Sunday, 3 July 2011

Who are we?


We are a funny old bunch really. But recently I’ve been thinking, what exactly IS a Paramedic? And from things I’ve read from the College of Paramedics and other sources, this question is one that is coming up again and again.

It’s difficult to define really. When you stop to think what we actually do, then try to explain it, nothing seems to come close. Some will say “a Paramedic is like a Technician only they can cannulate, intubate and give more drugs”. Is that what we are? A Technician with extended skills? Personally, and I mean no disrespect to Technicians, I think that isn’t a very good description and sells us short. Besides, with the way the profession is moving I don’t think you can sum up what we are just by the mechanical skills we perform and drugs we are licensed to give!

Another description I hear a lot is “Jack of all trades, master of none”. While this hints at our need to have some knowledge about all and sundry in the medical world since we never know what we are going to come up against, again I think this sells us short. Master of none? I’d argue that there is one trade we are masters of – Pre-Hospital.

I’d say we are “Pre-Hospital Specialists”. While this may seem a bit vague, I think it is true. The pre-hospital world is a very strange, sometimes dangerous place. It is not just “here is a patient, please make them better”. While many doctors, nurses and other health professionals can deal with the medical side of our patients, dealing with the complex medical needs of the patient in ever changing environments with little or no backup, while being conscious of your own safety, and dealing with the often tricky extractions from said environments to your ambulance and then to wherever is appropriate for the patient... well that is a whole different ball game and one we are right in the middle of.

Much, if not a very large percentage of our job is not all about the medical knowledge, the things we do medically to patients, but about talking to people, dealing with their emotions, dealing with the people around them, problem solving, negotiating. It is hard, and often draining work but it is what we must do if we are going to truly help our patients.

Of course, there needs to be firm underpinning knowledge and skills to go along with the talking and dealing with people. A Paramedic who can’t walk in and recognise the “big sick” patient who needs rapid treatment & transport (drug of choice –DIESEL) is not very good at all. But increasingly we are not just dealing with the big sick patients. We have to be able to deal with the not-so-sick and all their complex needs as much as the big sick.

A blog post that really captures the essence of what we do is one from the Legendary Insomniac Medic and can be found here - And really, if God had that much trouble with us, will we ever be able to get a good definition of what we are?

In the ever changing dynamics of the NHS I feel it is important that we as Paramedics keep a sense of self. We need to make sure that what we do is recognised and appreciated by the wider health care community. We need to shout about what we are good at, make people realise we are no longer just stretcher taxies with first aiders on, but also to recognise what we are not good at and ask for help. In a little plug, I also feel that we need to get behind our professional body, the College of Paramedics, as without a strong professional body, how can we as Paramedics stand up and say “Hey, this is what we think and we do actually know what we are talking about”. Any medic who may happen to read this and is not a member, please do join. It’s not that expensive at all and they are gathering momentum. If we get over half the 17500 Paramedics in the UK as members, they can apply to be the Royal College of Paramedic – and that will provide even more clout!

So, next time someone asks you “what is a Paramedic”, pause for a second before you answer. If you really think about it, I’d say we are unique, special, highly adaptable members of the health care community who have to be able to deal with anything life can throw at us in a calm, professional manner with the highest levels of patient care and treatment available. We are Pre-Hospital Specialists.



  1. Nice post, and agree with most of you points, but: We're Out of Hospital Specialists, not Pre Hospital Specialists. We need to try and treat people and keep them out of hospital if possible, otherwise the system will just collapse like a matchstick roof under tonnes of snow.
    Here's my take:

  2. Completely agree. Good point! Part of the changing world of the Paramedic is more about the right treatment in the right place - and much of this CAN be done out of hospital, either at home or in other settings like the GP, Minor injury / walk in centre type things or other referral pathways. So indeed, we are Out of Hospital.

    And like your post as well!

  3. Great post NM, I completely agree. We had a similar discussion the other week with a College of Paramedics rep; "are we professionals?" and the answer is yes we are, but we need the backing of a Royal College in order to be true professionals. Their main point was that "Our guidelines (JRCALC) are written largely by doctors (in hospitals) who want to keep us Paramedics in our little boxes". I guess this is why the argument for intubation is still happening, and why some staff may not be happy with certain guidelines. We see what needs improvement but we can't improve it.

    I think that with the backing of a Royal College (lead by paramedics, FOR paramedics) we may be able to have a say in our guidelines, guaranteeing true autonomy. I believe that the newer staff members (who haven't fallen out of love with the service) will push this forward and give our profession what it really deserves!

    Keep up the good work, I've got some fire in my belly about this one!

  4. Amazing way of presenting the thinking. Keep it up and thanks for sharing.

    Clinical Medicine MRCP 2 Sanjay Sharma