Paramedic Science and Paramedics - Essay Example

of the of the Health sciences and medicine June 10, Paramedic science and Paramedics Now and future I have come a long way since I joined this profession. There was always a desire in me to opt for a profession in which I could contribute to the society and help the people in need. What better way to do this than to be a paramedic who tirelessly works to aid people in distress. On joining this profession, I learned to apply theoretical knowledge that I had to clinical and field situations. I have learned many procedures and updated my skills. No day is a routine day. Every day, the shifts are different, the locations changed and clinical scenarios unique. The work pertains to attending calls such as trauma, cardiac and respiratory emergencies, substance overdose and many other situations and every call teaches some lesson. Apart from providing clinical help, paramedics have to act as efficient organisers and counsellors. Thus, I have had exposure to varied situations and developed my clinical and personal skills immensely in this profession. As far as the goals for the future are concerned, I intend to complete my degree and then aim for further research in this field as the this aspect of the paramedic practice is still in its infancy. Also, after seeing the way my teachers educate and disseminate knowledge, I have become inspired to do so myself in future. Areas of effective learning and areas of possible growth The areas of effective learning have been clinical basics, assessment of clinical scenarios, decision making and execution, and patient care. Theoretical knowledge about the field of emergency medicine is the foundation on which other aspects of knowledge are built. Physiological, pharmacological, pathological and diagnostic knowledge are imparted as a part of the course. There are many factors that have impacted on my learning. My teachers have acted as my mentors and aided me on my journey to become a high quality paramedic. They have imparted me the required knowledge and encouraged me to seek more. For any health care practitioner, patients are the best teachers. By observing and interacting with them I have honed my clinical skills. Daily practice and company of my seniors and supervisors have significantly impacted on my learning and education. Apart from medical and clinical knowledge, soft skills are also a part of learning. My profession has taught me teamwork, leadership, time management, resilience, empathy, lifestyle management, organisational and prioritising skills. All these qualities are inherent in this science and are inevitably acquired in some time. However, these skills are also influenced by the willingness of the individual to learn and the mentor to teach. There is always a potential to grow no matter how intensive the training has been and the same is true of paramedic science. Given the evolution of this science into an entity of its own and crossover in to the domains of other health care professionals like physicians and nurses, there is a need to upgrade our skills and deliver high quality of care and in turn build up a rewarding practice. Clinical learning experience Clinical learning is an important part of paramedic curriculum. It involves practical application of the theoretical knowledge in real life context. It can be provided on-site in the real clinical setting with real patients. Budding paramedics observe and learn to perform procedures such as airway management, intravenous access, cardiopulmonary resuscitation, manual handling procedures and drug administration in difficult and uncontrolled environments. Students learn to cope with the limitation of resources and infrastructure, and emotional demands of the patients. This experience is important to develop the qualities of critical thinking, analysis, judgement, decision making and implementation, and public dealing. Apart from the field experience, another way of imparting clinical experience is through simulation equipment and techniques, and creating the clinical scenario in the class room. Problem solving approach is applied to different situations in different ways and algorithms and actions are performed repetitively. Thus, class room based teaching is conducted in the clinical context. Also, clinical case studies may be taught using the virtual means. This enables the patients to test their knowledge before applying it to real persons so that learning curve doesn’t harm the patients. Thus, a combination of actual authentic experiences and fictitious case studies provides the clinical learning experience to the paramedics. To enhance this learning experience, trainee paramedics should be deployed in different areas which should be frequently rotated. These areas are critical care unit and intensive care unit, cardiac care unit, burn units, stroke unit, orthopaedic and trauma emergency, surgical emergency, medical and paediatric emergency. This will expose us to an assortment of patients and their conditions and management. On actual confrontation with similar conditions, the management protocol can then be quickly recalled. A clinical learning experience significant enough to be remembered by me forever was when I transported a chest trauma patient to the hospital. Patient was worsening haemodynamically and there were no breath sounds on one side of the chest. All the clinical features were of tension pneumothorax. An immediate decision was required to put in a needle into the chest to relieve the tension. As I did that, air escaped from the pleural cavity and on reaching the hospital, patient was saved. These skills of intuition, anticipation and quick decision making are an invaluable asset in this profession. This profession sharpens the senses and quickens the reflexes. Once these skills are acquired, they become invaluable in personal life too. Learning style When I had joined paramedic science, I had only a vague idea about the purpose of this profession and the skills I will be acquiring. With the passage of time, I have come to know and respect the amount of effort required in this profession and the gratification achieved. The learning process has been quite an experience. As I am a non native English speaker, it was very difficult for me in the beginning to follow the instructors’ teachings. Gradually, hard work, persistence and a desire to learn has led to an improvement in this area. My learning style is a combination of observation and performance. Over the time, I have paid attention and carefully watched the world of emergency medicine unfold in front of my eyes. As I have observed and learned, I have tried to retain the best practices and tried to replicate them in my own clinical practice. I have never been satisfied by mutely copying what others do and what I am taught. Rather, I have questioned what I have been taught, tried to find if there is any evidence behind the claims and protocols and made my own judgement by real life application of what is taught. I consider my teachers as my mentors and their guidance has helped my learning process in a big way. Paramedics are trained with a blend of verbal, visual and audio cues and the key to success lies in being able to apply what one knows. For that it is important to keep on refreshing the theoretical knowledge as well as clinical and practical skills. Key professional relationships and their importance Paramedics very rarely work alone. There is always a person who drives the vehicle, ambulance technician and usually another ‘partner’ paramedic unless the call is very low priority. Apart from the vehicle members, there is interaction and communication with the physician who is in charge of the emergency and pre-hospital care services. Thus, the work involves many professional relationships with juniors, colleagues and contemporaries, and seniors, and calls for efficient and cordial team work. It is natural that in responding to calls in highly stressful and emergent situation, there may be difference of opinion over many issues. It is important that these differences do not jeopardise patient care and all efforts should be made to resolve any disputes amicably. Ego hassles are a part of paramedic work as much as any other profession and it is up to the individual paramedic to deal with them in such a way so that professional relationships are maintained. In case of an emotional turmoil or loss of a patient, co-workers can provide psychological support. Work place bonding also decrease psychological stress and increases the sense of well being (Ozaki et al 2012). Ambulance team partners and members pitch in to deal with emergencies together. Thus, apart from the friendship, they rely on each other for knowledge, help and experience in innumerable ways from airway management to obtaining IV access, CPR and more. Manual handling operations especially require precise coordination of movements between the team members. Thus, paramedic does not work in isolation and professional relationships are of key importance in this job. Paramedic practice: science and aims Paramedic practice involves administration of medical care in out –of-hospital and emergency settings. However, the scope of the practice is expanding and some paramedics are also working at the hospitals akin to a ‘nurse practitioner’. The kind of aid provided includes immediate response to distress and emergency calls in coordination with a telephone dispatch system. On reaching the venue, paramedics proceed systematically by assessing scene safety, quick assessment of the situation and calling for more help, if required. The patient is assessed and lives saving measures are administered if required. These include but are not limited to oxygen administration, fluid resuscitation, cardiopulmonary resuscitation, defibrillation and drugs. If time and situations permits, history, physical examination and diagnostic tests such as ECG, peak expiratory flow rate and arterial blood gases measurement can be done, more so on the way to the hospital. Concomitantly, arrangements are made to shift the patient to the nearest or most appropriate medical facility. Accurate assessment of the patient allows the transport and referral to an appropriate facility such as specialising in burns, stroke, spine or other trauma, cardiac facility etc. Paramedic practice aims to deliver highest standard of care to the patients and save their lives. Paramedics manage life threatening situations themselves and the timely primary medical/ first aid given to the patient may halt or modify the progression of the disease process. Consequentially the prognosis of the disease is improved. The future aims of this practice are to establish paramedics as globally recognised medical professionals. Vision of the practice is to develop a practice that provides the highest quality patient care, upgrade and standardise the skills and qualifications of paramedics and is rewarding and aspiring. Paramedic practice: skills Although the skills formally imparted to and expected from paramedics may vary from region to region, certain core skills are always a part of the paramedic work profile. A paramedic can perform a basic assessment of the patient with components of history taking, relevant examination and determination of positive clinical findings and a few diagnostic tests. Assessment of scene safety is also a part of the work. After the assessment is over, next set of clinical management skills take over such as skills pertaining to management of trauma patients such as fractures, haemorrhage, chest trauma, airway injuries, wounds and penetrating injuries, and head, neck and spinal injuries. Paramedics are proficient in splints, tractions, immobilisation, fluid resuscitation, protection of open injuries, supplemental oxygen administration nad airway management. Other clinical areas with relevant skills required are medical emergencies such as cardiac (angina, myocardial infarction, arrhythmias, cardiovascular collapse) in which the skills of cardioversion, administration of narcotic and other drugs, recording and interpretation of ECG are included. Patients with respiratory illnesses may require, in addition, nebulisation and positive pressure application. Obstetric skills involve management of obstetric complications of delivery and haemorrhage. Other skills which are as important as those mentioned earlier are those of intuition, anticipation, triage and emergency airway management in trauma patients, organisational skills, maintenance of records and findings. Necessary skills are familiarity with latest and routinely used medical equipments such as defibrillators, oxygen cylinders, suction machines, nebulisers etc and basic troubleshooting of these equipments. Ability to man the emergency vehicle and operate the communication equipment is also desired. Paramedic practice and guidelines Given the possibility of inadequate assessment, diagnosis and treatment of certain conditions and to standardise the level of care, much emphasis is being placed on the development of uniform guidelines to manage clinical conditions. Also, these guidelines are evidence based so that practices based on rituals, traditions and anecdotal evidence is eliminated. However, researchers studying the usefulness of these guidelines as well as the compliance by the paramedics to these guidelines have found them impractical and misapplied in clinical settings (Snooks et al 2004). This led to inaccurate diagnosis and treatment of the conditions (Figgis, Slevin & Cunningham 2010). Moreover, research in the field of paramedic science has produced inconsistent results and low quality of evidence resulting in poor outcomes with these guidelines. So far as the issue of compliance is concerned, difficult and uncontrolled situations with limited resources often makes it hard to adhere to the guidelines. Additionally, these guidelines have proved counterproductive in the sense that they have caused suppression of independent thinking, questioning ability and autonomous decision making amongst the paramedics. They limit the role of paramedics as care providers being dictated by the physicians. There is no doubt that evidence based guidelines are required and should be used by the paramedics equivalent to any other health care practitioner. However, there must be some margin and space within these guidelines for the paramedics who are often faced with unusual and exceptional circumstances so that they can adapt and apply the guidelines in that particular situation. Paramedic practice: evidence supporting the practice Research work to validate the principles of paramedic practice has been mainly carried out only in the last 10 to 15 years. The basic policies and scope of the paramedic science are still undergoing development and refinement. Many aspects of paramedic science are similar to and overlap those of nursing practice. The science has evolved from first aid and patient transportation to higher levels of patient care (Ball 2005). The role is set to expand even further in view of the current inadequate primary and emergency health care. With the upgrading of their roles, paramedic will be able to perform additional procedures and administer a larger number of drugs autonomously and will have a more proactive role in patient care, in general. Thus, there is a need for regulatory agencies to supervise and review the training and qualifications of paramedics. Already, evidence is available that equipping paramedics with additional skills leads to more effective management of emergency cases and reduces hospital workload (Mason, Wardrope & Perrin 2003). Benefits and hazards of the practice Biggest benefit of paramedic practice is job satisfaction. It is altruistic and immensely satisfying to bring relief to those in distress and also gives the feeling of contributing to the society. Paramedics serve the nation by maintaining the health of its citizens. Another benefit is varied nature of the job. The work is far from monotonous and provides new challenges every day. It’s a job where one has to keep himself updated. There are regular encounters with newer drugs and equipment. This provides opportunity for growth and self development. Learning quotient of this job is very high. With newer recommendations calling in for overhauling and upgrading of the ambulance and pre-hospital care services in many countries, there is going to be no dearth of opportunities, promotions and remuneration in this field. There are many risks and hazards associated with this profession. A paramedic is usually the first person to respond to disaster situations like natural calamities, infectious disease outbreaks and terrorism and warfare related medical emergencies (Smith et al 2009). It is inevitable then that in all these situations, paramedics are exposed to life threatening situations and infections (Leiss 2009). In addition, there have been so many cases of physical assault and violence against paramedics that administrators are planning to introduce anti stab vests for their protection (Summers 2005). Infact, it has been shown that sometimes the threat perceived by paramedics to themselves or their families is so great that they may not report to work (Smith et al 2009). For managing this aspect of profession, that is, occupational hazards the paramedics should adopt the best possible safety and self protection rules and follow them diligently. These risks also call for stringent regulations for paramedic safety. Moreover, as a part of job, manual handling procedures are done which can lead to muscle and bone pains due to weight lifting, inappropriate postures and prolonged sitting. To deal with this problem, ergonomics and physiotherapy consultation is advised ( Gilad & Byran 2007). Recommendations about the practice Specialisation of the practice is the need of the hour as in any other health care service. Also, along with specialisation, the qualifications as required by paramedics to practise will also become uniform and standardised. At present, the courses and qualifications of the paramedics are varied and there is no uniformity leading to doubts about their professional competency. The concept of ‘paramedic practitioner’ such as emergency care practitioner, community paramedic, advanced paramedic practitioner has been introduced in tandem with that of ‘nurse practitioner’. Formal evidence of the impact of this concept is being gathered and it is likely that this practice may assist the existing health care services and be effective in triage and emergency patient acre. Paramedics will need extended clinical diagnostic, management and referral skills according to the increased responsibilities and work. For this purpose, it is necessary to have a stronger clinical base and thus the curriculum of the course should be accordingly enhanced and upgraded (Woollard 2006). Ambulance services and telephone response systems also need to be more advanced and organised in their approach towards patient and disaster management. Funding and accreditation issues also need to be resolved. The basic text and policies of paramedic practice should derive more from the current evidence. For this, more personnel are required to conduct research and evaluate the practices followed by the paramedics and their outcomes. Only with the availability of evidence, evidence based medicine can be practised. Reference list Ball, L 2005, ‘Setting the scene for the paramedic in primary care: a review of the literature’, Emergency Medicine Journal, vol. 22, pp. 896–900. Figgis, K, Slevin, O & Cunningham, JB 2010, ‘Investigation of paramedics' compliance with clinical practice guidelines for the management of chest pain’, Emergency Medicine Journalemj.highwire.org Emergency Medicine Journal, vol. 27, pp. 151-155. Gilad, I & Byran, E 2007, ‘Ergonomic evaluation of the ambulance interior to reduce paramedic discomfort and posture stress’, Human Factors, vol. 49, no. 6, pp. 1019,1032. Leiss, JK 2009, ‘Management practices and risk of occupational blood exposure in U.S. paramedics: non-intact skin exposure’, Annals of Epidemiology, vol. 19, no. 12 , pp. 884-890. Mason, S, Wardrope, J & Perrin, J 2003, ‘Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions’, Emergency Medicine Journal, vol. 20, pp.196–198. Ozaki, K, Motohashi, Y, Kaneko, Y & Fujita, K 2012, ‘Association between psychological distress and a sense of contribution to society in the workplace’, BMC Public Health, vol. 12, no. 253, pp. 1-7, viewed 10 June 2012, . Smith, E, Morgans, A, Qureshi, K, Archer, F & Burkle Jr, F 2009, ‘Paramedics’ perceptions of risk and willingness to work during disasters’, The Australian Journal of Emergency Management, vol. 24, no. 3, pp. 21-27. Snooks, HA, Dale, J, Hartley-Sharpe, C & Halter, M 2004, ‘On scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the Literature’, Emergency Medicine Journal, vol. 21, pp. 212–215. Summers, C 2005, ‘Murder highlights paramedic risks’, BBC News, 22 December, viewed 9 June 2012, . Woollard, M 2006, ‘The role of the paramedic practitioner in the UK’, Journal of Emergency Primary Health Care, vol.4, no.1, pp. 1-9. Read More