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 

 

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.  


 

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. 

 

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. 

 

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. 

 

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. 

 

 

As you may already be aware body-worn cameras are currently being rolled out in a trial programme to all NHS Ambulance Trusts in England in a bid to help prevent and detect crimes being committed against ambulance staff. The ground-breaking move comes after new NHS England figures revealed that paramedics have suffered a 32 per cent rise in assaults over the past five years, with 3,569 incidents taking place in 2020/21 alone. It is the reason why the cameras are being issued now instead of 2024, when they were originally planned to be introduced, and it is hoped that all ten trusts will have their allocation of cameras by the end of July. A total of £8.4million was invested across all the trusts to operate a three year programme using the body-worn cameras, however, South East Coast Ambulance Service have only committed to one year across five of their stations.

Following a preliminary trial of the equipment at London Ambulance Service and North East Ambulance Service in February, paramedics and other frontline ambulance staff said they felt safer and better supported as a result of wearing the cameras. They also noted that the cameras helped to de-escalate situations when patients, service users, their relatives or other members of the public became aggressive towards them.

Kelvin Langford, a Senior Project Manager, Violence Prevention and Reduction Programme, NHS England and Improvement who is jointly leading the body worn camera trial, said: “The body-worn camera has been introduced to offer support and safeguard our staff. The use of the camera is not mandatory, however, we do encourage their usage wherever feasible. It remains the user’s decision to activate the camera during an incident where they feel at risk.”

While the response to wearing a body camera has largely been a positive one by paramedics, Martin Nicholas, Security Management and Violence Reduction Specialist for LAS, admits there is still some hesitancy amongst ambulance staff. “I think the main concern is that the camera could be used against them in some way,” he explains. “But this simply is not the case. The purpose of these cameras is to ensure staff safety. Of course, if a camera is turned on and there is a threat of violence or an act of violence against staff then ultimately the camera can be used as a prosecution tool.”

Over the next three years trusts will be expected to report back monthly on the impact of the cameras against an agreed set of data. Sam Harrison, a clinical team manager at LAS and alternate representative for London for the College of Paramedics took part in the trial at LAS. He said: “I have spoken with several members of staff who have needed to activate their camera, and it absolutely contributes to the protection of our crews. Locally, footage has so far been used to support the immediate placing of a risk marker on an individual’s address, where the premises are deemed too hazardous to crews to enter without police attendance. We have also had multiple requests from the Metropolitan Police for this footage to support their prosecutions. I have experienced activating the camera myself in an escalating situation which was very quickly diffused once I turned my camera on and voiced its presence.”

The rollout comes after a year in which NHS staff have treated more than 400,000 Covid patients while continuing to see millions of non-Covid conditions and successfully deliver the world’s first vaccination programme.