build into the next face to face sessions, so we thank the LAS colleagues for being open and honest with their feelings and experiences.

The feedback for this session was collated on a Microsoft form, 7/7 participants stated that the case studies were the best mode of delivery for the face-to-face element of the day, however 3/7 stated that they felt this section was still too long, which the academic leads will review for the next delivery. The main positive points of the day were around the introduction of the WRAPT tool and the discussion elements of the session, with some participants stating that it was inclusive and promoted participation and sharing of experiences.
 
The next face-to-face session will be at the East Midlands ambulance service.

Written by Emma Geis & Katie Pavoni
Firstly, we want to thank the Southwest Ambulance Service for welcoming us to deliver this pilot education package in Bristol on the 4th April 2023. This pilot is to support the implementation of the work completed for intervention 3, the development of a e-learning package to support practice educators supporting students with their mental health and wellbeing. 

As the co-academic leads, we felt that the E-learning package needed supplementing with a face-to-face element to be able to fully engage the audience. The face-to-face session was made up of case studies to put the theoretical learning from the E-learning into practice. The day lasted from 10 until 2 (including time to complete the 25-minute E-learning) so that we could get real time feedback from the participants.

The room was filled with experienced people from different areas to capture feedback from a range of fields. There were plenty of meaningful discussions which enabled us to explore different topics that were raised from both the E-learning and the face-to-face elements throughout the day.
The feedback for this session was collated on a Microsoft form, 10/10 participants stated that the length of the E-learning was just right and that it provided the information needed to participate in the face-to-face session. Participants gave 4.5 out of 5 for how informative the e-learning session was and stated that discussions were the best way to deliver the face to face element, 2/10 participants stated that the face-to-face element was too long and therefore we have reduced the amount of case studies to be able to reduce this for our next delivery. Six out of ten participants stated that the session was beyond their expectations with the case studies and discussions being the most enjoyed part of the day. When looking at what could be improved all points stated to reduce the case studies, which will be done for the next time we deliver this session.
The next face-to-face session will be on the 21st of July at the London Ambulance Service.

Have you fixed work yet? A question from my four-year-old son! 

A sad day in every respect, and a reflection I never wanted to write.

Written by Carl Betts
I am writing this piece on the evening of the 20th of December 2022 sat in my living room while my young children are in bed, sat by a warm fire where I should feel relaxed.  

It is the eve of the day that none of us want to be a part of but now feel that no other option is available to us. 

I’m a paramedic, an NHS paramedic, a proud NHS paramedic who is privileged to work in a vital role within our health care system.  I’m also the son of a mother who spent 30 proud years as a nurse in the NHS and as such this fine institution has been a part of my life since the day I was delivered into the world at Cameron’s hospital in the small coastal town of Hartlepool on November the 19th 1980. 

Tomorrow will be a momentous day for all the wrong reasons, and it absolutely should not be needed. Tomorrow is the day that we as a profession and as ambulance trust staff stand shoulder to shoulder on a picket line to formally offer the only option we have left to state how we feel by withholding our labour and formally striking. We are broken as people working with broken systems and outdated and underfunded infrastructure to name a few issues. The result of these broken systems is our patients and us as a workforce suffer. It really hurts us when day-in, day-out we can’t deliver the absolute best care because of circumstances out of our control, where our colleagues are fed up of apologising to patients and their families because there loved one has been on the floor for a shocking length of time and then apologising that they are sat in the back of an ambulance for hours waiting to enter the hospital.   

Tomorrow when the picket lines happen, be clear, we are caring professional people who are making this stand because of exactly that. We care! We care about the NHS, we care about our patients, we care about our colleagues, and we care because we are passionate about what we do. 

This strike is very different to previous. Strikes in the ambulance sector have previously been called due to discontent between the workforce and the organisation who the staff are employed by. This strike is different in that we are not striking because of a local issue, we are striking because of the national carnage that is going on throughout the whole NHS.  This makes my decision to strike even more difficult because our senior leaders and our colleagues who aren’t members of a union or have chosen not to strike (which I commend as this decision will not have been taken lightly by many) will have to cover a service that is already at breaking point, and I apologise to them all for the added stress the strike action I have been a part of may have caused. 

It's now the morning of the 21st of December and the day has arrived that the action will begin. It’s a fine day thankfully, which will make the thought of standing on a picket much more bearable. When I arrive on the line the first thing, I notice is that there is a sense of unity, a sense of we all have each other’s backs and dare I say it a sense of happiness. It’s very rare that we as a cohort of people get to spend any time with each other where we can and have a chat, because time on station on normal days is a very distant dream due to demand. The other striking note was the number of passers-by who beeped their horn or shouted support which is always comforting knowing that our communities understand why we are doing what we are doing. However, there was also the word regret noted on multiple occasions by multiple people about getting to this point and not feeling like there are many alternatives. 

When I arrive home my kids have just finished their pudding and my 4-year-old son asked me if I’d fixed work yet. I said I hadn’t, but I was trying. I soon started to muse over a statement Aneurin Bevin is believed by many sources to have stated “It (the NHS) will last as long as there are folk left with the faith to fight for it”. I write this knowing that my colleagues and I live by this, and therefore today I joined a picket and withheld my labour. 

When I started writing this piece 24 hours ago, I noted my kids were in bed asleep completely oblivious to the actual detail of the challenges that we face. I hope one day they will read this and be proud of the fact that their daddy stood up for what he believed and made a very difficult decision to try and safeguard one of the pillars of our identity and force the current, future, and past political institutions into admitting that it is there failings that have led us down this road. It is not my colleagues who have battled through a torrid few years and saved countless lives, consoled countless relatives and made very scared patients smile through our deep engrained desire to care.  

We are the care givers, but we are also human, and we need care ourselves. Please start looking after the care givers as we only have so much to give and like a car, if it isn’t refuelled it will be unable to function.  

This is where we are now, running on empty with very little more to give. 

Time will tell if our deep-rooted concerns and frustrations have been listened to. I’m not hopeful and as a result I genuinely fear for the future of the health system in our country. 

I for one in my role am determined to make as much positive change as I can and will sleep knowing that I’ve done my best and I hope my colleagues can also reflect to the same point. 

Nelson Mandela famously wrote “After climbing a great hill, one finds that there are many more hills to climb” (A long walk to freedom), This is the greatest hill the NHS and the ambulance sector has climbed and there will be many more to go but we can’t climb them alone. We need support and a bit of love from the absolute top of the political system to stop this ambulance rolling all the way to the bottom in a ball of flames. The time is now, we cannot wait. Please listen to us. We are not making this stand just to be difficult, we are making this stand because we feel we have no other option left to us. 

I hope this little piece has offered you some clarity as to why I have chosen the decision I have made today. 

Your faithfully, a very sad and scared ambulance paramedic. 

Carl 

Written by Wasim Ahmed
OVERVIEW 
I signed up for this year’s Emergency Services Mental Health Symposium as I was curious. Conversations around the mental health and ‘wellbeing’ of staff have grown in recent years, but what do these involve? What do these concepts mean amongst the emergency services? What issues and challenges have been identified? What is being done to address them? Moreover, what is available for staff in relation to their mental health and wellbeing? 

This two-day event was a follow up to the inaugural Emergency Services Mental Health Symposium in 2021 where several organisations adopted pledges to the Mental Health at Work Commitment (visit https://www.mentalhealthatwork.org.uk/ for more information). Since the 2022 Symposium featured countless speakers and nearly 145 organisations were in attendance, I thought it was a great opportunity to find answers to my questions. 


Wasim at the Emergency Services Mental Health Symposium

My personal highlights of the Symposium have to be the first and final sessions. Beginning the event with the Lived Experience Panel helped to frame its significance and relevance. The emotive, powerful and inspiring stories of each panel member emphasised why it was so important for people to come together and explore how to address growing issues and the challenges staff experience with mental health.  The final panel, Building with Diversity, underlined how crucial identity is to the mental health of staff in the workplace, going beyond protected characteristics like race and gender to also discuss neurodiversity. 

The choice and range of sessions throughout the Symposium was almost overwhelming. It was intriguing to learn about the array of projects and activities other emergency services were undertaking surrounding mental health and wellbeing. Attending thus provided a great opportunity to share learning and good practice with many people who were passionate about making a difference. What was particularly new and refreshing to me was the growing work being done to support voluntary staff, and to engage family and friends in relation to supporting staff mental health and wellbeing. 

As Silverstone Race Circuit was the venue for the Symposium, we were lucky to have the opportunity to tour both the podium and racetrack, which was fun. It provided a nice escape from the Symposium, and another way to interact with other attendees. I was never going to turn down the opportunity of a picture on the podium!


Wasim enjoying one of the Podium visits offered by Silverstone Medical Services

REFLECTIONS 
Although it is great we are having such open and collaborative events dedicated to the mental health and wellbeing of staff, I still feel there is huge scope for improvement, starting with the scope of the conversations being held. 

Much of the language around wellbeing and improving mental health heavily emphasises the individual. Informal models of peer support, self-help activities, self-care initiatives, to name a few examples, often dominate what wellbeing has come to mean to many. Yet, as Martin Hewitt (NPCC) remarked in his closing address, the huge dependence on individuals is not only unreliable, but also not fair. Is it fair to expect staff to undertake so much away from work to ensure they are able to perform well at work? Can we rely on staff to look out for each other in settings where harassment, bullying, burnout and discrimination take place? To expect staff to identify signs in other people experiencing issues with their mental health and wellbeing when they are struggling with their own? 

Many staff members feel disillusioned with such notions and common practices of wellbeing for these reasons and more. Emphasis on individual cognitive and behaviour modification seems to translate as ‘the problem isn’t with the environment and system you’re working in, but with you, and you need to be better at dealing with it’. To those who hold this view, wellbeing initiatives and activities are about encouraging and enabling staff to accept and deal with the adverse impact their work has on their mental health, rather than to address the root causes to mitigate this impact instead. 


Wasim with Neil Basu (Assistant Commissioner for Specialist Operations, Metropolitan Police Service) who took part in the 'Building with Diversity Panel Discussion' at the Symposium

What are these root causes? As well illustrated by the Lived Experience Panel, it’s not being valued, appreciated, or supported in the workplace. It’s managing a widening scope of practice and immensely growing workload throughout the last decade with insufficient training, support and resources. It’s negating bullying, harassment and discrimination due to one’s identity and position in the workplace. It’s adopting unhealthy and unsociable work routines in toxic work settings. It’s struggling to live well with a depreciating salary. And the list goes on.  

Although individuals need to be part of the conversation, they aren’t in control of these root causes, of how all these factors manifest and more. These are shaped at a policy level, the institutional culture in the work environment, and the systems we adopt to manage staff. The need to prioritise areas of focus surrounding mental health in the emergency services makes sense. But first we need to have a comprehensive understanding of how these issues and challenges are manifesting to ensure any strategies adopted are effective and sustainable. Otherwise, the current approach of dealing with the aftermath and consequences of problems with policy, culture, environment and systems rather than preventing or mitigating their occurrence will mean issues with the mental health of staff will only grow, particularly in the current conditions of political and economic instability.  

Wasim is a UK-based Paramedic who will be presenting his webinar, ‘The Elephant on the Road: Emotions in Paramedic Practice’, on Monday 30th January from 10.00-11.00.  

This webinar is free for members of the College of Paramedics and £10 for non-members. Click here to book your place.

Aimee Boyd MCPara, Research Co-Ordinator, Paramedic, Yorkshire Ambulance Service
I was still a newly qualified paramedic when I decided to participate in the BREATHE research trial. BREATHE is a study investigating Breathlessness RElief AT Home.  It’s working off the statistic that 1/3 of the people living with chronic respiratory diseases (such as Chronic Obstructive Pulmonary Disease (COPD)) and breathlessness who are taken to hospital, are discharged with no additional interventions. The long-term aim of the BREATHE study is to see if this breathlessness management intervention is effective at increasing safe on scene discharges in this patient demographic, rather than taking them to the ED when not needed. This part of the study was a feasibility trial; it’s a smaller scale of the study to see if it is possible and acceptable for paramedics on the road to collect consent and data from breathless patients and carry out the intervention, before a full study takes place on a larger scale to see if the intervention is effective.

I initially signed up because I wanted to get some training and CPD under my belt. I also knew research is one of the College of Paramedics ‘Four Pillars.’

What I didn’t count on, was a respiratory virus interfering with things!
  I completed training for the study around May 2020 – so we were still in our first COVID lockdown. I don’t think training for BREATHE paramedics was initially planned to be held online, and I hadn’t participated in anything virtually before. I think there are positives and negatives to online training – I didn’t have to commute anywhere and we still had our cameras on, so we were given some feedback about the techniques we were using. It would have been nice to do it in person so I could practice coaching another person through the techniques, rather than modelling them myself.

I was in the intervention arm, so I had some additional training on the BREATHE intervention. We used the BREATHE acronym, as both an aide memoire and a training tool, to help patients and their carers manage breathlessness independently. BREATHE stands for;

• Be reassured
• Resting positions – get comfortable, relax your shoulders
• Exercises to calm your breathing
• Airflow – using a fan, or opening windows
• Take your time
• Help with fears, use an action plan
• Educate – read the booklets for practical solutions to help.

We were given fans to give to each patient, but we were unable to use them due to the unknown risks of COVID at the time. This was a shame, because when I have been to COPD patients in the past, I know they found fans helpful. Outside of the trial, I would give patients a folder paper fan. We did some breathing techniques where the patient looks at a window or a TV screen – anything rectangular, and focuses on breathing out on the long edges, and in on the shorter edges. This helps prevent short sharp hypoventilations that can make a person feel like they aren’t getting enough air, and the anxious feelings that follow. This is so easy and relatives would always take over coaching without any prompting from us as the crew. Finally, to help people relax, we put pillows under their armpits – it really works! People are suddenly aware of how much tension they are holding in their shoulders.



We also asked patients to rate their breathlessness every few minutes, on a scale of 0-10, where 10 is extremely breathless, and 0 is not breathless at all. It’s a good tool for patients, because they can see from their own self report that their breathlessness has improved compared to their baseline. For me, it was helpful to document something quantitative to reiterate breathlessness had improved.

Despite the inclusion and exclusion criteria being clear, it was tricky to recruit patients as I didn’t know where we stood with COVID patients. I would be really interested to see how COVID and long COVID are built into the inclusion and exclusion criteria should we do further research with BREATHE. Even though I didn’t recruit many patients into the trial, I found the techniques I learned worked well with patients having panic attacks, so it was nice to be able to apply that learning elsewhere in my clinical practice.

I really like that Ann, the lead researcher, is proactive about dissemination. Ann was keen to hear from us and she invited the recruiting paramedics to share our feedback, and I do feel like my feedback was valuable to them and will be something that is acted upon. I have also attended a conference where I have seen Ann present the study.

BREATHE was a great introduction to research in the pre-hospital environment for me!

Want to find out more?

For more information on the BREATHE study watch this video.

Read the Protocol Paper - Northgraves M, Cohen J, Allgar V, et al. A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): Study protocol. ERJ Open Res 2021; in press (https://doi.org/10.1183/23120541.00955-2020).

Read the Paper - Hutchinson A, Allgar V, Cohen J, Currow D, Griffin S, Hart S, Hird K, Hodge A, Mason S, Northgraves M, Reeve J, Swan F, Johnson M. Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): Study findings. ERJ Open Res, 2022. Doi:10.1183/23120541.00257-2022

Follow us on Twitter! - @YASResearch @AHutchinsonHull @HullYorkMed @wolfsonpallcare

https://www.hyms.ac.uk/research/research-centres-and-groups/wolfson/breathe

 Find out more about getting into research 

 

The theme this Black History Month is ‘Time for Change: Action Not Words’. 

Black History Month is a time to come together to commemorate, educate and celebrate the contribution that Black people have made and continue to make in all areas of society and around the world. 

Following the Black Lives Matter protests in 2020, many organisations and individuals made commitments and pledges to tackling racism. People took time to increase their awareness and understand the lived experience of Black people. 

Commitments to tackle the legacy of inequity from colonialism and slavery were brought to the forefront of public consciousness. This was a momentous step forward but many of us recognise that change is slow, and racism is persistent. The eradication of racism will take consistent and hard work to dismantle the structures and systems that ensure its longevity.   

We see numerous reports and statistics calling out racism across a range of sectors, from healthcare to education and policing. We know that racism is societal and an extremely complex issue.   

We must use every Black History Month as a call to action, an awakening to renew our resolve and to continue the fight against racism. This commitment is not only for the month of October, we must carry on taking anti-racist action all year long to root out racism.   

To ensure sustainable and lasting change it is important that we all work together and that our allies continue to support change through their actions. Actions have always been louder than words. 

 
Advancing inclusion - The Diversity Steering Group 

The College of Paramedics strives towards ensuring that the profession is more inclusive, diverse and a place where everyone belongs regardless of their background.  

The Diversity Steering Group plays a vital role in advising the College on equity, diversity and inclusion. Their work focuses on five strands: Race Equality and Cultural Heritage (REaCH), LGBTQI+, disability, gender equality and socio-economic status.  

The College of Paramedics has built important connections with the AACE National Ambulance Diversity Forum, the National Ambulance BME Forum, the National Ambulance LGBT Network and the National Ambulance Disability Network, as well as partnerships across the health and education sector. It has forged relationships with employers, in order to advance the work on equity and inclusion to make the paramedic profession a place where everyone has the opportunity to thrive and achieve, whatever their background. 

Article by Bo Escritt, a member of the College of Paramedics' Diversity Steering Group
 

I’m Andrew Hodge, I’m a paramedic and the Director of Allied Health Professions at Mid-Yorkshire Hospitals NHS Trust.  This was a new post starting in April this year as the agenda to strengthen the professional leadership of AHPs has been rapidly developing across the country.

The main aim of this role is to provide a voice for, and represent the Allied Health Professionals across our organisation, much in the same way that the nursing and medical professions do.  The role focuses on the strategic development of our different Allied Health Professions, providing a collective voice amongst the Trust’s senior management teams, and working to develop the contribution that AHP’s can make to patient care and service delivery.  Without this voice, AHP’s have traditionally been at risk of being omitted in developments such as service planning and redesign.

Having a career as a paramedic has provided me with the opportunities to develop into advanced clinical practice, non-medical prescribing and 6 years as a consultant paramedic in an ambulance service.  Developing into the consultant paramedic role’s 4 capabilities of leading on research & service improvement, teaching & practice education, clinical leadership, and clinical practice enabled me to develop the skills I needed for my current role.  I enjoyed the professional leadership aspects of the consultant role, engaging in national forums to represent the profession while also being part of regional groups which included the AHP Council where I started to understand the issues and developments related to the broader AHP community.

Leading on research and publications became a particular focus of my work that I could see was important to our profession in demonstrating our impact on current and future service models.  Developing our profession’s clinical career framework around specialist and advanced practice required the delivery of many pilots such as primary care rotations and advanced practice schemes to develop the evidence to argue the case for the framework.  

The role of the consultant paramedic is also to represent the profession and provide a clinical voice amongst our operational management colleagues, contributing to senior management discussions through a clinical lens, and providing the vital clinical opinion that contributes to informed decision making.

These experiences, amongst others, enabled me to develop in a way that prepared me for my current opportunity, after having a few unsuccessful interviews for other roles along the way of course.

Now, working in a Trust that provides both Acute care and Community Services has been both a culture shock and presents new challenges in adapting to the complexity of the services delivered.  But the learning and opportunity to work in a different part of the healthcare system is invaluable.  Extending my experiences as a paramedic into professional leadership of AHPs is both an advantage and a challenge.  An advantage because being a paramedic means that I’m an AHP without any particular bias towards the AHPs normally employed in the organisation, and a challenge as it feels like it’ll take years to understand the nuances of each of the different professions within our collective group.

For those paramedics who are interested in doing so, pursuing a professional leadership career outside of our own profession’s traditional environment can be interesting, fulfilling and rewarding.  Many years ago I spent two years working in commissioning and a further 5 years in community urgent care services in advanced practice, and while I missed working for an ambulance service I also knew that I was gaining experience in ways that I couldn’t necessarily get in one organisation.  It all builds upon your knowledge base.

Now, I’m currently going through the transition again; in leaving an ambulance service where my paramedic identity fits most easily and into another part of the system traditionally occupied by other healthcare professionals.  However, my observation over the years of working in different organisations, is that the value the paramedic can bring to what are currently (although increasingly less so) non-traditional environments for the profession, is unique and valuable.  We bring with us a different perspective, shaped by our clinical responsibilities and experiences, and this enables us to contribute in a different way that adds value through our distinct perspective not easily found in other professions.

Just as the profession develops more into advanced practice and can be increasingly found in advanced clinical practice roles across primary, community and acute care, it’s important that we take the opportunities to develop into senior leadership roles.  Partly, for this to happen we need more opportunities in ambulance services for those of us who don’t necessarily want to pursue solely operational management careers more consultant paramedic roles for our clinicians to develop into and more paramedics sitting on ambulance service boards to influence our profession’s and the organisation’s direction.  It will also create more opportunities for those clinicians who are interested to develop in these roles, gaining skills and experiences that are transferrable across the health and social care system.

We also need to develop leadership programmes and fellowships with opportunities for exposure in a range of different environments.  Where I’ve seen this happen, I’ve observed those involved to become inspired and pursue careers in ways that they probably couldn’t previously have imagined.

Looking back over the past few decades, our profession has developed quickly and continues to do so.  As the NHS looks for new ways of working, our profession can, and is, starting to play a valuable and larger role in addressing some of the challenges.  With this comes more opportunities, which we must be aware of and grasp with both hands, even if we don’t feel fully prepared we should trust the process and if appointable then believe in what you’ve learnt so far and enjoy the development journey offered.  


 

The Future is Bright Mental Health Future Workforce Project Conference

On the 30th of August, the College of Paramedics Future Workforce Mental Health Project (FWMHP) officially launched three new interventions; a new national mental health and wellbeing curriculum, a WRAP wellbeing reflective support tool and an education suite for practice educators and preceptors to support pre-registration and early career paramedics.

The conference saw co-academic leads Katie Pavoni and Emma Geis present the context of the project and give an overview into the development of these interventions, which included stakeholder engagement groups with academics and subject matter experts for the development of the curriculum, a pilot study with 37 students from four different universities around the effectiveness of the WRAP support tool and finally stakeholder engagement groups with  students and practice educators for the development of a supportive package for practice educators.

We also heard the lived experience of 2nd year St George’s, University of London (SGUL) student Chloe Richards who shared her insight of taking part in the WRAP pilot study and the positive impact this had made upon her wellbeing, along with Josie Newsome, London Ambulance Service Paramedic Practice Educator who gave a powerful personal perspective on how increased awareness and understanding of mental health and wellbeing as a practice educator is vital to supporting students and the role of educators. 

Finally, Gemma Howlett, Principal Lecturer at Cumbria University, delivered an inspirational presentation which explored the importance of ensuring a culture of inclusivity which challenges discriminatory practice, celebrates the diversity of students, promotes true equality and advocates for students to be their ‘wholeselves’.

The afternoons’ structure included four best practice workshops. Peter Phillips, Course lead at Bournemouth University, and Amy Halck, Lecturer at Staffordshire University led the curriculum workshop and facilitated a discussion around how to embed the new curriculum into an already packed undergraduate program, identifying tips and tricks of integrating wellbeing into an already established curriculum. Sam O’Brien, Lecturer at Staffordshire University, developed and facilitated discussion around three case studies that will form the face-to-face element of the intervention three learning offer. These case studies were based around three hypothetical students with the aim to recognise distress and difficulty and how to support students within clinical practice. Katie Pavoni and Abi Blythe, recent St George’s, University of London graduate, presented the SGUL peer support network and facilitated a workshop on how this could be embedded into different universities, in order to promote mental health and wellbeing advocacy and compassionate communities. Finally, Emma Geis and Chloe Richards facilitated a discussion around the use of the WRAP reflective tool and supported the delegates in signing up and utilising the tool.

The day concluded with future plans for the project being outlined, which include hopes for a collaborative platform for academics and educators to come together and share best practice of how to implement the new mental health and wellbeing curriculum for pre-registration paramedics. A rigorous research study into the effectiveness of the new reflective wellbeing support tool for student paramedics (WRAP). Finally, a pilot with 5 ambulance trusts to deliver a face-to-face train the trainer education package to assist practice educators in supporting students with mental health and wellbeing needs when on clinical placement.

Feedback from delegates showed a real sense of commitment and passion for the promoting positive mental health and wellbeing within the paramedic profession and the hopeful message that together, the future is bright. 



Emma Geis: Academic Lead FWMHP, Lecturer, Keele University 

Katie Pavoni: Academic Lead FWMHP, Associate Professor, BSc Paramedic Science Course Director/Pastoral Lead, St George’s, University of London.

Click here to find out more about the Future Workforce Mental Health & Wellbeing Project
 

Newly Qualified, Newly Terrified. The Fear of Starting as an NQP.

By Adrian Whateley, Paramedic, Yorkshire Ambulance Service. 

One of my first encounters with a paramedic was as at a tender young age when trousers were everything. I remember my Nan had bought me a pair of perfect gold-coloured trousers, which at the time I treasured. What I didn’t know was that one night those trousers would be the reason for my encounter with said paramedic. Without giving too much away and less said the better, zips and bits do not mix, and tuff cuts come in handy.

20-odd years later and here I am, a Newly Qualified Paramedic (NQP) wondering whose smart idea it was to become one and why on earth someone would give me the responsibility of Morphine.

It was back in 2015 when I joined the Yorkshire Ambulance Service, I started as an Emergency Care Assistant, I remember how I thought that every call was an emergency and that everybody needed to go to hospital. 4 years later in 2019 and a little less naïve, I began my journey as a student paramedic at Teesside University. I loved my time as a student, my time at university was fantastic (I can appreciate it now, no more essays!), I’ve met some amazing people and have made friendships that will last a lifetime. My mentors on placement were fantastic (you know who you are), I went to some amazing calls, and I was based where I worked. I cried and threatened to quit only a handful of times!                                                                                                                                                             
Moving forward, It’s now 2022, I’m newly qualified, newly terrified.

It was the 4th of July when I started as an NQP, a fitting date I thought. I spent the first nine days in a classroom sitting through the new employee induction, before I knew it I was out on the road alongside the more experienced paramedics, not that this made a difference however, as I was promptly told, and rightly so “you’re the paramedic now, it’s your responsibility”. Never before have I recoiled at such a curse word.
                                                                                                          
Three weeks later and that was it, I was out as a single paramedic alongside an Emergency Care Assistant, my first command as it was, no more safety blanket. I remember how my hand trembled as I was writing my name and number into the Morphine book, booking out my first ampoules of Morphine, the word ‘responsibility’ smashing around in my mind, wondering what manner of horror was going to come through on the screen. Was it a full moon? Who was I going to kill? Is it home time yet? A plethora of irrational thoughts. In reality, it was a ‘standard’ shift, I attended a few mental health related calls and took a few people to hospital, nothing too stressful.

A couple of weeks later and I am starting to feel more grounded in my new role. I have achieved a number of firsts such as my first self-care, my first missed cannula (as an NQP, I missed loads as a student) and administering my first dose of Morphine, which was quite an experience. I recall he was an anxious gentleman with severe crushing chest pain, he had never had Morphine before and so I started with a small dose of 2mg, the effects of which caused him to have a panic attack and become short of breath, which in turn caused me to become panicked and short of breath thinking id given this gentleman a lethal dose! Clearly I was wrong and a few minutes later we were both fine. Needless to say, I put the Morphine down.

I am now 10 weeks into my role, and it is still early days, I am feeling far more confident than I was in July.  I have found that the single most effective tool against the fear and something that I have learnt over these short months is to understand and accept it. It's ok to be afraid, it’s a normal part of the process and a process which every paramedic, nay every member of the ambulance service goes through when they first start, some of us twice! It does get easier with time and the enjoyment soon outweighs the negative. It’s important to record reflections and maintain a good level of CPD, I have found that doing so has helped me tenfold with my confidence and insecurities. If however you do find that things are starting to get the better of you and you are starting to feel overwhelmed, remember that you are only human, it is ok and do not be afraid to speak to someone about it.
 
The College of Paramedics have recently launched the WRAP tool to support both student paramedics and early career paramedics. This online tool encourages users to reflect on specific incidents from a psychological or emotional perspective. It is laid out as a simple form for completion at any time and it can remain personal and private to the user or be shared easily with a mentor or educator if needed. Click here for more information. 

 

The 9th Annual Medical Special Operations Conference

By Benjamin Watts   

After a short Covid-19 based hiatus the Fire Department of New York (FDNY) held its 9th annual Medical Special Operations Conference from May 12-15th 2022. This years conference had attendees from 6 countries and 26 states of America!

The conference falls into 3 main parts.

- MSOC EMS competition
- Pre-Conference workshops
- Main Conference and Workshops

I was fortunate enough to be invited to represent World Extreme Medicine (WEM) and the Emergency Medical Retrieval Service (EMRS) facilitating a full day pre-conference workshop at Fort Totten (EMS Training academy) exploring Human Factors and non-technical skills in low resource and wilderness environments.

Eoin Walker (Philips, RDT – ex-LAS AP-CC and LAA HEMS Paramedic) and I worked with Mark Hannaford (Founder WEM), Stephen Wood (Director of APP MICU St. Elizabeths Medical centre Boston MA) and Jeremy Neskey (Intern at Uniformed Service University College of Operational Readyness) to deliver the days teaching and simulation. A multi-disciplinary team from the USA and UK with a wealth of experience from healthcare, military and expedition settings.

We ran a series of practical sessions exploring and leadership, followership, shared mental model and the importance of developing robust communication strategies in challenging environments. The day culminated in a protracted, low-resource multicausality incident in challenging terrain, where the teamworking and human factors within the flash-teams was tested.

Other workshops included cadaveric labs, drone work, animal/K9 first aid and the Tactical Casualty Care Course (TCCC).

The MSOC EMS competition looked an excellent combination of technical rescue, high-fidelity simulation and complex clinical situations. The teams were all US based and performed to a very high standard. Perhaps a UK team should compete next year? HART/SORT teams from around the UK…

The main stage of the conference was host to some incredible international speakers proffering topics from ‘Space medicine’ and the lessons learned, to the management of prolonged confined space incidents and crush patients. Dr Stuart Weiss presented some fascinating crowd-based trauma and the lessons learned and how apply them to a plan for mass-gathering events, mitigating the risks of crush.

Randall’s Island is the New York Fire Department equivalent to Moreton-in-the-Marsh fire training centre in the UK, multiple burn buildings, a subway station, airplane carcass and rubble piles with a tunnel system as well as a purpose-built contained street with working at height gantries and multi-purpose buildings which can be used for hostage situations, MTFA exercises or technical rescue.

During the conference there were multiple practical workshops with one exercise simulating a patient trapped between a subway carriage and platform, a ‘oneunder’ with a critically unwell patient under another subway carriage. At the other end of the subway track is a second station which held a 15 casualty MTFA exercise.

The opportunity for joint working, shared learning and making friends and connections with colleagues from across the US and Canada was a privilege and one I would highly recommend. The conference was a brilliant experience. I look forward to next year!

Essential places to visit for any emergency services personnel visiting New York.

- Ground Zero and 9/11 Museum
- O’Haras Bar (A true emergency services bar – ask to see ‘The Book’ incredible history!)
- FDNY museum.

Benjamin Watts – Advanced Retrieval Practitioner – Emergency Medical Retrieval Service – Scottish Ambulance Service. 

 

Ambulance Pressures Today and Everyday

By Liz Harris   

The stark images of queues of Ambulances lining up outside of Emergency Departments is an unmistakeable and bleak warning signal of a whole system that is in trouble and not delivering the healthcare that we would expect in this country.

Paramedics and our ambulance colleagues turn up to work every shift to make a difference to someone’s life, to improve life, to save a life. They don’t go to work to be stood in a queue for hours and hours. This is an appalling waste of the NHS’s most valuable asset, its staff. And for every ambulance in that queue that is one less available to respond to the next 999 call, hence the long waits for an Ambulance that the public are having to experience and endure currently.

Paramedics and their Ambulance colleagues know that while they are stood in that queue, 999 calls are coming in and other patients are waiting, maybe even their own family and friends are waiting. Not only do they know this, they can hear it too. Ambulance staff carry radios and in some areas call centre staff will broadcast a plea to them to call clear and available, as they have 999 calls waiting or one of their colleagues working alone on an ambulance car is with a seriously ill patient and asking for assistance. The echo of the message resonates along the queues of paramedics standing by their occupied stretches at ED, powerless to respond.

This reality is unabating and has a detrimental effect on their personal and professional wellbeing. Paramedics are arriving at people who have deteriorated, and people who have died because of the delay in the time it’s taken the ambulance to get there, the guilt and the burden of this builds over time. Having to repeatedly manage this and the often overwhelming but totally understandable fears and frustrations of affected families is exhausting.

The situation is just as grim for the Emergency Control Centre staff too, the 999 call takers and Ambulance Dispatch teams, who arrive at work to computer screens full of what we call ‘stacking calls’, that’s hundreds of 999 calls waiting for an ambulance to become available, with the painful knowledge that they will never get to the bottom of that stack and manage to deal with everyone, no matter how many hours that they work.

The situation is breaking our ambulance workforce and breaking our hearts.

Paramedics and ambulance colleagues are currently seeing the usual mix of patients including anecdotally more calls to people experiencing significant difficulty with their mental health. Covid has lengthened pre-planned waiting times so people have had their treatments and procedures delayed, which leads to more urgent complications that might now require 999 or ED. And of course, we currently have the high temperatures contributing towards more demand on healthcare.

Hospitals are seeing more people accessing through the ‘front door’ of the ED or 999 and together with not enough people leaving and going home through the back door, it means that hospitals have many more patients than they have the capacity or the space for. The discharging of patients from hospital is a really important factor to highlight as the process of getting someone home from hospital requires an efficiently functioning system including adequately funded community and social care services.

The sustainability of an underfunded and overstretched NHS is not a new debate. Neither is the increase in demand for ambulance responses or the long ambulance handover delays seen at the moment. It must be remembered that this situation did not just arrive during the dark nights of the pandemic. Many of these issues have been repeatedly highlighted by a range of organisations for over 10 years. The difference now, is that the scale of the issues are beyond what any of us have ever experienced. We are way beyond the point of increased risk, we are facing a public health crisis, and if those in government could wholeheartedly accept and acknowledge this as a reality, that could be the first step towards tangible and implementable solutions.

Within the demoralising and desperation of this unfolding catastrophe, it is really important to not apportion blame to specific areas of the NHS or organisations within it, it’s not the Ambulance Services fault, it’s not the EDs fault, it’s not the GPs fault, it’s not the patient’s fault.

There is no simple solution, not to a complex and chronic problem such as this. This situation is a result of many intertwined issues. An historical lack of funding, a lack of systemwide planning with regards to developing connected and integrated 24/7 services, and a lack of setting out what the future workforce looks like in terms of numbers and skills required to deliver the healthcare needed.

The College of Paramedics will continue to push hard and lobby alongside our healthcare colleagues in the hope that the emotive words and appalling truths in the headlines will instigate some real change that makes a positive difference to paramedics working lives, the care that they can provide to the public and the ambulance sectors capacity to deliver a safe and effective service to those in the most need.

Liz Harris, Head of Professional Standards

Retention in the World of Frontline Ambulance Staff: The Seesaw Balance of Frustration and Contentment

By Carl Betts  

We as a cohort of individuals who work within the varied roles of the ambulance sector are one of the key threads that keep the fabric of pre-hospital emergency and urgent medicine intact.

Through multiple factors these threads are now wearing thin, fraying, and starting to fall apart which is having a direct impact on our crew’s health and wellbeing as well as the care that ambulance services offer patients.

Currently the retention rate within the frontline ambulance sector is dire which, if it came with warning lights, would light up a dashboard like a Christmas tree. As this issue has worsened over time, we have grown to live with the situation. We now find ourselves at present with the warning lights being so bright that they are ready to combust. This issue has been present for a long time and will only carry on getting worse if significant changes are not made to the profession, and within the wider scope of the NHS.

For many of us in frontline work the general feeling of being a back stop for the NHS can and does cause a lot of frustration to crews who feel like they are mopping up other NHS services work that are also under considerable strain. Now let’s please be clear, this is no fault of our other NHS service colleagues directly. This, as with many other sectors, is due to years of mismanagement and a clear lack of long-term vision. The lack of vison has left primary and community care at crisis point. By its very nature this is causing a knock-on effect, increasing the pressure in the acute setting.

The word frustration is a key one at this point. We all to work to do the best we can for the patients that are in our care. We as a cohort of staff did not join this profession to see one or two patients in a 10-hour shift and spend the rest of it sat in a hospital car park with a patient who needs hospital treatment and assessment. This current state of play seems to be a now “Business As Usual” (BAU) with no clear end in sight.

Currently the “frustration seesaw” is hugely biased to the wrong side. Whatever role we work in, if the positives outweigh the negatives, we can gain some contentment. No role is perfect unless you’re very lucky, but there is a balance to be had between the level of negativity and where that negativity sits in your day-to-day life.

As we all know a “seesaw”” has two ends and a pivot point in the middle. The weights at either end are that of contentment and frustration with the central pivot being the patients. Frustration and contentment aren’t discussed a lot taken as a pair in the ambulance service. In isolation, the word frustration is used daily, but sadly I can’t recall the last time I heard a colleague hint at being content at work!

The things that never change are the patients, thus becoming the central pivot. Yes, over time the acuity and the volume of patients we see may have changed, but the steadfast part of the ambulance world is that there will always be patients and they should be at the centre of all we do. However, without a content workforce and functioning organisation we will never be able to offer the best service to our service users. If a service looks after its staff then staff will look after the service and help to ensure the best service possible is available for our patients.

The seesaw within the ambulance sector is currently hugely frustration heavy. When we become frustrated lacking a vison then the feeling of contentment disappears. If we cannot be content, we will always be looking for a way out and if frustration is the key weight on the seesaw, then the positive / negative equation will always be out of balance favouring frustration.

This imbalance leads to staff becoming disillusioned, annoyed, angry, and burnt out, resulting in high levels of staff absence. On occasions really good staff leave the ambulance service altogether.

It is imperative that this seesaw is weighted the other way so that contentment becomes the key gold standard and the only acceptable option. Currently I cannot see where this will come from which is a very depressing situation and leaves me feeling genuinely sad that this great career path is very quickly becoming a no-go for many. The increased risk of burn out being ever present for the staff that do choose to do continue. This mental burn-out not only has profound long-term consequences for the person involved, but also for their nearest and dearest.

We must act now with all the vigour and resources available to the sector to ensure the seesaw is tipped from “frustration to contentment” for the long term. Many Trusts are looking at rotational opportunities for clinicians as accepted by Health Educational England’s Model. As for Emergency Care Assistants, there are now opportunities to complete their Associate Ambulance Practitioner (AAP) as well as accepting that flexible working agreements are key to supporting our colleagues. This is positive but is it too little too late to alter the trend of organisational staff retention issues? The seesaw has been weighted the wrong way for far too long and has affected far too many colleagues and families for it to be acceptable. This is now the legacy we have been left with and it’s not one to be proud of. If the world of ambulance life is to be seen as a long-term career option things must change and some very big decisions way out of the normal organisational cultural boundaries need to happen. One such way is humanising our colleagues and understanding their other skills and attributes. By doing this we should then be guiding people into short term redeployment before they are too far down the burn out road and be actively doing all we can to stop staff going off sick as this not only adds value to the person but also the organisation.

I am genuinely fearful for our profession in the frontline ambulance setting. Staff being unable to cope and the potential long-term damage our profession is doing to some wonderful human beings who will bend over backwards to support their colleagues and patients. The question is: Who will bend over backwards to support them? I would love to be able to offer you the answer to this question, but I can’t and that just leaves me feeling sad.

The profession I love and the people who I highly respect and admire are crumbling in front of our eyes. Let’s hope that one day soon our seesaw will be firmly weighted to contentment and that this fabulous career will be seen as just that again, as opposed to a job that will make you ill and fill you with disillusion.

Carl Betts – Paramedic

Managing Right Ventricular Myocardial Infarction: A Prehospital Service Evaluation

By Mark Stanley 
Edits by Prof Joanne Garside and Dr John Stephenson 

Introduction
Traditionally, the focus of pre-hospital treatment of acute myocardial infarction is to reduce the impact on the left ventricle while customarily also, the impact on the right ventricle was largely unnoticed. Yet Cohen et al (1974) highlighted the express need for specifically tailored pre-hospital treatment for those with RMI.  Jacobs et al. (2003) further argued two fundamental interventions of pre-hospital care namely, that morphine and nitrates should be avoided in RVMI pre-hospital care. Furthermore, that giving fluids for hypotension is essential to maintain cardiac preload. 

RVMI is however, is a relative rarity occurring in less than 3% of all acute MIs. Nevertheless, RVMI have been found to occur in 30-50% of patients presenting with inferior wall MIs (IWMI) (Kakouros & Cokkinos, 2010) (Namana, et al., 2018). 

Pathophysiology 
The heart forms two pumps; the left ventricle, the high-pressure chamber, and the right ventricle, a low-pressure chamber sensitive to pre-load and after-load changes (Kelly & Cohen, 2008). Right ventricle myocardial damage causes reduced contractility, dilation, compliance and stroke volume, consequentially reducing left ventricular output (Pike, 2009; Kakouros & Cokkinos, 2010). Right ventricle dysfunction is predominantly influenced by venous volume and pressure to maintain adequate return, both of which can be compromised in RVMI (Garcia, 2015), reduction in either has a negative impact on cardiac output, resulting in complications such as hypotension and bradycardia.
Diagnosis of RVMI can be confirmed through clinical examination, the 12 lead Electrocardiograph (ECG), ultrasound and/or magnetic resonance imagining (MRI) (Kakouros & Cokkinos, 2010). In turn, inaccurate diagnosis of inferior MI with right ventricular involvement has a higher incidence of in-hospital short-term mortality (Pfisterer, 2003). More specifically, an IWMI patient with RVMI has a 17% mortality rate compared to inferior MI alone of only 6.3% (Inohara, Kohsaka, Fukuda, & Menon, 2013).
RVMI in-hospital management includes early recognition, early reperfusion, followed by (depending on size of MI), fluids for hypotension, inotropic support such as Dobutamine, while avoiding diuretics and nitrates (Namana et al., 2018; Kakouros & Cokkinos, 2010). 
The aim of this service evaluation, therefore, was to identify factors associated with acute MI diagnosis and possible RVMI involvement, clinical interventions and pre-hospital complications.

Methods
Patient records and 12-lead ECGs were reviewed from September to December 2018. Approval was received from the Ambulance Trust and anonymity was ensured through redaction of identifiable features. 

Data Collection 
1) Diagnostic data: Patient care records were organised and grouped by anterior or inferior MI. 
Within the inferior group, recognised as most often associated with possible RVMI/extension, STEMI anatomical territories were identified. RVMI/extension was also identified for each case utilising criteria for possible RVMI/extension diagnosis (Table 1). 

ECG Criteria

Non-ECG Criteria

IWMI & ST Elevation in lead III > ST Elevation lead II Equal or >1 mm of elevation in the Right chest leads (V3R to V6R) ST Elevation in V1 extending to V5 and V6. ST Depression in lead II unless ST Elevation extending to V5 and V6. ST Depression V2 cannot be more than half the ST elevation in aVF (< ½ = Inferior RVMI, > ½ = Inferior, RV and posterior a significant MI). ST Elevation V1 or V1 – 3 or 4 with no Inferior reciprocal changes

Inferior wall MI + history of syncope Hypotension systolic BP 90mmHg Blood pressure drop >30mmHg post GTN Bradycardia Bradycardia, 2nd and 3rd degree blocks

Table 1 RVMI diagnostic criteria

2) Clinical intervention data was collected, including administration of morphine and glyceryl trinitrate (GTN). 
3) Pre-hospital complications data was included: cardiac arrest; hypotension with a systolic <90mmHg or a drop ≥30mmHg; bradycardia (<60 beats per minute (bpm)); any AV heart block; all periarrest arrythmias.
Data Analysis 
Descriptive findings were used to identify high-frequency outcomes. The association between identified complication outcomes and the interventions of GTN and morphine administration; and between suspected RVMI cases and STEMI territories was assessed using chi-squared testing. 

Results
A sample of 277 patients presented: 23 patients were excluded due to duplicate records (1), lack of adequate data (5), inter-hospital transfers (10) or other conditions (7). The remaining 254 patients were carried forward for analysis (table 2.0).

Variable	Mean (SD)
Age (years)	65.2 (14.3)
On scene to hospital time (minutes)	59.6 (22.1)
Variable	Frequency (valid %)
Gender (n=249) Male Female Not recorded	179 (70.5%) 70 (27.6%) 5 (2.0%)
STEMI region/ territory Anterior Inferior Lateral Inferior(only) Inferior Lateral Inferior Posterior Inferior Post Lateral Posterior Post Lateral	130 (51.2%) 124 (48.8%) 8 (3.2%) 83 (32.7%) 18 (7.1%) 14 (5.5%) 5 (2.0%) 1 (0.4%) 1 (0.4%
GTN administered	223 (87.8%)
Morphine administered	143 (56.3%)
Occurrence of complications Cardiac arrest Bradycardia Hypotension Blood pressure drop > 30 mmHg Blocks (1st degree) Blocks (3rd degree) VF VT PVC Uni PVC Multi	14 (5.5%) 72 (28.3%) 28 (11.0%) 38 (15.0%) 3 (1.2%) 2 (0.8%) 13 (5.1%) 3 (1.2%) 4 (1.6%) 4 (1.6%)
Possible RVMI	81 (31.9%)

Table 2: Descriptive summary of sample

The complications of cardiac arrest, bradycardia, hypotension and blood pressure drop ≥30 mmHg was identified as occurring in sufficient frequency for exploratory analysis of associations. Other outcomes did not occur with sufficient frequency and were not considered further. The dominance of the inferior territory in the STEMI group precluded the analysis of the effect of all individual MI territories: analysis was conducted on the effect of inferior territory only. 

Cardiac arrest
10 of 223 patients (4.5%) who received GTN and 4 of 29 patients (13.8%) who did not receive GTN experienced a cardiac arrest. Six of 143 patients (4.2%) who received morphine and 8 of 109 patients (7.3%) who did not receive morphine experienced a cardiac arrest. Hence the risk of cardiac arrest in patients who did not receive GTN was approximately 3 times the risk in patients who received GTN, and similar in patients who did and did not receive morphine. Chi-squared tests for association revealed evidence for association at the 5% significance level between GTN and cardiac arrest (2(1)=4.24; p=0.040); but no association between morphine administration and cardiac arrest (2(1)=1.17; p=0.280). 

Bradycardia 
30 of 83 patients (36.2%) classified as inferior STEMI and 42 of 171 patients (21.6%) not classified as inferior STEMI had bradycardia. Fifty-eight of 223 patients (26.0%) who received GTN and 13 of 29 patients (44.8%) who did not receive GTN experienced bradycardia. Forty of 143 patients (28.0%) who received morphine and 32 of 109 patients (29.4%) who did not receive morphine experienced bradycardia. Hence the risk of bradycardia was about 1.5 times greater in the inferior MI territory; approximately double in patients who did not receive GTN compared with those who did receive GTN; and similar in patients who did and did not receive morphine. 

Chi-squared tests for association revealed evidence for an association at the 5% significance level between GTN administration and bradycardia (2(1)=4.49; p=0.034); but no evidence for an association between the inferior infarct territory and cardiac arrest (2(1)=3.69; p=0.055) (albeit with a substantive association) or between morphine administration and low bradycardia (2(1)=0.058; p=0.809). 

Hypotension
Seventeen of 82 patients (20.7%) with inferior MI and 11 of 171 (6.4%) patients not classified as inferior MI had hypotension. Hence the proportion with hypotension was nearly 3 times greater in patients with inferior MI. Chi-squared test revealed the inferior MI territory was significantly associated with hypotension occurrence (2(1)=11.5; p=0.01).

BP reduction ≥30mmHg
37 out of 223 patients (16.6%) who received GTN and 4 out of 29 patients (13.8%) who did not receive GTN experienced ≥30mmHg BP reduction. Twenty-two out of 143 patients (15.4%) who received morphine and 19 out of 109 patients (17.4%) who did not receive morphine experienced excessive blood pressure reduction. Hence the risk of excessive BP reduction was similar in patients who did and did not receive GTN, and in patients who did and did not receive morphine. 
Chi-square tests for association revealed no evidence for association at the 5% significance level between GTN administration and excessive BP reduction (2(1)=0.148; p=0.701); or between morphine administration and excessive blood pressure reduction (2(1)=0.190; p=0.663). 

Outcome: RVMI/extension
30 out of 82 patients (36.6%) classified as inferior MI and 28 out of 168 patients not classified as inferior MI were classified as RVMI/extension (16.7%). Hence the proportion of patients classified as RVMI/extension was about double in the inferior MI territory. A chi-squared test for association revealed that the inferior MI territory was significantly associated with hypotension occurrence (2(1)=12.3; p<0.001).

Discussion
This study found evidence to suggest associations between hypotension and both GTN administration and inferior STEMI; with GTN administration lowering risk by approximately 3-fold; and inferior STEMI raising risk by about the same factor. Moye et al. (2005) argue the possible cause of the hypotension is due to sensitivity to nitrates. O'Rourke & Dell'Italia (2004), however, presume that the Bezhold-Jarish reflex causes hypotension and bradycardia in IWMI. 

Jaton (2017) maintains that nitrate-induced hypotension is easily treated by posture, and that GTN only has a short half-life limiting its effects yet maintains data from larger studies demonstrate that IWMI and other infarct territories have similar incidences of hypotension. 

Besides hypotension, administration of GTN was also significantly associated with cardiac arrest and low bradycardia, with GTN reducing the risk of these outcomes by factors of approximately 3 and 2 respectively. In-hospital, the administration of GTN during RVMI is avoided. 

Morphine has a vasodilatory effect (Acute Coronary Syndromes, 2017). The importance of excluding certain drugs in the management of RVMI has been noted in previous studies, for example vasodilators, diuretics and morphine (Kakouros & Cokkinos, 2010; O'Rourke & Dell'Italia, 2004). However, we demonstrated no significant associations between morphine and any of the measured complications of cardiac arrest, low bradycardia, hypotension and excessively reduced blood pressure. 

None of the factors tested for association with excessive blood pressure reduction were significant at the 5% significance level; however, a substantive association with inferior MI was observed. A reduction in blood pressure of ≥30mmHg may demonstrate the presence of RVMI: described as post-GTN hypotension or sensitivity to nitrates and ≥30mmHg BP below baseline the administration of GTN should be avoided (Boateng & Sanborn, 2013).

Electrical dysfunction is a complication of acute myocardial infarction (AMI) (Boateng & Sanborn, 2013). RVMI arrhythmias are common and contribute to the development of cardiogenic shock (Creamer, Edwards, & Nightingale, 1991). However, we found no evidence for a significant association between inferior MIs and cardiac arrest. 

Limitations
In the context of an exploratory analysis with no a priori hypotheses, significant associations may be interpreted as inconclusive but are certainly worthy of further study. 

Conclusion
The significant pre-hospital care link between IWMI and bradycardia needs to be taken very seriously, considering the statistically significant number of participants in the inferior STEMI group who became hypotensive post clinical intervention. Clinical interventions that could induce hypotension should be either avoided or given with great caution in patients with IWMI.  Hypotension in IWMI and nitrate-induced hypotension require more research, due to the close association in IWMI and significant BP drop. 
Hence, more in-depth research into this subject is required to evaluate the pathophysiological experience of the patient and to investigate the complications suffered by the patient and interventions in the hope of reducing early in-hospital mortality of STEMI patients with RVMI or RV extension.

The findings of this study lead to the recommendations that:
• A right sided chest leads in all cases of IWMI
• RVMI should be excluded from the diagnosis in all cases prior to GTN administration  
• Further research on the management of RVMI in prehospital settings is strongly indicated












References
(2017). Acute Coronary Syndromes. In S. N. Brown, D. Kumar, M. Millins, & J. Mark (Eds.), UK Ambulance Services Clinical Prctice Guidelines 2016; Including 2017 supplementry guidelines (pp. 152-154). Bridgewater: Class Professional Publishing.
Boateng, S., & Sanborn, T. (2013). Acute Myocardial Infarction. Disease a Month, 83-96.
Creamer, J. E., Edwards, J. D., & Nightingale, P. (1991). Mechanism of shock associated with right ventricular infarction. British Heart Journal, 65, 62-67.
Jaton, E. (2017). Inferior Wall Acute Myocardial Infarction: Not as Preload Dependent as Once Thought. Air Medical Journal, 27-29.
Kakouros, N., & Cokkinos, D. V. (2010, October 18). Right ventricular myocardial infarction: pathophysiology, diagnosis, and management. Postgraduate Medical Journal, 86, 719-728. doi:10.1136/pgmj.2010.103887
(2016). Morphine Sulphate. In S. N. Brown, D. Kumar, M. Millins, & J. Mark (Eds.), UK Ambulance Services Clinical Practice Guidelines, Including 2017 supplementry Guidelines (pp. 347-350). Bridgewater: Class Professional Publishing.
Moye, S., Carney, M. F., Holstege, C., Mattu, A., & Brady, W. J. (2005). The electrocardiogram in right ventricular myocardial infarction. The American Journal of Emergency Medicine, 23, 793-799. doi:10.1016/j.ajem.2005.04.001
O'Rourke, R. A., & Dell'Italia, L. J. (2004). Diagnosis and Management of Right Ventricular Myocardial Infarction. Current Problems in Cardiology, 29(1), 6-47. doi:10.1016/S0146-2806(03)00193-2
Pike, R. (2009). Right Ventricular Myocardial Infarction. Canadian Journal of Crdiovascular Nursing, 6-8.

It's Ramadan! The holiest month of the Islamic calendar has arrived once more. This year it starts at the beginning of April 2022. Many Muslims throughout the world will fast during daylight hours during Ramadan for 30 days. Muslims demonstrate their fast by refraining from eating or drinking (even water) and sexual relations (yes sex - disappointing for some) amongst other things, from sunrise to sunset. The length of the fast will vary depending on where you are in the world. Muslims wake up before sunrise to have the morning meal – early I know!

Non-Muslims find Islam equally as fascinating and captivating as Muslims do, and one of the most commonly asked questions about Ramadan is, why Muslims fast during this blessed month? 

Ramadan is a month of intense religious observance. Prayer is performed with increased intensity.  This month was when the Quran (Muslims holy book) was revealed. 

Muslims spend time in prayer, reciting the Quran, doing charitable acts, practicing self-discipline and self-control as well as spending time with family and friends and encouraging unity. The month of Ramadan is an opportunity to practice endurance and self-discipline, as well as anger management and the control of malicious speech. It's an opportunity to fine-tune the body and rid it of obesity and sloth, as well as to reap the therapeutic benefits of fasting.

Ramadan is a month dedicated to awakening compassion and connection with others, especially the poor. During Ramadan, Muslims are encouraged to be more generous in their donations. Although Ramadan appears to be a challenging and a difficult month, it is actually a pleasant experience. In houses, mosques, and Muslim communities as a whole, there is a distinct atmosphere. Muslims look forward to Ramadan with tremendous eagerness and anticipation, and many are disappointed when the month comes to an end.

Now that COVID-19 restrictions have been eased, this Ramadan will be considerably different for many people compared to the previous two. People will be able to break their fasts with their families and friends, go to the mosque for congregational prayers, and celebrate Eid al-Fitr (the festival marking the end of Ramadhan) with their loved ones. 

If you're not sure how to help your Muslim coworkers in this month, consider the following suggestions:

- Don't talk about how "crazy" fasting is in comparison to those who observe lent or Yom Kippur with your fasting pals. I know they are long days but if one billion people around the world can do it, they must not all be “crazy.”  
- If you see someone eating, don't enquire if they're "cheating" because anyone with a medical condition is exempt. And there are a few other exemptions from fasting such as children, the elderly, and pregnant or menstruating women. So, try not to ask why your female coworker may not be fasting - as mother nature has allowed us a few days off! 
- Don't make matters worse by apologising profusely and calling attention to people, while also embarrassing other individuals eating in front of them. You're not torturing us while you enjoy your food, if anything you might see me salivating while I enjoy the visual display. 
- Don't be shy about asking if you can join us for dinner so you can see how Muslims break their fast. 
- Enough of the don'ts – a little more of the do’s; You may support your colleagues in many different ways. Maybe you could try fasting yourself, it’s an unforgettable experience, trust me. Managers, team leaders and senior colleagues, try and support holiday requests from staff to take time off during Ramadan and/or Eid al Fitr. Allow meal breaks at different times, if possible - to coincide with the breaking of the fast. 
- Do ask lots of questions; your Muslim colleagues will appreciate your interest in learning more about Islam. And just be open, I myself have tried to have open conversation with colleagues to ensure that they are aware of Ramadan and what it consists of. I've even offered to share my iftar meals with co-workers when I break my fast.  

There are challenges with fasting and working long hours but they can be eased or even overcome. Talk to your friends, colleagues and managers for support. One of my obstacles in Ramadan is praying the five daily prayers on a shift however, managers allowing time off to pray, especially at sunset, is very considerate and helpful. I have also noticed changes being implemented for staff such as prayer rooms being set up which is really beneficial in Ramadan. 

Fasting strives to bring the privileged and poor closer together, as the privileged experience hunger and learn to respect and appreciate those who are less fortunate. I hope you all have some time this month to contemplate, heal, and find peace. Remember those who have passed and keep them in your prayers while you appreciate moments with loved ones that are still with you. Ramadan Mubarak! 

Some phrases you can say to your Muslim colleagues: 

‘Ramadan Mubarak'
This means Blessed Ramadan, may Ramadan bring us blessings. It's the equivalent of saying Happy Ramadan.

'Ramadan Kareem'
This means Generous Ramadan, wishing people many good rewards during the month.


Article by Nagina Zaroof, MCPara

Every day last year, a staggering 32 ambulance staff were abused or attacked – more than one during every hour of every day throughout the whole year: a total of 11,749 staff. This was an increase of 4,060 incidents over the last five years. The most significant rise covered the initial period of the COVID-19 pandemic in 2020 when assaults jumped up by 23% compared with the year before.

The assaults included kicking, slapping, head-butting and verbal abuse, and ranged from common assault to serious attacks involving knives and weapons.

The Association of Ambulance Chief Executives – with support from NHS England - has launched the national #WorkWithoutFear campaign to highlight the profound impact of this abuse on the everyday lives of ambulance staff and to encourage the minority of people who might commit these offences to have respect for the people who are trying to help them, their friends and families when they need it most.

Deena – WMAS Paramedic/Clinical Team Mentor

Deena is a mother of three and is a paramedic and clinical team mentor (CTM) based at Willenhall hub and has worked for WMAS since 2015.

On 6th July 2020, Deena and her crewmate Michael responded to a category 3 welfare check in Wolverhampton. Whilst trying to gain access to the property with police, Martyn Smith opened his front door and lunged at the paramedics with two large kitchen knives.

Deena was stabbed in the left side of her chest and swiped at the right side. Her colleague Michael stepped in front of Deena and pushed her out of the way to protect her when he too was stabbed. Deena's injuries resulted in her sustaining a pneumothorax and a 500ml haemothorax and she had surgery that night at a major trauma centre where she remained for three nights before being discharged. Deena continues to receive physiotherapy for her movement in her arm as a result of her injuries and still has pain. She was diagnosed with complex PTSD and has since developed OCD and is continuing to receive treatment from a psychotherapist.

The whole incident lasted about 12 seconds, from the moment Deena and Michael entered the property, to Smith being tasered. However, the devastating impact of those 12 seconds will stay with the paramedics forever. 52-year-old Martyn Smith was sentenced on 7th July 2021 to 9 years imprisonment and given an extended licence period of five years after pleading guilty to two counts of wounding with intent to cause grievous bodily harm.

Deena now wears a body worn camera every single shift and is also currently part of a stab vest trial in the service.

Deena said: “I wanted to be involved in this campaign because of my experiences, the severity of which has never occurred in a UK ambulance service before and I hope it never will again. I feel so strongly about what happened that I want the public to know it is just not ok to abuse people like us who are there to help others as we are just doing our job. Since the incident, many of my colleagues have been threatened with knives and I feel that it's getting dangerous to do the job.”

Victim Impact Statement – an extract from Deena’s statement which she read out in court:

“Your sentence will not give me back the year I lost, neither will it take away my painful and ugly scar, or the mental stress you caused. However, hopefully your sentence will be enough to act as a deterrent to others who think it is okay to attack other emergency services, when they have made a choice to simply do a job.”

You can pledge your support for this campaign by using and sharing #WorkWithoutFear on social media and by visiting www.aace.org.uk/vaa to view films about some of those affected. 

 

Even when we’re having a good day, stress and feeling tired can mean that we’re not fully focused and can prevent us from being our best selves in the workplace and at home. We know that too much stress, burnout, and moral distress – where we are not able to care for patients in the way that we know that we need to, can lead to disengagement, frustration, and feeling psychologically and physically unwell. The covid-19 pandemic has perpetuated this. Never has being well and feeling well been of greater importance.

Much work is ongoing at the College around the organisational and structural factors influencing paramedic psychological wellbeing - how we are and how we’re doing. This includes partnering with other organisations to prevent suicide within the ambulance sector. Whilst this work continues, practically supporting paramedic wellness is also a top priority and is aligned with our strategic aims. 

We are excited that funding from the Covid Healthcare Support Appeal (CHSA) has enabled us to launch today, a new wellness programme – specifically for paramedic members. Supported by an evidence-base and scientifically grounded approach, the Rejuvenate. Thrive. Breathe. programme of psychological wellness supports takes an innovative and fresh approach. 

Recognising that our lives are complex and ever-changing, with twists, turns and roller-coaster moments, we know that everyone’s wellness journey is different. So, when it comes to our own psychology, there is no one approach or support that suits everyone. 

This is why the RTB wellness programme offers something different. It allows members to access psychological wellness support in ways that compliments a diversity of needs. 

The first of these exciting opportunities involves the Great British outdoors. 

It is widely acknowledged that being in nature, in the outdoors, is rejuvenating and beneficial to wellbeing. A wide range of international scientific studies confirm this and demonstrate the healing and grounding impact of spending time in natural environments. Being outside has even been shown to enhance immune system functioning as well as increase energy levels, improve sleep, reduce blood pressure, and stress, and improve mood. 

Our Rejuvenate. Thrive. Breathe. programme launches by offering paramedic members opportunity to experience the freedom of spending time exclusively in wild, natural, and beautiful destinations within the UK. In collaboration with qualified experts from Blackdog Outdoors and Mind over Mountains, we are offering a choice of day-walks, mountain/hills skills courses, and a three-day psychological wellness retreat. 

Before you sign up, we encourage you to use the mental health continuum to identify where your mental health is currently at. This will help you to know if these opportunities will be most suited to you.

How to use the mental health continuum.
The mental health continuum visual illustration.

See the latest Rejuvenate. Thrive. Breathe. events on offer here.

Day walks

Hosted by Blackdog Outdoors accredited leaders and mental health first aiders, there are six different events to choose from – all in stunning locations across the UK. Each walk offers a little escape from daily life where you can breathe in and reconnect with the world around you, as well as meet other paramedics from around the country. The walks are most suited to those members who are ‘thriving’ or ‘surviving’, members who feel they just need a bit of time out, to get away into the open countryside, and have a breather.

You don’t need to be super-fit – these walks are of low to moderate intensity, where emphasis is on recharging, rebalancing, and enjoying rather than it being a race. There are twelve spaces available per walk.

Mountain/Hills skills courses

A two-day formal course affiliated to the Mountain Training Association that will offer members the necessary skills and training to safely be able to hike in the hills and mountains of the UK., thereby equipping you with a new, positive coping strategy for your wellbeing. 

This is a course that is most suited to members who are ‘thriving’ or ‘surviving’. Due to safety and course requirements, numbers are strictly limited to eight members per course.

Wellness retreat

Facilitated by colleagues at Mind over Mountains, this is an opportunity for those members who are finding life tough and feel that their mental health is being impacted. We are offering a three-day retreat in a tranquil and secluded area of the Peak District; a safe haven where you can take a breather and invest time in you. The experts have hand-picked two stunning day walks in the hills giving opportunity for connection, calmness, self-reflection, and relaxation. During the retreat, you’ll have time for mindfulness and meditation to help you focus on the nature around you, and release stress. You’ll also have the unique experience of an evening talk from an inspirational speaker or mental health advocate. This retreat offers a safe and confidential space where participants are encouraged to access the life coaches and counsellors who will be joining the event. 

Members who are ‘surviving’ or ‘struggling’; who perhaps are feeling burned out, exhausted, anxious, of low mood, have experienced trauma, or are affected by a difficult life event such as loss/ bereavement, are those who are most suited to this outdoor opportunity. 

This is a unique and bespoke event for members and only 18 spaces are available.

Important bits: 

We know that times are difficult for many right now, and financial pressures may be a barrier to spending time on ourselves, which is why each of these supports are being offered to members for free – thanks to generous funding from the CHSA.

They are not backpacking trips or boot camps. Each event is an opportunity for recuperation and rejuvenation – to enhance psychological and physical wellbeing and to enable you to feel well. 

You’ll need to feel comfortable enough being in outdoor spaces with limited access to facilities during the activities. This may include limited phone signal. You’ll also need a general level of fitness that you’ll be able to walk for the duration of the event – on average, this will be around six hours per day, although depending on factors such as the weather, this may be more or less. More details are available on the events webpages.

We strongly advise that to get the most from the event, you are not booked to be at work on the same day (such as doing an evening or night shift). You need time out for you, and this is strongly the ethos of these activities. 

Each event is offered on a first come – first served basis. However, if they prove popular, we may be able to add further dates in the future. Because places are limited, we suggest that members only sign up for one event. If an event is full, you will be placed onto a reserve list.

If using the mental health continuum, you identify that you are in crisis, it is really important to prioritise your wellbeing right now – seek support and talk with your employer, contact your GP, reach out to The Ambulance Staff Charity (TASC), NHS Practitioner Health, your family, and/or friends. 

TASC – www.theasc.org.uk 
NHS Practitioner Health (England & Scotland) - www.practitionerhealth.nhs.uk 

Benefits of the RTB wellness outdoor programme:

• Sense of freedom, enjoyment & time out from daily life and routines
• Spending time in an incredible place
• Interconnectedness – with the natural environment & those around you
• Feel calmer and more relaxed
• Safe space to try something new
• Personal empowerment & accomplishment
• Trust in oneself, and in others
• Increased sense of worth and personal value
• Holistic benefits to physical health 
• ‘Lift’ feelings that may have been weighing you down
• Access to confidential psychological wellbeing support

If you would like further information about the RTB wellness programme, please contact Paramedic Mental Health Project Lead, Jo Mildenhall – Jo.Mildenhall@collegeofparamedics.co.uk or our events team – events@collegeofparamedics.co.uk 

See the latest Rejuvenate. Thrive. Breathe. events on offer here.

Advanced Retrieval Practitioner and Expedition Medic, Wayne Auton MCPara, talks to Carly Dutton from the College of Paramedics about his paramedic journey and his most recent expedition with the Endurance22 team, who recently located Sir Ernest Shackleton’s ship, Endurance, nearly 107 years after she sank. 

On 5th February, a team of explorers departed Cape Town on the S.A. Agulhas II in search of the wreck of Endurance, Sir Ernest Shackleton’s ship used for the voyage to Antarctica where an attempt to make the first land crossing of Antarctica was planned.  

Unfortunately, Endurance never made it to Antarctica, getting stuck in pack ice in the Weddell Sea in January 1915, with the crew living onboard for several months until 27th October 1915 when Shackleton took the decision to abandon ship. She sank on 21st November 1915 and was lost undersea for nearly 107 years. 

The crew set off on a remarkable journey consisting of trekking on sea ice, where they camped for several months until the ice broke, then sailing to Elephant Island on 9th April 1916 in lifeboats that were salvaged from the ship before it sank. They remained here, surviving on seals and penguins until 30th August 1916, when Shackleton and the ship’s captain Frank Worsley, who had months earlier led a small group on a voyage to a whaling station in South Georgia to get help, were finally able to return to rescue the rest of the crew. 

On 5th March this year, 100 years to the day when Sir Ernest Shackleton was buried on South Georgia, history was made when the Endurance22 Expedition, organised and funded by the Falklands Maritime Heritage Trust, succeeded in their aims to locate, survey and film the shipwreck. 

One of the expedition team members was Wayne Auton, an Advanced Retrieval Practitioner who usually responds to major trauma and the retrieval of critically ill or injured patients throughout Scotland and the Islands, alongside a Consultant. On the expedition, Wayne’s role was Paramedic and Field Guide, responsible for the safety and wellbeing of teams when they deployed onto the sea ice.  

We spoke to Wayne to find out more about his time on the expedition and how his career pathway led him to being part of the team who made this remarkable discovery. 

Speaking of how he prepared for the role, Wayne said, “I’m lucky, I’ve had a lot of experience of working in cold environments primarily within the Arctic circle. I’m also a keen mountaineer and climber, so I know how to suffer, which can be a daily occurrence in these environments when the weather is bad.  

On expeditions like this one, you have to be confident in your ability as a medic as you are a long way from any definitive medical care in Antarctica. So, I made sure I recapped on areas of my practice that I wasn't using on a regular basis such as suturing, and minor injury and illness.” 

As well as working on physical fitness for a trip like this, it’s important to prepare mentally. 
 
“It won’t always be fun and there will be highs and lows. I knew there were going to be times when I wasn't going to be doing much, when sailing out to the search site for example, and so I knew I would have to keep myself occupied. Looking after yourself is vital on these expeditions as if you don't do that you cannot fulfil your role of looking after the team.”  

Even during the preparations for an expedition, medics can be hit with a few curveballs. 

“Unfortunately, I did not get the medical kit until I reached South Africa a few days before the start of the expedition. This was not ideal but most things I had asked for were there, however a large amount of the medication were written in Afrikaans which was interesting.” 

Fortunately, Wayne did not have to deal with many medical incidents on the Endurance22 Expedition, but the crew was ready to deal with a number of things that could have occurred. 

“The S.A. Agulhas II is an awesome ship with some really cool kit on board. There was a hospital and ships doctor onboard, which is a good job as I have no idea how to use an X-ray machine. The hospital was fully stocked with everything you could need to look after several patients at a time including a three-bed ward, an operating/resus room, a ventilator, and even a bath. Due to the remote location of the expedition a comprehensive medevac plan was in place. It involved flying a patient using the ship’s helicopter to a base on the Antarctic peninsula that has a runway, and then onward flight to a hospital on the mainland of South America. It sounds pretty simple saying it, but it is pretty complex with fuelling and weather.”  

I’m a firm believer in prevention is better than the cure. It’s about having a good public health message and stopping things happening before they become problems. Obviously, working in Antarctica is cold so it’s important to highlight relevant conditions such as hypothermia, cold injuries, snow blindness and dehydration. But we were also working with some very heavy equipment, so trauma was always a possibility.”   



The S.A Agulhas II

Not only does Wayne share a birthday with Sir Ernest Shackleton, but he was actually onboard S.A. Agulhas II during the expedition this year. 

“I’ve had some birthdays in some far-flung places and in some crazy situations, but this was up there. It was really nice, everyone gathered in the lounge onboard and presented me with a special Endurance22 birthday cake and sang ‘Happy Birthday’. Trying to cut the cake into 65 slices wasn’t the easiest.” 

It’s no surprise that it was a special moment when the wreck of Endurance was found. 

“Part of the job of being an expedition medic is also just digging in and doing whatever is needed and so when we weren’t on the ice, I had shifts working on the back deck with the underwater search helping with the launch and recovery of the AUV, so, I was quite close to the action. We actually had a few false alarms throughout the trip. But then when you’re on an expedition like this, for a long time in a small space you really get to know people and how they act. When I saw some of the underwater search team members acting a bit differently, I thought something must be going on. Then there was the odd wink and wry smile from some of them in the know and I knew we must had found it.”  

The team actually found the wreck relatively near the end of the trip so not only was there a massive buzz of excitement there was also a huge sense of relief. Seeing the first footage of the wreck coming out of the darkness was unreal and everyone was just in shock at the great condition it was in. It was an incredible feeling and wonderful to have been part of it all. Moral certainly improved after that day, we were even allowed two cans of beer that night (it’s a dry ship normally).”  

For me the highlights apart from finding the wreck have been the wildlife. There are so many different animals to see, and the penguins are so curious and will walk right up to you. We’ve been fortunate to have seen Adélie, King and Emperor Penguins, minke whales coming up into the pool we made in the ice for the Autonomous Underwater Vehicle (AUV), Wandering Albatross, and Leopard, Fur and Weddle seals - it’s an amazing place. Also getting everyone back to Cape Town in one piece is an obvious highlight.”  



The stern on the Endurance shipwreck found in the Weddell Sea. Photo credit: Falklands Maritime Heritage Trust/National Geographic

Wayne’s paramedic career began after leaving the Royal Marines. Wayne was unsure what to do next and a neighbour said they thought he would enjoy being a paramedic, so he decided to start his new career path, being a student paramedic with the North East Ambulance Service until 2009.  

“Once qualified I did several years on the road ensuring I built up my experience, then wanting to develop my skills and experience in critical care I moved to Scotland in 2012 for a job as a Helicopter Technical Crew Member with Scotland’s Air Ambulance.” 

From there I moved onto working on Search & Rescue as a Winchman for a couple of years for a private company providing support to UK Oil and Gas, before moving to where I am now, the Emergency Medical Retrieval Service (EMRS). I decided to make the move as I have always been interested in critical care and I really enjoy working in high pressure environments. At EMRS I completed the Diploma in Retrieval & Transfer Medicine as well as my PgDip, and have started my Masters.”  

Advising others on how to move into expedition medicine, Wayne notes, “I probably made my life difficult and chose the wrong pathway to be an expedition medic. There are obviously transferable skills from my current role such as leadership, communication, teamwork, dealing with pressure, but clinically I rarely use my critical care skills. The route I would recommend would be an urgent care route. Minor illness and injuries are the more likely to be seen and Urgent Care would give you a massive base and knowledge to call upon. The trauma side of things will come from your paramedic background anyway.” 

I would also suggest having another skill as most of the time on expedition, being a medic is secondary to other things. Maybe gain an outdoor leadership qualification such as summer/winter mountain leader. The more you can offer an expedition the more likely you are to be accepted onto it.”  

Networking is huge so doing an expedition medicine course would allow you to get an insight into expedition medicine, but also meet like-minded people. There are so many courses and providers out there, make sure you do your homework and like the content they offer.” 

Finally, I think it’s really important to be able to look after yourself in the environment you will be working. When the weather is at its worst and things are going wrong that’s normally when you need to step up as a medic. For example, be a mountaineer first, then a medic when working in the mountains.”     

Wayne is already planning for his next few expeditions. 

“We are planning a climbing trip to Tajikistan with the U.K. Alpine club. Alongside this I have a big project supporting a really cool guy doing some amazing stuff, but you will have to wait for that one.”  

When asked of the College of Paramedics’ future development, Wayne, who has been a College member since qualifying, said he would like to see the College to continue to outline paramedics’ worth and provide them with a knowledge of all the possibilities that are out there for them.  

“It’s nice to know there are people speaking up on our behalf and driving the profession forward.”  

The profession has come a long way even in the short time I’ve been a paramedic. When I joined, we were still looked upon as ambulance drivers with a stretcher, a blanket and a packet of Polo mints, so for me I think recognising our own worth and the value we bring to the NHS and wider communities is one of the biggest challenges facing paramedics today. We are doing great things and offering our patients alternative pathways than just emergency departments.”  

Speaking of what he thinks are the other biggest challenges facing paramedics today, Wayne continues, “Mental health amongst the profession is currently a big issue and after the last couple of years it’s important that we prevent poor mental health, recognise it, and offer help and advice when needed.”  

Also, it’s about recognising that it’s not all ambulance work. We can sometimes be sucked into the routine. There’s so many opportunities and different things that can be done alongside the day job, humanitarian work, expeditions, mountain rescue, education. In my view these things can only improve us as clinicians and humans.”  

I’m not sure I’m qualified to give advice, I’m the boy that never grew up! Which probably makes me a good expedition medic. But my advice would be to every now and then step out of your routine and see what else is out there for you as a paramedic.” 

We’d like to say a big thank you to Wayne for taking the time to tell us about his recent adventure. You can find out more about the Endurance22 Expedition at endurance22.org and take a look back at Wayne’s journey on his Instagram account @wayneauton 

 

Every day last year, a staggering 32 ambulance staff were abused or attacked – more than one during every hour of every day throughout the whole year: a total of 11,749 staff. This was an increase of 4,060 incidents over the last five years. The most significant rise covered the initial period of the COVID-19 pandemic in 2020 when assaults jumped up by 23% compared with the year before.

The assaults included kicking, slapping, head-butting and verbal abuse, and ranged from common assault to serious attacks involving knives and weapons.

The Association of Ambulance Chief Executives – with support from NHS England - has launched the national #WorkWithoutFear campaign to highlight the profound impact of this abuse on the everyday lives of ambulance staff and to encourage the minority of people who might commit these offences to have respect for the people who are trying to help them, their friends and families when they need it most.

Sarah Haddada – WMAS Paramedic

Sarah Haddada is 28 years old and is a British Muslim. She lives in Birmingham with her husband and is a Paramedic based at Hollymoor hub. Sarah has worked for WMAS for 10 years this October. She joined in 2012 as a Patient Transport Services Apprentice before completing her technician training and then qualifying as a paramedic in February 2021.

Throughout her service, Sarah has been a victim of physical and verbal abuse on a number of occasions, from a range of different patients and of different severities. Sarah's worst physical abuse was when she sustained a wrist injury and needed time off work to recover. However, she argues that, for her it has been the verbal abuse she has suffered which has been more psychologically damaging.

Whilst on duty, not long after losing her best friend, Sarah and her crewmate were responded to a Category 3 job where a male, with no fixed abode, was lying on the floor being abusive in a bus stop. When Sarah and her crewmate arrived, the patient immediately started being verbally racially abusive to her and her crewmate. This was in front of approximately 30 bystanders, who had gathered round to watch what was unfolding. The man called Sarah a P*** B****** multiple times, for absolutely no reason and continued to shout racist remarks to her crewmate commenting on his ethnicity while they were trying to assess him. He was calling all NHS staff scum, and spat at them multiple times. The patient was also abusive to the attending PCs, who arrested him and took him into custody.

Sarah contacted counselling services, Remedy, after being a victim of hate crime and was also under bereavement counselling due to the recent loss of her best friend.

Sarah knew she always wanted to care for others when she was younger and, before seeing the PTS vacancy, was ready to embark on a midwifery course. However, she had to miss out on the course after suffering a broken jaw following an assault but, once healed, applied as an apprentice with WMAS. She’s never looked back and has a genuine desire to help others. She never knows what her Paramedic role will take her to next and enjoys the variety of her role. Sarah wears a body worn camera when she’s on shift.

Sarah said: “I wanted to be part of the campaign because I’ve been the victim of hate crime whilst on duty and it’s not okay. I pray that people, after seeing this campaign, are nicer to each other, with no exceptions. We are all individuals, and that is what makes the world a beautiful place and the sooner people accept that we’re all different and have different beliefs, the better. I pray that I, and my colleagues, stop being subjected to verbal and physical abuse because all we want to do is help. When we have our green uniform on, we are just human like you. We’re not the enemy.”

Responding to the Association of Ambulance Chief Executive's national campaign, Tracy Nicholls, CEO of the College of Paramedics said: 
“The College of Paramedics wholeheartedly supports the #WorkWithoutFear campaign and firmly believes that every paramedic should be able to go to work and do their job without fear of abuse or violence.

“The fact that every day last year, 32 ambulance staff were abused or attacked is totally appalling  and unacceptable. We know from our own engagement with members that nearly three-quarters of paramedics have feared for their own safety or felt threatened at work. Enough is enough, it has to stop.

“Now is the time for us all to take a stand and find new ways of working together to prevent abuse from happening, as well as demanding zero-tolerance when it does occur.”

You can pledge your support for this campaign by using and sharing #WorkWithoutFear on social media and by visiting www.aace.org.uk/vaa to view films about some of those affected. 

 

Paramedics are used to working in close-knit teams, after all, we share in the good, and the not so good, the difficult calls and ones that are really rewarding. We work together during holidays such as Christmas and at times of the year that are special to us. We’re there, day and night, working alongside each other, whether that be in an ambulance, an operations centre or control room, a hospital emergency department, or on the battlefield. But, when it comes to our mental wellbeing, something very hardy within our culture can stop us, and hold us back from sharing with others, exactly how we feel. That to do so, would be awkward, would show vulnerability, and perhaps wouldn’t really ‘fit’ with how we see ourselves as paramedics who can, and have to deal with whatever is placed in front of us. 

Just as we might go from ‘job to job’ or ‘patient to patient’, our thoughts and emotions about the things that we see and experience, can bounce along in rhythm to this, and get lost along the way and maybe not even recognised by us at all. Yet, unknowingly to us, sometimes, they remain within, with more difficult experiences adding to the pot over time. 

Whilst, of course, everyone’s experiences are deeply personal and may or may not resonate with things that have presented in our own lives, there is something to be said for having the support and understanding of those who know the job that we do. Sadly, with rising demand and expectations for healthcare, down-time between calls to recuperate with colleagues is more difficult to take, especially given the additional pressures experienced over the last couple of years. We know that research has also identified that ‘69% of emergency responders feel that their mental health has deteriorated due to the pandemic’ (Mind, 2021). 

As such, the College recognised the importance of providing a safe, confidential space where paramedics could talk with peers. In particular, listening to the voices of members, our experience of working within paramedicine, and indicative research, highlighted to us that paramedics actively working on the frontline and those who were shielding or away from work for a long period of time due to long covid or other reason, were isolated by the pandemic situation and limited in being able to talk with colleagues and friends. 

In the autumn of last year, as part of the College’s year-long ‘Paramedic Mental Health Project’ funded by the Covid Healthcare Support Appeal, two online reflective spaces groups were facilitated in collaboration with the charity ‘Doctors in Distress’ who provide psychological wellbeing supports for a variety of healthcare professionals. The bespoke programme – designed especially for the UK paramedic community – provided confidential group spaces for members, and were facilitated by experienced and trained psychotherapeutic practitioners. 

Groups, such as these, are brilliant for sharing experiences, and offer the opportunity for confidential support from those who do the same work, and understand the job and what it’s really been like. They provide time out from the demands of life and work, and a safe space to decompress, chat, and learn about other people’s challenges and what has helped them to cope.

The programme started with an introductory webinar which took place on 6th September 2021. This featured an inspirational talk by NWAS Advanced Practitioner, Craig Hayden, and was followed by eight weekly online meet-ups in the safe space of the two small groups. Each week, participants were encouraged to join the sessions, which lasted for an hour-and-a-half - although there was no pressure to attend all sessions, or for the full amount of time. The challenge of working around shifts was considered, and to best meet the availability of attendees and the facilitators, a mutually agreed day and time was arranged.

It’s totally normal to feel a bit anxious or apprehensive about joining a group, and can take time to feel more relaxed about it. Getting to know the others and seeing familiar faces every week, as well as the facilitators approachable nature, was helpful to the paramedics who came along to the sessions and enabled them to feel at ease. It’s also normal to be worried about being expected or feeling pressurised into bearing your soul to people who are pretty much strangers. However, this is a misdemeanour and not anything that is expected. People are free to choose if they talk or not, and they can choose to listen if they prefer. Nattering about and sharing experiences informally in this way however, can be so beneficial to everyone in the group – a finding that was penned in the feedback that we received.

Concluding just prior to Christmas, the overwhelming value of the groups was highlighted by those that took part. They shared how they realised that they weren’t alone, and how the groups were a safe, trustworthy, and supportive place, where it was ok to share life and work experiences with the group, without judgement – as group rules were agreed so that no one was judged for what they said or what was shared – hence this being a safe space.

Listening to and hearing others who were further along in their journey was a really powerful experience, and offered opportunity to learn practical tips for things that had helped, made life a bit easier, and enabled them to move forwards.

By being open and having a chinwag with others in a similar boat, the facilitators noticed how those who attended started to become less stressed and feelings of being weighed down or anxious started to lift.

Whilst none of us has a magic wand to make things that are bothering us disappear completely, the groups achieved their aim in providing a safe, contained space where paramedics with similar experiences could find mutual support from each other, and through this, they felt better in themselves. 

Whilst some might say ‘nah, that’s not for me’ – and we acknowledge that group support is not for everyone – what remains important is that we challenge beliefs that see reaching out to others (in whatever form this takes) as associated with a flaw of character, or that confiding in others is a waste of time and is pointless, and we should ‘deal’ with things alone and without help and support. That generally, will only get us so far, but is not usually helpful or sustainable in the long run. 

The College continues to advocate for paramedic’s psychological wellbeing, with much work being undertaken around organisational and professional factors which have been associated with conditions of work. We know that there continues to be strides we need to make within this area – and we are working hard to do so with colleagues from collaborative organisations. However, whilst we do this, we are also mindful that providing opportunities for support, and opportunities to maintain and enhance personal psychological wellbeing are equally important. So, this year, as we continue our mental health project, we will be launching further initiatives including additional reflective groups and also exciting new opportunities for physical and psychological wellness. More details will be released on social media and on our website shortly!

References:

College of Paramedics (2021) Reflective Spaces: Paramedic Support Groups, Available at: https://collegeofparamedics.co.uk/COP/News/Reflective%20Spaces%20-%20Paramedic%20Support%20Groups.aspx [accessed 26th January 2022]. 

Mind (2021) Our Research in the Emergency Services, Available at: https://www.mind.org.uk/news-campaigns/campaigns/blue-light-programme/our-blue-light-research/#BlueLightCovid19ResponseReport2021 [accessed 26th January 2022]. 

 

 

Becoming a lecturer: See one, do one, teach one.
Paul Thomson-Elliott MCPara shares his experience of leaving the NHS and becoming a lecturer at the University of Sunderland.

Leaving the NHS having worked as a paramedic for some time, was a difficult decision leading me to question; Was there life outside of the NHS for me? Well, YES there was. My journey from paramedic to lecturer.



“Congratulations, we were impressed with your interview and the passion you demonstrate for education. We would like to offer you the post of ‘senior lecturer’ on the paramedic practice program”

This one phone call changed my career trajectory and how I would spend the next four years of my life, if not, the rest of my working career. 

Let’s take a step back; I completed a foundation degree in paramedic science in 2010, this was a program that was jointly delivered by a university and the local ambulance trust. The first year of my course was inspirational due to one tutor, who was not only an accomplished paramedic but an outstanding educationist. Setting the bar high, inspiring all students that they taught. Encouraging us to challenge what we thought it meant to be a paramedic, encouraging us to become critical thinkers and evidenced based practitioners.  This was 12 years ago so all being said, they were a true educationalist and advocate of the development of the paramedic profession. Above all, I remember the passion they possessed for the profession and subject they taught, this was infectious and provided me with a thirst to learn more. 

However, like a cruel twist of fate in a Hollywood blockbuster this tutor vacated the trust and was replaced by a what could be described as an ‘old school trainer’. They lacked theoretical knowledge, clinical ability, or any air of professionalism. This event right here, was the initial spark that ignited my interest in a career in education. I thought to myself; “I could do a better job than that.”

Fast forward a couple of years and the trust I worked for advertised for a clinical tutor in their training department. I saw my opportunity to pursue my career goal. This role was always going to be a steppingstone for me towards my career aspiration of lecturing at a university. I gained, what I thought was valuable experience (to an extent it was) however, on reflection I delivered training packages, concentrating on practical skills mainly surrounding advanced life support and trauma management rather than academic educational courses. While I developed such skills as classroom management, lesson planning and how to engage an audience that may not be that enthusiastic to be taught, it provided me with a false sense of ability regarding my educational prowess.

One year on, an opportunity presented itself and a position became available at a university teaching on an undergraduate paramedic program. I thought to myself, this was my time, this was my opportunity to achieve a career goal I have had since qualifying as a paramedic back in 2010. Having worked within the NHS from the age of 19, I had no experience of an interview outside of an NHS ambulance trust. The task of preparing for an interview, for a job in a world I had little experience of, was a daunting prospect.  I was pushed to develop an understanding of higher education institutes, the framework behind paramedic education, pedagogical theories, and high-fidelity simulation. However, self-reflection and assessment of my own strengths and weaknesses to formulate a professional development plan proved useful during the interview. They could see how I would fit into the university and how they could support and develop me into the team member they needed. 

That was four years ago, and in that time I have taught hundreds of students who have gone onto graduate and find employment in their chosen career. I am often asked by students why I left the ambulance service to pursue a career in education.  This isn’t a simple question to answer. I loved my role as a paramedic, and I will always remain clinical in one role or another but from the moment of thinking ‘I could do a better job as a tutor’ I wanted to prove to myself that I could. I help more patients now than I could have ever helped as a paramedic, educating the next generation of paramedics ensures I continually help patients. Finally, within academia you are in a privileged place to effect real change in the paramedic profession whether that be through research or raising the educational standards of the profession.

Developing as a lecturer requires both personal and professional growth. A wise colleague and good friend of mine explains this as ‘adding to your toolbox’.  The greatest lessons I have learnt regarding engaging students in a topic or how to ensure a lecture is interactive have come from observing colleagues from different disciplines such as sociology and psychology. As with your level of competence in clinical practice is an evolving concept so is your competence as a lecturer. You will never know everything however, you need to have the ability to develop students to enable them to take ownership of their own education and enable them to acquire the higher level thinking they require. Graduate attributes and preparing students for professional practice are essential components of being a lecturer. If you finish a lecture with the students enthused by the topic and wanting to know more, you have done your job.

Advice from personal experience:
• Develop yourself as a clinical professional but also your own educational background, an MSc with a clinical focus is useful, however a post graduate qualification in educational practices is vital. 
• Have a specialist interest in something outside of teaching clinical modules as this is such a small aspect of a modern paramedic program, law and ethics, communication theory, pharmacology, leadership, and management are just some of the topics you will need to be able to deliver. 
• Develop relationships with your local higher education institute, gain some experience of lecturing prior to taking your first post.
• Understand the role of a lecturer in its entirety, physical delivery of content is about 20 percent of the overall workload of a lecturer; pastoral support, dissertation supervision, marking, being research active and writing for publication are just some of the other elements involved.  
• Don’t expect to be paid large sums of money, “academia is its own reward” true, but be realistic, in the early stages of your academic career you may earn less than you were making in your clinical role. Don’t forget this is a different role all together and the opportunities within academic are vast.

Final thoughts: a question for you.
Think back, to a lecture that you have attended, what makes that lecture stick in your mind? What was it about the lecturer that was so special? Be the lecturer that is remembered by their students’ decades after they were taught.  

Twitter answers:
Credible (ongoing experience active in the subject). Engaging (not just telling but conversational, joint learning). Not taking themselves too seriously and able to talk about own errors and misconceptions. Not ‘do as I say!’ but ‘listen to what I have to say! And review/consider.

The mixture between credibility and humility is so important but often not quite right. Some of my favourite teachers have left me saying to myself “wow you’re impressive…But also approachable and not a totally unrealistic role model”

Passion for subject taught, engaging and interactive, has humility, genuinely cares. My paramedic instructor (for my IHCD course) was all of these. He literally sparked joy in the lessons he taught. I owe him so much.
Encourage learning as a concept rather than facts or an idea.

Every day last year, a staggering 32 ambulance staff were abused or attacked – more than one during every hour of every day throughout the whole year: a total of 11,749 staff. This was an increase of 4,060 incidents over the last five years. The most significant rise covered the initial period of the COVID-19 pandemic in 2020 when assaults jumped up by 23% compared with the year before.

The assaults included kicking, slapping, head-butting and verbal abuse, and ranged from common assault to serious attacks involving knives and weapons.

The Association of Ambulance Chief Executives – with support from NHS England - has launched the national #WorkWithoutFear campaign to highlight the profound impact of this abuse on the everyday lives of ambulance staff and to encourage the minority of people who might commit these offences to have respect for the people who are trying to help them, their friends and families when they need it most.

Bradley – WMAS Call Assessor

Bradley is 28 years old and is a dual-trained Call Assessor, answering both 111 and 999 calls. He is based at the West Midlands Ambulance Service control room in Brierley Hill. Bradley joined in 2019 and qualified as a Call Assessor after completing his training in March 2020, just as the pandemic took hold. Bradley lives in Dudley with his partner and newborn baby.

During a night shift at Navigation Point (111 control room) at the start of April 2021, Bradley took a call from a patient who became increasingly angry whilst Bradley was trying to go through the triage questions to assess him. He started to become verbally abusive and was inappropriate, threatening and made upsetting comments to Bradley. The patient said that he was going to punch Bradley’s face and remarked that he ‘hoped that his children would die from COVID-19’. Soon after the comments, the patient put the phone down.

The experience affected Bradley’s mental health and he found comments about his (then) unborn first child upsetting. Despite this, and other examples of verbal abuse Bradley and his colleagues face on a daily basis, it has made him more strong-minded as a person.

Working as a Call Assessor, Bradley knows that his role is vitally important to help others who call 111 or 999. He enjoys his role as no two calls are the same and gets that sense of satisfaction knowing that he’s made a difference, reassuring people and being calm on the phone to get the right help for them.

Bradley said: “I want to help spread the message that we’re here to do a job and when people call us, our main focus is on them or the patient. Whether that call last four minutes or 20 minutes, we want to get the most appropriate help to you. We’re not just a voice on the other end of the phone, we’re human beings doing our best to help you and people do forget that sometimes. When people get angry on calls, it’s sometimes with the questions that we ask or the outcome that we provide to them. I understand that calling 999/111 for help can be distressing, especially if it’s a life-threatening emergency, but we aren’t asking questions for the sake of it, they’re important to gather vital information so we need you to stay calm and listen to what we’re asking you. Similarly, the questions genuinely aren’t delaying help either as we’ll already be arranging the best help for you or the patient behind the scenes. Everyone has their own tolerance levels when it comes to abusive calls and I can handle most things but that call in particular got me.”

Responding to the launch of the Association of Ambulance Chief Executive national campaign #WorkWithoutFear, Tracy Nicholls, CEO of the College of Paramedics said: 
“The College of Paramedics wholeheartedly supports the #WorkWithoutFear campaign and firmly believes that every paramedic should be able to go to work and do their job without fear of abuse or violence.

“The fact that every day last year, 32 ambulance staff were abused or attacked is totally appalling  and unacceptable. We know from our own engagement with members that nearly three-quarters of paramedics have feared for their own safety or felt threatened at work. Enough is enough, it has to stop.

“Now is the time for us all to take a stand and find new ways of working together to prevent abuse from happening, as well as demanding zero-tolerance when it does occur.”

You can pledge your support for this campaign by using and sharing #WorkWithoutFear on social media and by visiting www.aace.org.uk/vaa to view films about some of those affected. 

 

The Power of Advocates and Supporters 

Gemma Howlett MCPara, member of the College of Paramedics Diversity Steering Group introduces Nicola Hunt MCPara, Chair of London Ambulance Service (LAS) Women’s Network. 

As part of my work with the College’s Diversity Steering Group I have had the great pleasure of talking to, and hearing stories from a variety of truly inspirational people, for which I will be forever grateful. For previous International Women’s Day celebrations, I have interviewed Yvonne Ormston, one of the very few women to have held the title of Chief of an ambulance service and Becky Connelly, a true advocate for equality and diversity, who is a pivotal member of the Diversity Steering Group. This year, I got to interview another exceptional woman, Nicola Hunt, the Chair of the newly-formed London Ambulance Service Women’s Network, and one of the first HCPC apprentice board members. Hers is a story of phenomenal determination, difficult circumstances, the overcoming of adversity and one that showcases the importance of role models and champions. It highlights the pivotal part played by the people around us who dare us to be better, who help us in different ways at different times in our journeys. The people who have such a profound impact on you that they not only help you but prompt a desire in you to pay it forward, for you to go on and be the person in someone’s corner, encouraging them to reach their potential, to reach for big things.  



Nicola joined the London Ambulance Service in July 2005, a week after the 7/7 bombings. While some people may have questioned their decision after witnessing such a horrible event, Nicola knew that this was the career for her. She was excited to start and threw herself into the role with great passion and enthusiasm. The joining age at the time was 21 so Nicola had some time from leaving school before she could embark on her career. She never considered university, growing up in a socio-economically deprived part of London, it just wasn’t something that people like her did, or so she thought at the time. Nicola had at the time undiagnosed dyslexia and ADHD so found some aspects of education challenging due to a lack of the right support. No one in Nicola’s family had been to university so it was not something that she gave any thought to. Instead, Nicola enrolled in a local college and did a BTEC diploma in public services. She joined as an Emergency Medical Technician (EMT) and loved the role; she remembers the feeling of excitement and thrill whenever the emergency phone rang. She always looked up to the paramedics in the service and hoped that one day, she too would reach that level. In 2014, Nicola finally took the plunge and successfully enrolled on to a paramedic course, nine years after first joining the service. By the time Nicola had earned a place on the programme she had two young children and it was difficult to balance the demands of study and work with being a mum. Nicola hired a nanny, which took up more than 50 per cent of her monthly pay check, but she felt it was one of the only options she had.  

Nicola achieved her paramedic qualification and was proud of her achievements but with over 10 years’ experience in the ambulance service she had started to feel restless, frustrated by what she felt was a lack of opportunity. She had a performance and development review with a team leader and discussed how she felt. She had had enough and felt like she was going nowhere. Her relationship with her children’s dad had broken down, in part due to the sacrifices she’d had to make and the amount of time she’d had to dedicate to her dream of becoming a paramedic. She felt like a victim. This meeting turned out to be pivotal in what Nicola went on to do next. The team leader listened and then asked one question, ‘what are you going to do about it?’ Taken aback initially, the question was a good one. Nicola discussed her desire to go into education, she wanted to help students in general but particularly ones like her, ones with learning difficulties, ones who needed more or just different support to achieve what they were capable of. If she wanted to do these things then she was going to have to go after the opportunities and put herself in the mix. Shortly afterwards, and supported by LAS, she enrolled on her BSc top-up degree with the University of Cumbria. Racked with self-doubt, initially Nicola questioned her decision to take part and didn’t really believe that she would be able to complete the programme.  

But thanks to the truly supportive approach of team and course leaders Nicola excelled, proving to herself that she wasn’t the problem; she just needed fair and reasonable adjustments, support that suited her, and a course team that encouraged her. It felt good, it felt like for the first time the sky was the limit. Sadly though, fate once again conspired against Nicola. Her mother, one of her main inspirations, a strong woman who had grown up in tough circumstances, and who struggled to make ends meet while striving to offer the best for her children, became terminally ill. Nicola studied one of the modules on her top up degree at her mother’s palliative care bedside.  

Nicola’s mother died with Nicola and her sister sat at her bedside. The first inspiring and strong woman in her life was gone but had left a determination and fierce spirit in Nicola, one that has clearly helped overcome much adversity and will continue to do so when needed, I am sure. Nicola started her longed-for role in education. The woman who as a school leaver, did not think university was for her, now had a first-class honours degree and was starting on her postgraduate certificate of education. Which it is important to say, she passed with flying colours also.  


Elaine Rudge 
3rd November 1947 - 23rd November 2019

The journey into education also led to another pivotal person in Nicola’s journey. Whilst working in the education department Nicola met one of the senior directors of the organisation. Nicola recalls being on a Teams call from home with senior leader, Tina Ivanov one day (Tina no longer works at LAS) and her daughter asked her who she was. Nicola said “this is my boss, one of my big bosses” and her daughter said “but she’s not a man, she can’t be the boss.” Society, the world, and her experiences up to now had told Nicola’s daughter that bosses were men. There had been no specific conversations on this in the household as far as Nicola could remember, it had just been absorbed. This was something that both Nicola and the director wanted to address. A video arrived for Nicola’s daughter from the leader telling her that if she wanted to be the big boss one day then she absolutely could, and she should aim high. What a role model for both Nicola and her daughter. It is much easier to be what you can see, which is why representation really does matter. The version of what is possible, what is perceived as ‘normal’ is set very young and can take a long time to redress. Nicola sought counsel from this senior figure, voicing her frustrations, her want for change and her desire to progress. The woman advised that she try and get some board experience, to start to understand how decisions are made. This was a clear goal, but Nicola initially had no idea how to achieve it.  

Then by a very happy coincidence, the HCPC launched their innovative and trailblazing apprentice board member position. The HCPC were actively looking for people with no previous board experience and would provide mentorship from senior council members for the apprentices, they wanted them to be actively involved in public interest matters (HCPC, 2020). The advice was to gain experience on a board and now here was the opportunity. Nicola applied for the role and was surprised to be interviewed by an all-female panel, including the chair of the council, Christine Elliot. Nicola recalls being notably taken aback by the panel, her image of a board was typically male. 

The board that had embraced her, that had accessibility and opportunity in mind when they launched the apprenticeship scheme, was clearly different from what was the norm. They wanted to provide access to the seat of power for those who would not normally be granted it. Maybe because they were women, maybe because they too had faced obstacles, barriers, limited opportunities, a tough ride to even get to the glass ceiling, let alone smash through it. Whatever the motivation, it provided Nicola with an amazing chance and experience that she embraced wholeheartedly and one that she was not going to let pass her by.  

The experience allowed for a view into decision-making, how complex the systems are, the considerations that need to be made, the processes that need to be followed. It was a world away from Nicola’s original assumptions and perceptions. Every member of the board gave her time, understanding, they listened to Nicola’s views and wanted to understand her story. Nicola was given a mentor, another woman to help navigate her through the process, to help her make the most of the opportunity. Nicola feels strongly that due to the female representation on the board it helped her feel seen, it helped her feel heard. They all had very different stories, some were privileged in terms of education, and opportunities, some were not. 

Nicola’s preconceived ideas and assumptions about who got to sit on a board were all challenged. It stands to reason that if more boards were diverse then the more people would be willing to involve themselves in them, to want to be part of the decision-making processes, to feel enabled to do so, this would inevitably help to move away from white middle class male dominated boards. Nicola learned for the first time how to run a formal meeting, how it is formatted, how board papers are used and why they are needed, an understanding of the thoroughness, and therefore perceived slowness of decisions. When her year-long apprenticeship ended Nicola was back on the lookout for the next opportunity, the next position where she could make a positive change. 

As Nicola explained, the HCPC apprenticeship had offered her an experience that she may never have gone for if she had not been encouraged by that team leader to change her situation, by being motivated and pushed by the senior leader in her organisation, she would not have had access to unless some of the actual and perceived barriers had been removed, if the welcome sign had not been so visibly put up. I hope that more organisations start to embrace this practice and find ways to welcome all onto boards and into senior roles by actively removing barriers. Achieving her academic qualifications, getting out of the rut she had found herself in and making positive changes and embarking on the role helped Nicola in many ways. She has embraced her ADHD and understands it more, she now views it as her superpower, it makes her more determined to achieve, when she sets her mind on something she will do everything she can to get it. The role with the HCPC also helped build her confidence, it helped her see her worth, that she was important, she did and should have a voice. The opportunity encouraged Nicola to not only want to be involved in the network but gave her the confidence to want to chair it.  

The Women’s Network had been started by Alex Ulrich, an LAS APP in critical care paramedic. She was unable to stay on as chair due to taking maternity leave just after its start, but it is thanks to her that it was up and running. She is a pivotal part in the network’s story and Nicola and the rest of the network members, are extremely grateful for her efforts in getting it off the ground. The Women’s Network and the other staff networks in the LAS have been hugely supported by London Ambulance Service Chief Executive, Daniel Elkeles. He has provided support of the networks, allowing people allocated work time to carry out network activities. Allies such as Daniel and other senior figures are vitally important in the fight for equality in any organisation. Six out of thirteen members of LAS’s Board are female. It is heartening to see this representation in ambulance services now. As Nicola observes the support and recognition of the work carried out by network chairs and members is vital, it is a tough road fighting the fight without it, it can lead to anger and frustration, a feeling of hopelessness, it can lead to brilliant people being unable to carry on anymore as the sacrifices become too great.  

It is early days for the network but Nicola has two key aims that she feels are vital for it to work: the safety of women in the ambulance service and career progression of women. Nicola stresses the importance of women feeling and being safe at work, protected from sexual or gender harassment and feels that these issues run at the core of several problems for women nationally in the ambulance sector. Women being represented in roles at senior level, is also high on her agenda.  

Women’s networks across the country need to be at the forefront of this fight. Shining a light on the problem, raising awareness to senior management through network channels, encouraging women to call it out. However, and it is very important to point out, it is not just a problem that women have to solve, that is treading into the realms of asking women to wave down buses for help if they feel in danger rather than addressing the perpetrators.  

Men and women need to be at the heart of the solution at all levels of the ambulance service. But these solutions need to be coordinated, strategised and informed by women. Nicola also wants to help ensure that women have the same opportunities as men in the ambulance service, creating an even field, where all women have the same chances. Pushing for more flexible working opportunities in line with the NHS Flex movement. Challenging culture, enabling a culture that allows people to call out unacceptable and inappropriate behaviour. There is a long list of things to do but I am excited to see what happens next, to see what Nicola and the network can achieve and I urge any women reading this in LAS or in any other service to please join your women’s network, there is strength in numbers. If there isn’t a network in your area, start one. It is important that women have a space to coordinate, to lead, to make things better for all women. There needs to be more opportunities for women, whether we like it or not we still have to fight for these things, the playing field is still far from equal. Men, we need your help too, find out what you can do to help, how you can be an ally. 

I am sure our profession will be enriched by these improvements, but we need everyone to help. #BeTheChange 

 
 
 

 

A Pioneer For The Paramedic Profession 

Advanced Practitioner in Critical Care, Vicki Brown MCPara, has achieved many firsts during her illustrious career. Here, she talks to Natasha Weale, Press and Communications Officer at the College of Paramedics, about her paramedic journey and the job ad which started it all. 

When Vicki Brown was a little girl she always dreamed of becoming a vet. But somewhere along the way she swapped animals for humans and became one of the UK’s most accomplished paramedics, most recently becoming the first person to be registered on the Faculty of Pre-Hospital Care Register of Consultant (Level 8) Practitioners by qualifying from a purely paramedic background. It’s a remarkable achievement but then, Vicki, who lives in Gloucestershire, has spent her entire career pushing boundaries and challenging the status quo.  



“I’m very driven, work-wise and I’m always looking for the next challenge,” she confesses. “I’ve been called a trailblazer but really I just want to be a good role model for the next generation so that they know what can be achieved in our profession with a lot of hard work and determination.”  

Vicki, who is an Advanced Practitioner in Critical Care at Great Western Air Ambulance Charity (GWAAC), began her career as a trainee technician with Gloucestershire Ambulance Service in 2002, after seeing an advert for the job in her local paper.  

“To be honest, I’d never considered a career in paramedicine,” she explains. “Before I started as a paramedic, I worked as an assistant racehorse trainer and at the same time, also trained to become an acupuncturist. I suppose it was while I was doing the acupuncture that I became more interested in helping people, and after a friend suggested paramedicine, I thought ‘why not?’”  

Having successfully secured the job as a trainee technician, Vicki worked her way up to become an ambulance technician and then qualified as a paramedic in 2004, after completing a six-week course in Bolton. Between 2004 and 2006, while she was based in Gloucestershire, Vicki gained her teaching qualification and also became the station’s operational manager, proving, even in the early days of her career, that she was going to be a force to be reckoned with.  

By 2006, however, she had set her sights on working for the air ambulance service, despite it being very male dominated. “I realised it was going to be tough and had been told by people I knew who worked for the service not to get my hopes up. But I’ve never been one to shy away from a challenge and became even more determined to get through the application process,” she reveals. 

And succeed she did. Vicki was seconded to County Air Ambulance, now known as the Midlands Air Ambulance Charity (MAAC), which covers the counties of Gloucestershire, Worcestershire, Shropshire, Staffordshire, Herefordshire and the West Midlands for five or six shifts a month, while continuing to work as a road paramedic for Gloucestershire Ambulance Service. It was while working for County Air Ambulance that Vicki completed her HEMS Technical Crew Member Course, learning everything from aircraft safety, the weather, navigation and map-reading to helicopter inter-communications systems and the use of on-board medical equipment.  

In 2009, she achieved her Post Graduate Certificate in Pre-Hospital Critical Care and three years later joined GWAAC as a full-time critical care paramedic, now known as a Specialist Paramedic in Critical Care. She admits: “I’ve always been a bit of an adrenaline junkie so I think that’s why becoming a HEMS paramedic appealed to me so much. I loved going to trauma calls as a newly-qualified paramedic and now, working for the air ambulance I get to help the most critically ill and injured patients. When these people are having the worst day of their lives, knowing that we’re doing the utmost for them, and trying to make it better for them, is something I find very rewarding.”  

Working for GWAAC, which covers the areas of Bristol, Bath and North East Somerset, South Gloucestershire, Gloucestershire, North Somerset and parts of Wiltshire, means Vicki will either be on shift 7am to 7pm or 1pm to 1am. In her team, she could be joined by a critical care doctor, a trainee doctor, a Specialist Paramedic in Critical Care or a combination of all three roles. Alternatively, she could be on her own. There is a 30-strong clinical crew at GWAAC which, on average, attends five critical incidents a day. She says: “You never know what the day is going to bring but we always spend the first 15 minutes of each day preparing the drugs we’ll need for all the critical care incidents we’ll attend and checking that the equipment we require is available and in good working order.  

Next, we’ll have a briefing to go through the aviation side of things and confirm that everything is prepared and operational, and then once that is over, we’ll wait for the jobs to come in. Any downtime we have is spent training, which could mean simulation training or talking through recent cases to pick up and identify any learning points.”  



And learning, it seems, is at the heart of everything Vicki does. While she admits that she’s a naturally curious person, it’s her quest to broaden her knowledge, skillset, competence and ultimately, the profession itself which have propelled her into a different league altogether. Four years after completing her MSc in Advanced Practice, Vicki was appointed an Advanced Practitioner in Critical Care at GWAAC in 2020, in what was the first of its kind within the pre-hospital critical care environment. The role was developed and approved as a career pathway by SWASFT.  

In order to achieve this career milestone, Vicki had to have a Masters degree, carry out a minimum of three years working in Critical Care, two of which in a Pre-Hospital Critical Care Team, a Diploma in Immediate Medical Care, a completed Non-Medical Prescribing qualification and an extensive portfolio evidencing her work. She also needed to undertake a clinical examination and interview. On her final assessment, her performance was described as a ‘demonstration of mastery’ by the examining faculty which comprised of consultant clinicians in pre-hospital care, emergency medicine and intensive care.  

“That was very nice to hear,” she confesses. “But for me, the biggest thrill has been getting to the stage where I can do more for my patients because I can administer a lot more drugs now than I could before and autonomously, I can do interventions such as a thoracotomy or a resuscitative hysterotomy which I never thought I would have been able to do as a paramedic.”  

Not content with everything she has achieved, Vicki has continued to smash the glass ceiling by becoming the first paramedic in the country to be registered on the Faculty of Pre-Hospital Care Register of Consultant (Level 8) Practitioners by qualifying solely from a paramedic background. She achieved her registration last December after providing evidence to the Faculty of Pre-Hospital Care of her experience and knowledge by submitting portfolios of clinical and operational experience and attending an interview.  

It now means Vicki can do every intervention a doctor can do, outside a hospital setting, except for a pre-hospital emergency anaesthetic. But, of course, this is on her ‘To Do’ list, along with developing a Consultant Practitioner in Critical Care pathway for SWASFT. “That’s the next step,” she reveals. “I’d like to go into hospitals and undertake the anaesthetic competencies, as well as further in-hospital training but it’s just not possible at the moment because hospitals are too busy.”  

Despite being the first paramedic on the register to reach consultant status in pre-hospital care, the role doesn’t currently exist within SWASFT so Vicki is pushing hard to get it acknowledged, with the hope that one day it will be a nationally-recognised role in the profession.  

“It means having to write lots of documents and policies on what the competencies are behind this role but once I complete it SWASFT will then have a clear career pathway for all paramedics in their service and hopefully, it will inspire a future generation to reach the pinnacle of their careers,” says Vicki, who was the 2019 winner of the Paramedic of the Year award at the Association of Air Ambulance Awards of Excellence. It's clear that Vicki has certainly blazed a trail for other Specialist Paramedics in Critical Care to follow yet, ironically, she doesn’t see herself as different to anyone else. “If I can do it then anyone can,” she says. “Yes, I’m the first one but I’ve always looked at the bigger picture, about what we can achieve as a profession. I think the more you do, the more you want to do. I’ll never stop thinking about that next challenge or striving to break barriers. It’s who I am.” 

 

 

Celebrating International Women’s Day: where does this leave the paramedic profession?

Authors 
Caitlin Wilson  
University of Leeds; North West Ambulance Service NHS Trust  
ORCID iD: https://orcid.org/0000-0002-9854-4289
 
Larissa Stella  
Prothero East of England Ambulance Service NHS Trust  
ORCID iD: https://orcid.org/0000-0002-5440-8429
 
Julia Williams  
South East Coast Ambulance Service NHS Foundation Trust; University of Hertfordshire
ORCID iD: https://orcid.org/0000-0003-0796-5465
 
 
International Women’s Day 2022 has adopted the theme #BreakTheBias. It is encouraging people to look at how we can break the bias in our communities, in the education system and in the workplace. It promotes a vision of a gender equal world – one where diversity is celebrated and differences are valued. With growing numbers of women working in unscheduled, urgent and emergency care settings, what progress are we making within our working roles?  
 
Of the 1.3 million staff employed by the NHS, more than 75% are women, but how many work in UK ambulance settings? The ambulance workforce has been traditionally dominated by men; however, times are changing and now women represent 42.5% of ambulance staff across all service roles (NHS England, 2021). For UK paramedics, the Health and Care Professions Council (HCPC) reports 41.7% of paramedic registrants to be female and our profession remains the only one with more male than female registrants (HCPC, 2021). Looking to the future, hopefully this gender imbalance will be addressed by the increasing numbers of women on pre-registration degree programmes across the UK.  
 
But do women think of the health challenges they may face when entering the paramedic profession? There is evidence which shows shift-work negatively impacting both mental and physical health, including female reproductive health – that is, menstruation, pregnancy and the menopause (Harrington, 2001). Night shifts and long working hours can alter a woman’s circadian rhythm, affect hormone levels and disrupt the menstrual cycle. For women of child-bearing age, shift-working has been linked to increased risk of spontaneous abortion, low birth weight and prematurity (Fernandez et al., 2016; Stock et al., 2019). All women will experience a menopause transition when their oestrogen levels decline, and their menstrual periods cease. This typically occurs at 51 years; however, up to 10% of women can experience early menopause or premature ovarian insufficiency, which are both associated with typical menopausal symptoms (National Health Service, 2018). Also, transgender, non-binary and intersex people can experience the menopause. We should not forget our male colleagues in this discussion. As they work alongside us as crewmates or office colleagues, they too will experience our health challenges, and some will experience the male menopause as their testosterone levels fall (National Health Service, 2019). Menopausal symptoms can be challenging, and impact on personal well-being, workplace attendance and performance. Employer consideration of flexible working; maternity, paternity and adoption leave; childcare arrangements; alternative roles; and improved staff support may allow women and men to successfully balance work and family life and remain valued members of the ambulance workforce before retirement. Currently, there appears to be a paucity of evidence as to why and at what age women (and men) leave the ambulance profession and this is an area that would benefit from further exploration. 
 
 Linked to this is a need for more research on the daily experiences of women working in the ambulance setting. Bullying and harassment, including sexual harassment, have been reported in ambulance services in the UK and internationally. The ambulance profession has been referred to as a ‘boys’ club’ culture that is resistant to change (Manolchev & Lewis, 2021). In some countries there are examples of women-only ambulance services that provide female healthcare to communities with specific cultural requirements (Arab News, 2017; Julian, 2014). Understanding the roles, responsibilities and experiences of ambulance women in diverse clinical settings will enable appropriate support resources to be developed and female working lives to be improved.  
 
When we begin to look at leadership roles within ambulance services and across the broader NHS, these positions are predominantly held by men (NHS Digital, 2018). Figures from the UK Government (2021) Gender Pay Gap Service suggest that across ambulance services in England, women occupy lower paid jobs compared to men. This is illustrated by women making up on average only 42.8% of the highest hourly pay quarter, while the other quarters are split 50:50. This gap is narrowing within ambulance services and across the NHS over time, but more change is needed to support women to take up these leadership positions – ideally supported by research. 
 
 Speaking of research, this is one avenue of career progression for paramedics and one that is increasingly gaining traction in the UK. While no data are collected on the gender of research paramedics or ambulance staff pursuing clinical academic careers, the gender split of research leads in UK ambulance services is similar to that of senior positions overall: five out of 13 research leads are women. However, it is inspiring that the College of Paramedics head of research is a woman, and here on the British Paramedic Journal editorial board, both women and men (3:5) are represented. 
 
But what about when it comes to disseminating our research? Nowadays, conference organisers consider a balanced selection of speakers – be that of gender, ethnicity, topic areas or roles. And what about publications? The BPJ editors have recognised this journal does not collect author demographic information (including gender), so cannot report this information. We are now discussing the introduction of a voluntary gender-identity question for authors. This will enable us to report author gender and relevant gender-related trends in our research publications.  
 
Lastly, while the focus of this International Women’s Day editorial is on women in the ambulance service and paramedic research, it is not our intention to dismiss the challenges of men and non-binary individuals in the ambulance and research workforce. We recognise the need to work together to advance the evidence-base for the whole paramedic profession.  
 
Author contributions  
CW and LSP are joint first authors as they developed the initial draft for this manuscript. All three authors jointly revised the manuscript for publication. All three authors are on the BPJ editorial board.  


First published in 
British Paramedic Journal 1 March 2022, vol. 6(4) 1–2  
© The Author(s) 2022  
ISSN 1478–4726  
https://doi.org/10.29045/14784726.2022.03.6.4.1  
Reprints and permissions: info@class.co.uk  
The BPJ is the journal of the College of Paramedics: www.collegeofparamedics.co.uk 
 
References  
 
Arab News. (2017). Dubai launches women-only ambulance service. https://www.arabnews.pk/node/1123636/offbeat.  
 
Fernandez, R. C., Marino, J. L., Varcoe, T. J., Davis, S., Moran, L. J., Rumbold, A. R., Brown, H. M., Whitrow, M. J., Davies, M. J., & Moore, V. M. (2016). Fixed or rotating night shift work undertaken by women: Implications for fertility and miscarriage. Seminars in Reproductive Medicine, 34(02), 74–82.  
 
Harrington, J. M. (2001). Health effects of shift work and extended hours of work. Occupational and Environmental Medicine, 58, 68–72.  
 
Health and Care Professions Council. (2021). Registrant snapshot – 1 September 2021. https://www.hcpc-uk.org/about-us/insights-and-data/the-register/registrant-snapshot-sept-2021/.  
 
Julian, H. L. (2014). New Jewish ambulance in Brooklyn ‘for women only’. The Jewish Press. https://www.jewishpress.com/news/breaking-news/new-jewish-ambulance-in-brooklyn-for-women-only/2014/06/19/.  
 
Manolchev, C., & Lewis, D. (2021). A tale of two trusts: Case study analysis of bullying and negative behaviours in the UK ambulance service. Public Money & Management. https://doi.org/10.1080/09540962.2021.1934995.
 
National Health Service. (2018). Menopause. https://www.nhs.uk/conditions/menopause/.
 
National Health Service. (2019). The ‘male menopause’. https://www.nhs.uk/conditions/male-menopause/.
 
NHS Digital. (2018). Narrowing of NHS gender divide but men still the majority in senior roles. https://digital.nhs.uk/news/2018/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles.
 
NHS England. (2021). NHS celebrates the vital role hundreds of thousands of women have played in the pandemic. https://www.england.nhs.uk/2021/03/nhs-celebrates-the-vital-role-hundreds-of-thousands-of-women-have-played-in-the-pandemic/.
 
Stock, D., Knight, J. A., Raboud, J., Cotterchio, M., Strohmaier, S., Willett, W., Eliassen, A. H., Rosner, B., Hankinson, S. E., & Schernhammer, E. (2019). Rotating night shift work and menopausal age. Human Reproduction, 34(3), 539–548.  
 
UK Government. (2021). Gender pay gap service. https://gender-pay-gap.service.gov.uk/. 

 

Defying Stereotypes: Women in the Ambulance Service 
By Mahdiyah Bandali MCPara, Paramedic 

 
Defined as ‘a preconceived and oversimplified idea of the characteristics which typify a person, race or community which may lead to treating them in a particular way’ by the Oxford University Press (2022), stereotypes exist in every community and can act as barriers to not only understanding an individual’s identity truly, but also for the individual themselves to access different opportunities. In becoming part of the ambulance service, whether it be a clinician, call handler, manager or other, we have all had a unique journey to these roles. Often, many of us will face different hurdles or obstacles that those around us may not be able to empathise with or struggle to understand. These can be formed of many different attributes: the way you look, the accent you have, the place you grew up, which each in turn will come with predisposed opinions within society. And as a frontline public-facing profession, this can become even more of a challenge when we do not have a choice of who we may be sent to. I spoke to three individuals, each with a stereotype they had to tackle in their journey into becoming a paramedic, and their experiences in the ambulance service. 

 
Waranya Kaewkhiew  
Student Paramedic  

 
Did you face any stereotypes during your practice placements as a student paramedic, or even before you came into the profession?  
I tend to just ignore stereotypes or push them to the back of my mind, however they become really evident and frustrating when people, crew-mates and patients, start to play the guessing game of my race in practice.  
 
Southeast Asian women tend to be on the smaller side, and many fellow colleagues, patients and even my family often will comment on how small I am which makes me doubt my place in the ambulance service. It makes me feel like I don’t belong because I’m ‘too small’ to manually handle larger patients or I can’t carry all the equipment. 

How do you feel in terms of your personal progression in the ambulance service as a Southeast Asian woman?  
At first, when I started my degree I was confident and I was ready to do anything and everything to impress my mentor. But my confidence began to drop slowly when I started experiencing racial abuse from patients or even certain paramedics I worked with (this happened once and I’m glad that I haven’t worked with him since). They would start commenting on Thai people being prostitutes which has nothing to do with me but it affects me because I’m Thai. Sometimes it wasn’t just the slurs, sometimes it would be the nice patient trying to guess whether I’m Japanese or Chinese that just got frustrating.  
 
Me, coming to terms with my place in this profession is trying to work on my confidence and strength through family. Sometimes I choose to ignore it, I don’t want to. I’m just scared if I act upon certain comments, it will turn back on me. I guess I’m just trying to work on myself. 

 
Emma Varney  
Paramedic  

 
Tell me about yourself and your journey  
My name is Emma, and I am a qualified paramedic. I have been diagnosed with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). There is often a very stigmatised stereotype when it comes to autism, and it is often missed in females by health care professionals due to females not meeting the ‘standard’ characteristics of autism. Women with autism are often more likely to be able to mask socio-communicative impairments through methods such as forcing eye contact, preparing conversation ahead of time to use in conversation and mimicking the social behaviours of others.  
 
Male and female autism share some similarities but overall women with autism tend to present differently than men. As a result, many women are still struggling to get the support they need and judge themselves harshly for finding life difficult. A fundamental issue with the current diagnosis procedure is that the behavioural markers used as a diagnostic criteria are based on pre-existing concepts of what autistic behaviours look like. These have been developed based on predominately male populations previously identified as autistic.  
 
How has this impacted you generally and as a paramedic?  
I did not get my diagnosis until later in life when I was 23. I was a well-behaved but quiet child, therefore nothing was ever picked up all throughout my school years. My journey into the profession was not easy, I often felt like I was watching every other student paramedic excel and could not understand why I was struggling so much, especially with my confidence. For a long time, I felt I didn’t fit in to the profession, I was so scared of being seen as different that I became quiet and scared. I worried if I mentioned my diagnosis, people may have a predetermined judgement of how I will act, based on the more common characteristics of autism people are taught.  
 
It was not until I was placed with a mentor who, understood my previous struggles on placement, gave me the support, time and help I needed to shape me into the paramedic I am today. She pushed me in a positive way, with no judgement, only kind words and constructive criticism and because of her I was able to grow and build my confidence, suddenly things clicked into place.  
 
How do you feel now in terms of your place in the profession?  
Overtime, the diagnosis became just that and with the right people around me and the right support I was able to become a confident, strong individual and paramedic and feel I have found my place within the profession. I now use my diagnosis and my experiences to advocate for females with autism and breaking down the stigma that there is around autism, educating people on the possible differences in females with autism in comparison to men and breaking down the stereotypes for individuals diagnosed with autism. 

 
Muna Abdi  
Paramedic  
 

Were there any barriers coming into the profession?  
I was lucky enough to have a very supportive mother, who wished nothing but the best. When I told her about becoming a paramedic, she was instantly my biggest supporter.  
 
Did you come across any opinions or points in practice which made you doubt your place in the profession?  
Not really from colleagues, this came more from patients. I had one patient blatantly say that it’s weird for her to be treated by someone who’s a hijab-wearing individual, which I was slightly taken aback from. However, you also go to patients who are proud to see someone wearing the headscarf working for the ambulance service, simply because they have never seen it.  
 
How did you feel when you came into the profession?  
Coming into the service as qualified was nerve-wracking and one of the main contributors of that was because there were hardly any girls that looked like me. During my time on placement, I had not seen anyone wearing the headscarf. This made me somewhat second guess whether this was the right path for me. However, I don’t regret my decision now. It is coming up to two years since I qualified as a paramedic and I’m glad I made the decision I did. 

 
Stereotypes exist in every community and can act as barriers to not only understanding an individual’s identity truly, but also for the individual themselves to access different opportunities. In becoming part of the ambulance service, whether it be a clinician, call handler, manager or other, we have all had a unique journey to these roles.  

 
Often, many of us will face different hurdles or obstacles that those around us may not be able to empathise with or struggle to understand. These can be formed of many different attributes: the way you look, the accent you have, the place you grew up, which each in turn will come with predisposed opinions within society. And as a frontline public-facing profession, this can become even more of a challenge when we do not have a choice of who we may be sent to. I spoke to three individuals, each with a stereotype they had to tackle in their journey into becoming a paramedic, and their experiences in the ambulance service.