Lots of talk questioning the qualifications, role and experience of non doctor HCPs recently. Thought I'd share my own career pathway to date to show why our role and experience is good and safe for pt care a 🧵
I can't help but feel we need to stop programs like ambulance etc. We seem to be recruiting some people into the profession who are more interested in the drama and taking selfies than they are learning and concentrating on high quality pre hospital care/ medicine.
@Dr_Done_
Hierarcy also why Elaine Bromley died because nurses felt they couldn't challenge doctors over a deteriorating patient because it wasn't their place to question them. Your not superior just because your a doctor and having that attitude is dangerous to patient care.
Can't believe in 2022, I'm having a conversation with a Paramedic who genuinley doesn't think paramedics are allowed to diagnose from an ECG or make a differential diagnosis. Who is teaching these people, When they aren't even aware of the HCPC standards of proficiency.
3 speciality consultants over the period of a conference have said they wished
#paramedics
would call them for shared decision making. Please mentors stop telling your students you can't call in hospital specialities for advice. This is a myth and not in line with HCPC standards
I often talk about perceived barriers in the ambulance service from appropriate conveyance, non conveyance or referal so here is a little thread of what I have collected over the years. Hope might be helpful with some myth busting and thinking differently.....
@AACE_org
/ NHS ambulance services. This is how
#NQP
should be done. Senior oversight, funded cpd time is what makes safe and effective clincians. Well done
@enhanced_c_s
Fantastic work from
@georgette_eaton
this is why I love being a paramedic. We are a registered autonomous profession, not an associate role to medicine like PAs and therefore can develop our domain and practice as we as a profession see fit. To compliment the workforce.
Disappointed to hear
#paramedics
being told they cannot refer to certain specialities. A registered HCP can and should as per hcpc standards of proficiency refer to whoever they wish for the
#rightcare
for their patients.
#autonomouspractice
.
@unisontheunion
Well you will be loosing my membership this is a shocking pay deal. I will be getting a new union. Can't believe people voted to accept this shocking and insulting deal.
Unpopular opinion but I do feel it should be mandatory for submission of a CPD portfolio for renewal of registration with a % then randomly checked, as opposed to submit if called. 12 years to date I could have done no CPD and checked a box if I was that type of paramedic.
@AACE_org
@NHSEngland
1. Not right way round. Put your most senior paramedics on response cars, people competent and willing to assess, tx at scene and discharge. Put lower scope staff on amb for transport only and paras can jump up if pt unwell.
A good post from
@DrLindaDykes
and useful for
#studentparamedic
#paramedic
#ambulance
, this is red flag bilious vomiting. Its very fluro-green and can be a sign of obstruction, compared to yellow physiological bile in vomit from empty stomach, make sure you check there meaning?
@ItsnotrightUK
Because we are seniors with our profession most of us with undergrad degrees, masters degrees and then significant years of expereince, portfolios and exams we completed practicing the high end of our professional roles. Doctors should be paid more but we shouldn't be paid less
#ambulance
#paramedic
MH education isnt always that good, especially around MH law, so do yourselves a favour and read this. I highly recomend reading this book for any students and amb clinicians wanting to improve. Great work
@PhDpara
and
@PartlowDavid
.
@HarryTtweets
You don't have to be a doctor to make safe decisions about appropriate conveyance, being a doc doesnt = better dec maker. Im so fed up of this perspective. Appropriately educated paras are perfectly capable of making safe decisions. Risk management is part of emergency care.
@The_HCPC
@ParamedicsUK
is it not about time we took a leaf from social work and create our own registratory body and disband from the hcpc. This way we could have more control over advanced practice regulation also?
Why I've always said that long term ambulance cohorting in temp areas does nothing. It frees a few up in the short but eventually just becomes part of the problem
Just read the new
@ParamedicsUK
curriculum, this is awesome and well written, really pushes the standards we should be expecting of our profession. Good work to all involved.
@hines_stephen
Improve education, offer development and rotational positions. Offer adv prac routes at band 8a. Stop treating people like children and allow them to practice. Accept some risk.
This is fantastic well done
@EastEnglandAmb
. Individual issues means staff will take care of their kit, can hopefully use it for enhancing judgement e.g. mdcalc app, bnf access etc and use for cpd and education. Impressed.
Spent the last 24 hours blocking certain accounts and key words. Makes Twitter nice to use again and back to education. I've had enough of arguing and how much it affects my MH. Its worth a try if anyone is feeling the same as I felt.
Teaching
#studentparamedics
about back pain in a few weeks. What stuff do people think is beneficial. What did you wish you knew when first qualified. Looking for ideas to include.
This 100%. I feel the nqp portfolio should have at least 3 months of primary care and 3 months of ED rotations in them. Clerking pts, working under supervision, learning risk management, time frames and how to differentiate pts who don't need or can wait for other services
@AshBrownett
@drgandalf52
Yes, ambulance service and universities delivering undergraduate education really need to look at paramedic scope. It’s not just specific skills but focussing on paramedic decision making and comfort with managing risk. All patients can’t be taken to ED or pushed back to GP.
When will people get the hint the modern NHS is made up of MDT. Job title is irrelevant it needs to be based upon competence. I get protecting your profession, I'm proud to be a paramedic doesn't mean I think I'm better than a nurse, doctor, ahp doing the same role.
Common thing done in amb practice that we need to change.... I've been guilty of it in past. We need to stop telling pts they can't bring mobility aids as they will get lost. We must transport mobility aids where possible to ED/ hosp when conveying older adults.
Come and work with us as a trainee ACPs in emergency medicine. Friendly team 20% non clinical development time and 80% clinical shifts. Supported MSc and RCEM portfolio.
@liambarker
@parajon82
Whilst I don't disagree with your point... I have to question why did the ambulance crew transport this to ED. I feel thats just a big a problem, we are asking a untrained call taker to remotely use a system to triage a call but a hcp feels a paronychia needs to be taken to ED?
#paramedics
#nqp
#ambulance
Remember that national strategic direction of NHS encourages ambulance service to refer appropriate patients to
#SDEC
on scene. We should encourage the use of these pathways to reduce hospital queues at EDs.
This is sound advice from one of our professions most senior consultant paramedics that I 2nd. You can learn so much from in hospital placements that will benefit your career and your current practice. Ask questions and learn. You shouldn't just focus on ambulance stuff
@GlyndwrPara
A good understanding of A&P will be forever useful and make learning most other things easier. Make maximum use of non-ambulance placements, even if you can’t directly see their relevance at this stage. Welcome to the profession! 👍🏻
This 🧵 is just an overview tbh there is probably a lot I have forgot about but I hope it shows why I get passionate and a little cross when some assume the ACP process is a shortcut or easy. It's not. We are professionals in our own right.
@ZShapcott
@GBod2
Not an excuse, we need to stop wooley offering transport and then using refusal as an escape from accountability. Likely if someone had been told the risks or potential concerns they would have consented to transport. This is something as a profession we need to work on.
Not where I wanted to be today on the other side. However does give me time to type up my reflective on the
@TheResusRoom
Intubation, RSI and RSI Assist course for my rcem portfolio
#acp
. Another excellent course from their team.
@MattCooperAmb
@NWAmbulance
This job role spec doesn't match an advanced practitioner role, no mention of MSc or extensive portfolio evidence working. Also band 7.... no no... band 8a for qualified Adv prac. Amb services need to stop watering down advanced clinical practice.
@AACE_org
@NHSEngland
2. Encourage amb services to recruit locum senior paras, primary care and EM ACPs who are ex amb service back to provide senior oversight, supported decision making and provide guidance to newer staff. B7 and B8a level clinicians... paid as such.
@georgebellstarr
1. I blame the uni for sending you on bad placements and for stupid time frames. I had 6 weeks of theatres doing 48 tubes and lots LMAs (no igels then) and bvm all, in ED I clerked tons of pt under supervision, did 100s of cannulas for that sign off.
@EMASNHSTrust
Reminder its not up to lay untrained members of the public to decide what is and is not an emergency.... thats your job as a service to do.
Yes and some on here need to grasp this quickly.... you have no right to dictate scope or role to another profession. Especially roles they don't even understand properly. The modern nhs is an MDT and a range of professions bring to the table.
It is not the job nor responsibility of any other health profession or other health professional body to tell us where we can work and what grades we can work and what jobs we can get
There are issues across every health profession with retention and recruitment.
@DrAsifQasim
@DrEmmaNash
@c3convertase
@ShabaNabi
As a paramedic I can prescribe and also I can order imaging the same as any physcian can. This is the issue you lot are so quick to slate other professions and think you know best, you don't even know what these professions can or can't do. I say again PA and ACP is not the same
Another twitter doctor who doesn't understand the professions they think they can have an oppinion on. Paramedic prescribers prescribe, we can also request imaging. Our roles in ED as ACPs have nothing to do with nursing team vacancies.
@simontutt88
@DrEmmaNash
@c3convertase
@ShabaNabi
But they’re not consultations, you don’t prescribe and you don’t order investigations
The decisions are about PHEC, whether to convey to hospital etc
The reason we had to employ paramedics in ED was because we were unable to recruit and retain suitably trained nurses and
@NJL_Blancq
I like the name NQP. think 2 years as a newly qualified is reasonable. What we need to change isn't the name imo it's the content. There needs to be better portfolio, more supervised practice, some paeds and adult ED and GP placement and then an osce and exam to earn B6.
@HidingSmith
@EastEnglandAmb
Fall absolutely needs a para they are some of the most complex medical cases you can go to many have subtle pathologies that cause the fall. Ask any geriatrician.
I really enjoyed recording this months episode it was fantastic speaking with
@andycollen
a leader in our profession about culture and feeling safe. If any
#ambulance
clinicians feel defensive in their practice all the time I really encourage a listen to this episode.
Feel like
#ambulance
and
#paramedic
training and cpd isn't enough. Unsure where to go for learning? That's what we are trying to help
@GenBroadCAST
, improve knowledge and education pre hospitally check out the podcast, this months episode silver trauma.
Once again
@enhanced_c_s
showing how paramedic roles should be done with heavy emphasis on education, non clinical and clinical time. Senior oversight for development. Great work and great opportunity.
@DCollingsHughes
Couldn't agree more. Once read a para moaning in paper they had to sit queing at ED because a pt couldn't be bothered to get OTC pain relief for a headache... if that's all they needed why did you convey them 🤔....
#paramedic
#ambulance
... winter is coming brush up on all things bronchiolitis by listening to our episode.. find out why you shouldn't give salbutamol for this wheezy baby. Which children need hospital and which don't. Subscribe for latest episodes
#studentparamedic
#ambulance
... this 👇 is what you should always remember. You should practice our area of medicine, not being a glorified first aider. You need high levels of knowledge and clinical acumen to be a good paramedic.
@simontutt88
I think most Student Paramedics don't realise that what they're embarking on is a career in medicine. Not a career in ambulance driving.
Learn medicine and it will be transferrable to any healthcare setting. Learn ambulance driving and you'll be stuck doing it forever.
@OrthopaedicOz
@Dilek807
Sorry but the word clinician is not isolated to doctors. Yes introduce yourself with title but the NHS has a robust framework for advanced clinical practitioner title. Patients will just need to get used to this like they have nurse practitioner etc.
@Billynomates8
@miffypoo
@drpoco
@Katynurse27
@doctor_oxford
@alisonleary1
I'm not taking away from kindness but see how long the person with sepsis lasts or the diabetic without insulin because a nurse isn't needed and they just needed a kind person. Sorry totally wrong and shows no understanding of the complexity of nursing.
@joshkimbre
If you don't diagnose or at least consider the formulation of differential diagnosis you aren't working to your HCPC standards of proficiency and not meeting the min criteria to be a registered paramedic. So the 23% who voted no, go and check what hcpc says you must be doing.
@DocDoLi
@aboabisabit
@MiloKostusiak
Sorry but what utter rubbish. Paramedics make life saving decisions on pts. We manage undifferentiated pts every day. This is the kind of ignorance that comes out when you don't understand others job roles.
June's episode of
@GenBroadCAST
podcast is in the editing stages as we speak. We are going through PHEA but specifically from an
#ambulance
crew approach. Which patients might need it, what prep to do whilst waiting for crit care, what you provide as part of the team approach!
@KHoulgate
I still say all para rotas should be 3x10 hour shifts per week and 7.5 hours of self directed learning. This way staff would improve clinically, maintain cpd be happier in general. But doubt that will ever happen.
@Paul98R
I'd like to know genuine question as it sounds like I'm challenging I'm not... what is the need for being duel registered, when AHPs and nursing many roles overlap now and competencies can be moved from one to another. I struggle to see the benefit?
@Xeon4f145d96s1
Do you honestly believe that an SHO on a 6 month rotation in ED knows more about emergency medicine than an EM ACP who has been doing the job for 20 years + portfolios, exams, post grad quals just because they went to med school... really?
@NJL_Blancq
2 years, allocared Educational supervisor of a senior paramedic who has been assessed to be preceptors. Rotational placements through ED, Paeds, PC and CC. Decent portfolio showing reflection and wpba of pts then college exam at end before allowed to move to B6.
@Dr_Done_
More proof of arrogance and assumption that someone doesn't know. Knowledge can be learnt. Non medics absolutely can specialise. I don't think you actually understand what training some non medics go through. Anyway we won't agree so there is little point debating further.
@NJL_Blancq
Whilst positive we need to be careful... we as a profession need to remeber that enhanced and advanced practice both require experience. If we want to deliver safe care, there needs to be consolidation at para level then enhanced level then adv level otherwise dangerous
@neil_lentern
@swasFT
If going to do
#ACP
must be done properly full MSc + minimum of 3 years of supervised consultant level oversight and WPBA rotating through ED, PC, paeds minimum of 3 months in each. Ambulance service needs to stop watering down advanced practice roles.
Love being part of such an amazing proffesion with so many opportunities. Working in a role with a level of practice I never thought I'd have the potential to get too and the privilege of doing it alongside some of the most and passionate
#paramedics
,
#ProudToBeAParamedic
What fears, barriers, beliefs do you have or have you heard as ambulance clinicians/ Paramedics that stop you using alternative care pathways and / or feeling comfortable with non conveyance decisions?
#nqp
#paramedic
#ambulance
@Dr_Done_
And I wonder what attitudes and beliefs caused that toxic hierarchy 🤔 medical school attendance doesn't equate necessarily to more knowledge or experience in a set field when compared to a non medic who has specialised in that area. So Dr doesn't necessarily = top of hierarchy
@robfenwick
@zollemsfire
@ZollHospital
Amazing work. Makes me reallt happy every time I hear you as an ACP delivering some of the best and most well known medical education around the world and working as team. Shows what ACPs can achieve and a model for us all to look too. Thanks.
@NatashaMDay
@Dr_Sarah_Bellum
@DrAliJSmith
The problem is we have lots of people who think they know what a paramedic is and what they should be doing... but don't. I wouldn't tell a ortho consultant what surgery they should do, why do people feel they should dictate what paramedics do.
@rcpsych
Maybe you'd like to send some representatives to every ED in the UK and manage it correctly then if you think its so bad. All well and good making a statement but you need to suggest how to safely action this to protect both patients and staff. Actions speak louder than words.
Really enjoyed teaching the 1st year
@BU_ParaScience
students today about barriers to providing the right care to patients and how we can overcome these. Great group really interactive and engaged. Thanks for having me.
@HeyTomAbell
@EastEnglandAmb
@MSEHospitals
If the plug is blocked the answer isn't build a bigger sink. It's reduce the water flowing into the sink and unclog the drain. These are the only 2 options that will work.
There are many reasons for ramping and delays in emergency care but let's just concentrate on the bit amb service plays a vital role in which if we think of cardiac physiology.... we are the pre load
@xxsnzz
Recently been told as a para I'm not good enough to manage a trauma. Despite being ETC instr. and probably have in my 16 year career seen more trauma than most. When they have managed max fax destr. inj. needing surg airway +shock poly trauma on side of 60mph road. let me know
@DrRJWebb
Amazing thread. Deff a problem in amb service. Same injuries in adults would get IV morphine everytime but kids get left with paracetamol only alot. Amb need better options but also use the options we have already and not to be afraid too.
@GlenwrightCook
Yes 100%, it would force courses to teach a standard and standardise levels of practice. The problem is some unis fail to fail because it looks bad on graduation numbers (not all unis before I get a moan) this would set a bar and force clinical content to be taught.
Finally some sensible recommendations for spinal immobilisation. Let's hope these are looked into and expanded into guidelines.
#paramedic
#prehospital
Amazing statement and 100% agree... although it feels like a long way off, your career is likely to be long and you will likely move into higher roles. Trust me.. that nice to know becomes need to know really really quickly and it's easier if you already know it.
The BEST piece of advice I was told when I started my Paramedic journey was this.
“Your Scope of Learning is not limited to your Scope of Practice”
Be a continuous student of your trade & don’t let anyone tell you otherwise.
#studentparamedic
#studentnurse
#nhs
#studentmedic
@Lemonymaid
@pepemac27
They are. It's more the pathology of bronchiolitis isn't bronchostriction based its oedema and mucous based from my understanding. I think the poor B receptor stuff has been questioned and evidence says not the case now?
@joshyjoshthorn1
We need to loose the thought as a profession that emergency care is a separate entity. We are an urgent and emergency care provider. Urgent and emergency care is a spectrum and we need to work along that spectrum.
@AACE_org
and ambulance trusts on a side note, you need to be taking care of the heart rate. Amb staff need welfare, improved education and training to do our job properly as part of the system.
I've never understood the need for ambulance documentation to use on arrival (o/a) I'm yet to see an example where that information isn't better placed in HPC, O/E, social hx sections etc. Anyone got examples to change my mind? Trying to teach SPs clerking? They use it on road?
After lots of hard work in parliament, the College of Paramedics is thrilled to announce that today the UK Government has made the regulatory changes to the Misuse of Drugs Regulations 2001 🙌
Read more here 👉
#ParamedicsUK
#NHS
Thoughts on gauze soaked in 1:10,000 adrenaline used as a vasoconstrictor for epistaxis management? Not after legalities etc only clinical use, do others use this in their practice?