Ambulance Pressures Today and Everyday


Ambulance Pressures Today and Everyday

By Liz Harris   

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

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

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

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

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

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

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

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

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

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

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

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

Liz Harris, Head of Professional Standards

The 9th Annual Medical Special Operations Conference


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. 


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


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

By Carl Betts  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Carl Betts – Paramedic

Managing Right Ventricular Myocardial Infarction: A Prehospital Service Evaluation


Managing Right Ventricular Myocardial Infarction: A Prehospital Service Evaluation

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

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

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

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

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

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

ECG Criteria


Non-ECG Criteria


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


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


Table 1 RVMI diagnostic criteria

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

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


Mean (SD)

Age (years)

65.2 (14.3)

On scene to hospital time (minutes)

59.6 (22.1)


Frequency (valid %)

Gender (n=249)



Not recorded


179 (70.5%)

70 (27.6%)

5 (2.0%)

STEMI region/ territory





Inferior Lateral

Inferior Posterior

Inferior Post Lateral


Post Lateral


130 (51.2%)

124 (48.8%)

8 (3.2%)

83 (32.7%)

18 (7.1%)

14 (5.5%)

5 (2.0%)

1 (0.4%)

1 (0.4%

GTN administered

223 (87.8%)

Morphine administered

143 (56.3%)

Occurrence of complications

Cardiac arrest



Blood pressure drop > 30 mmHg

Blocks (1st degree)

Blocks (3rd degree)




PVC Multi


14 (5.5%)

72 (28.3%)

28 (11.0%)

38 (15.0%)

3 (1.2%)

2 (0.8%)

13 (5.1%)

3 (1.2%)

4 (1.6%)

4 (1.6%)

Possible RVMI

81 (31.9%)

Table 2: Descriptive summary of sample

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


So, it's Ramadan!


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

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

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

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

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

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

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

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

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

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

Some phrases you can say to your Muslim colleagues: 

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

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

Article by Nagina Zaroof, MCPara

#WorkWithoutFear: Deena's Story


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 to view films about some of those affected. 


Launching the Rejuvenate. Thrive. Breathe. (RTB) Paramedic Wellness Programme


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

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

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

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

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

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

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

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

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

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

Day walks

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

You don’t need to be super-fit – these walks are of low to moderate intensity, where emphasis is on recharging, rebalancing, and enjoying rather than it being a race. There are twelve spaces available per walk. Dates are between April – September 2022. The first of these walks is on April 23rd in Sussex. More details are available here: Devils Dyke - A Wellbeing Walking Event
More dates/walks will be released shortly.

Mountain/Hills skills courses

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

This is a course that is most suited to members who are ‘thriving’ or ‘surviving’. Two different dates (in June and September 2022) and locations are available, but due to safety and course requirements, numbers are strictly limited to eight members per course. More details/ booking will follow shortly. 

Wellness retreat

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

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

This is a unique and bespoke event for members and only 18 spaces are available. The retreat will be held on 22nd – 24th June 2022. More details and booking will be released on our website shortly. 

Important bits: 

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

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

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

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

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

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

NHS Practitioner Health (England & Scotland) - 

Benefits of the RTB wellness outdoor programme:

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

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

An interview with Wayne Auton MCPara, Paramedic and Field Guide on the Endurance22 Expedition


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 and take a look back at Wayne’s journey on his Instagram account @wayneauton 


#WorkWithoutFear: Sarah's Story


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 campaignTracy 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 to view films about some of those affected. 


Paramedic turned educationalist 


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Removing the mask: Virtually Connecting in a Pandemic


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

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

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

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

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

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

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

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

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

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

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

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

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

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


College of Paramedics (2021) Reflective Spaces: Paramedic Support Groups, Available at: [accessed 26th January 2022]. 

Mind (2021) Our Research in the Emergency Services, Available at: [accessed 26th January 2022]. 



#WorkWithoutFear: Bradley's Story


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 #WorkWithoutFearTracy 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 to view films about some of those affected. 


A Pioneer For The Paramedic Profession 


A Pioneer For The Paramedic Profession 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




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


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

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

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



The Power of Advocates and Supporters


The Power of Advocates and Supporters 

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

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

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

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

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

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

Elaine Rudge 
3rd November 1947 - 23rd November 2019

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

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

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

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

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

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

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

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

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

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

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




Defying Stereotypes: Women in the Ambulance Service


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

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

Waranya Kaewkhiew  
Student Paramedic  


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

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

Emma Varney  

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

Muna Abdi  


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

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

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




We Need to Talk About Paramedic Mental Health


Time to Talk Day Article – 3rd February 2022

We Need to Talk About Paramedic Mental Health

March 23rd, 2020, a day that may forever be etched on our minds as the day that the coronavirus pandemic was declared in the UK, and Prime Minister, Boris Johnson, instructed us to ‘stay at home’. This was quickly followed by a collective sense of fear within society, & led to ‘clap for carers’ from 30th April 2020, whereby members of the public stood on their door steps, clapping NHS and vital workers in a visual show of gratitude for their work and the risks they were taking in the face of potential contagion. We now know how this was to pan out, and how the pandemic has continued to affect all of our lives, from the impact of school closures, caring for elderly and/or vulnerable relatives, and of course, the significant impact on our work and healthcare systems. 

So, where has this left us? Well, even under ‘pre-pandemic’ circumstances, we know that paramedic’s psychological wellbeing has been a cause for concern. However, the outbreak has seen us particularly exposed and the effects of the pandemic have exacerbated the stresses and demands placed upon us. As such, organisations and charities have provided supports and encouraged us to talk about how we’re feeling – after all, talking is good for us, and there is much research documenting so. But, talking is not always an easy thing to do, especially within the ambulance sector, which has a long cultural history of ‘man-up and get on with it’ – aka ‘be stoical and strong - showing your emotions is a sign of weakness’. 

Fortunately, these days, we’ve become more aware of these ‘old’ beliefs and assumptions within our culture which have for years, perpetuated stigma around mental wellbeing and reaching out for support. With the help of national campaigns, such as Time to Talk Day (established by Mind and Rethink Mental Illness), there is real opportunity to bring to the fore and address stigma and discrimination associated with mental ill-health.

In his 25 years as a paramedic, Matthew Syrat, thought that he’d seen it all. In this time, he had attended most things that ambulance work can throw at you, but some particularly tough and tragic incidents had unknowingly left him with unresolved feelings. ‘They’d affected me more than I realised’ Matthew said, in my interview with him. He added that ‘one day, a colleague at work noticed an acute change in my personality’. It was this conversation which was the catalyst to him booking an appointment with his GP. 

Matthew was subsequently diagnosed with post-traumatic stress disorder (PTSD); an anxiety disorder, reportedly affecting 11% of the ambulance workforce (Petrie et al, 2018). Newly diagnosed, Matthew shared how his mind ‘went into a bit of a whirlwind, not knowing what it meant, how I would be able to function, or even if I would be the same person anymore’. By this time, it was nearly Christmas. Despite his loving family, Matthew found it a lonely time and felt isolated. It was in the new year, that he began eye-movement desensitisation and reprocessing (EMDR) therapy, and quickly realised that the traumas that he had experienced had affected him far more than he’d realised. ‘I was sceptical about EMDR at first. I really didn’t understand how it was going to solve the mystery of my sudden change of behaviour’ but it soon became apparent to him that through EMDR he was able to identify those memories that were still unprocessed, raw and lingering, but importantly, through the techniques, could process them safely. ‘After five sessions, things were clearer, and I felt lighter, somehow. I was able to think straight again, and felt confident in moving on’ he added. 

Eighteen months later, the pandemic hit. For Matthew, as for many of us, ‘work was relentless with demands being put on everyone.. I wanted to remain stoic for my family and my team’. But by July 2021, Matthew had begun experiencing changes within himself and his behaviour. He said ‘I couldn’t quite put my finger on it, but I was losing interest in most things, work, play, and in general life… work had become pretty unbearable… I had put everything into ensuring my team were ok and had everything they needed to do their job, but I forgot to look after myself along the way’. With this self-awareness and realisation, Matthew knew that he needed to take some time off work and take another trip to see his GP. He was experiencing burnout and diagnosed with anxiety and depression, conditions which he never thought would affect him, a family man in his forty’s and an experienced, long-standing paramedic. 

In his reluctant admission to take some time away from work, and in the weeks and months that followed, Matthew sought to address balance within his life and rekindled his love for motocross; ‘I wanted to ride again, to see if I could still do it, but also to have something positive to aim for’. It felt exciting to focus on purchasing a new bike, and brought great reminiscence of his younger years. The next goal, was passing his CBT test, which he did with flying colours. Importantly, Matthew shared how critical it was to just take one step at a time and to find a sense of meaningful purpose; for him, this was motorbikes! Invigorated by his newly acquainted passion, Matthew went on to pass advanced tests and set his heart on a Honda African Twin Adventure (AT) which after some searching, he found and purchased with great enthusiasm. 

As I listened to Matthew talking of his experiences, it is crystal clear that his journey from that initial conversation with his colleague, through to diagnosis, treatment and beyond, has not been easy. There have been up’s and down’s, and added life and work challenges along the way including the ‘small’ matter of a global pandemic. However, underneath this, has been his emotional courage – to speak out, to seek help and support, and to value himself – to give himself the time and space to heal, and to develop helpful coping strategies. As a manager leading a team, this is particularly important, to not only role model positive wellbeing behaviours, but also to psychologically permit team members to also look out for their own and each other’s mental health. This will undoubtedly go some way to breaking the stigma that has been so inherent within our culture. 

Talking of his recovery and return to work, Matthew added, ‘I feel good. The world has changed since I’ve been away, but in myself, and my personal life, things have continued to evolve for the better. I guess this is what’s meant by a ‘work-life balance’. For me, the balance had tipped the other way, and I hadn’t felt happy for a long time. That conversation with my colleague was a turning point. Speaking out and getting help was the best thing I did. The treatment has helped, and I’m so glad to be riding again… I haven’t smiled so much in a long while. For me, biking has been the best anti-depressant; the feeling of being free and leaving stresses behind, has truly been the best remedy. I feel a sense of achievement in what I’ve done, I’ve got my life back and biking has helped me to do this’. 

With grateful thanks to Matthew for his openness in sharing his experiences with us.


By Jo Mildenhall, Paramedic Mental Health Project Lead, College of Paramedics

Petrie K et al (2018) Prevalence of PTSD and Common Mental Disorders Amongst Ambulance Personnel: A Systematic Review and Meta-Analysis, Social Psychiatry & Psychiatric Epidemiology, 53, 9, 897 – 909. 



Where Critical Analysis Becomes Critically Unhealthy



A practice educator’s perspective of student paramedics and newly-qualified staff regarding pre-hospital thinking and personal wellbeing.

By Carl Betts MCPara, Quality Improvement Lead Paramedic, Yorkshire Ambulance Service.

Within this piece, I aim to highlight concerns relating to premature burnout of student paramedics and Newly Qualified Paramedics (NQPs), although they are equally relevant to all clinicians.

As an experienced paramedic, I have regular conversations with student paramedics and NQPs who struggle to manage the pressures of their chosen role. Throughout these anecdotal discussions it is apparent that a plethora of issues are affecting their mental health. Some of these issues are personal, but many stem from inexperienced colleagues displaying high levels of self-critical analysis. Ideally, this analysis should result in positive self-esteem and learning, but sadly, many experience the complete opposite.

The Paramedic Profession

The expected skill set of the ambulance paramedic has grown dramatically in recent years. Working in small teams of one to three people can feel very isolating and stressful, especially with the potential for back-to-back incidents. The scope of incidents attended and the limited time we have with a patient often leaves us wondering if we did the right thing, and we usually never find out. These thoughts are understandable as we regularly make complex decisions which can have profound consequences on the lives of our patients, their families and ourselves. Once a patient is handed over, the only time we receive any feedback is if we a) receive a letter of thanks, b) are requested to write a statement for the incident, or c) re-attend the address at a later date. Whilst these may shed some light on a crew’s performance, it can be difficult to obtain constructive feedback. This leads to staff over-thinking their actions and concentrating on the ‘what ifs’ as opposed to ‘this incident went well because of …..’
Paramedic Education

Nine years ago, my university student paramedic training cohort comprised 20 students, with 18 of us graduating. We now see multiple cohorts each year with an excess of 60 to 70 students at a time. As such, I feel that student paramedics are not receiving the same level of support that was offered to the smaller cohorts of previous years and that this may negatively impact their educational journey.

Within modern paramedic education, critical analysis is vital for students to develop into successful and current clinicians. The ability to reflect, analyse and learn from both our own, and our colleagues’ actions is key to providing the best emergency and urgent care to our patients. Using critical analysis as a tool is encouraged in all study modules to evidence continual learning and produce succinct, constructive written essays and reflective pieces. 

Yet this perceived requirement to continually self-critique may be an important cause of our inexperienced and younger colleagues going through mental health struggles early in their careers. This perpetual analysis leads to an overwhelming burden as they try to maintain a constant, heightened level of awareness which doesn’t allow time to develop and consolidate their reflective and analytical thoughts. We need to actively teach that it is not healthy to over-analyse the details of every single incident, and instead concentrate on incidents where there are real positives for constructive learning to take place. I feel that a discussion is required to flip the cultural negative framing of reflective thinking on its head and turn this critical analysis tool into a positive one.

Reflective Thinking

A key feature of reflective thinking is having a focus, and this is something that seems to be missing within our students’ and NQPs’ toolbox. This focus allows a person to understand the parameters of what they are analysing and leads to a successful reflective experience without having to overthink every interaction with a patient.

One key ‘take home’ message that I stress to my newer colleagues is that we should not be fixating on the parts of an incident that have not gone well. These experiences are important, but the thought process needs to be a balance of both positive and negative. By dwelling on the negative aspects of incidents we condition our mind to always hunt out the negatives first. I personally believe that we should be focusing on the positives, followed by the negatives, and then finish with how we can flip the negative into a positive for future incidents. I actively question my colleagues to think of the positives that they can take from their experiences to break the typical negative focus. This builds confidence in their reflective abilities and enables them to become reflective practitioners over time. By allowing students to develop these skills, they will develop a more positive critical analysis and a healthier mindset. 

My lived Personal Reflective Experience

Whilst writing this article, I attended an incident which involved a traumatic paediatric cardiac arrest. This was a stressful and profound incident for me in many ways and sadly, it did not have a successful outcome for the patient. However, from a reflective viewpoint, this incident was a highly-valuable experience. During reflection, I understood that I made a dosage error during drug administration, and I found myself fixating on this mistake whilst churning over the emotional turmoil of treating a child the same age as my own. After a discussion with a friend and senior colleague, he highlighted all the positive aspects of the incident, which I was aware of, but I chose not to concentrate on initially. This highlights that even experienced members of staff sometimes need guidance from others to help process our thoughts in tough circumstances. Thankfully, I have spent time processing the positives and negatives of this incident and have managed to successfully organise my thoughts and feelings.

I liken this reflective process to going through a filing cabinet that represents my mental wellbeing. After attending an incident, the cabinet is in disarray with the drawers open, files all over the desk, and leaves me with a feeling of chaos. Reflecting on the good and bad, I can organise these files, throw away meaningless thoughts, and file away useful experiences and lessons learned into an ordered system. Once consolidated, the drawer is closed for that incident and recuperation can take place. All my thoughts, feelings, and actions are now stored away in an organised manner so that when I open them later, the feeling of chaos is replaced with clarity. Without this process, these jumbled thoughts and feelings would not have been properly digested and consequently, the filing cabinet would not close. This would result in continued chaos and disorder, leading to anxiety, confusion, and stress, as the mind churns over the incidents. New generations of clinicians, without this learned reflective process, may be unable to close the drawer, eventually leading to mental health and confidence issues.

Changes to be made

I feel that universities, educational providers, ambulance trusts and colleagues all have a duty to prepare our new paramedics not only to look after their patients, but to also look after themselves. There should be a real emphasis on acknowledging that poor reflection can be as detrimental as doing no reflection at all. There needs to be a clear focus in all educational critical analysis activities for them to be meaningful and constructive, enabling learning and progression to take place. Alongside this, we should also encourage students to re-frame incidents to facilitate positive reflective experiences. We need to equip our newly-appointed paramedics with the right skills to support them throughout their future careers and create an open and honest culture to assist with handling difficult incidents or when mistakes have been made. 

I understand that critical analysis and over-analysis are not the only contributing factors for the negative mindset shown by some of our new staff. However, I do believe that they have a significant impact by causing low confidence, increased anxiety, and a general fear of our role. I strongly feel that current reflection processes need to be altered so that universities can equip students with the skills to reflect positively and progress with lifelong learning. This has the potential to greatly improve the mental wellbeing of student paramedics and with our duty of care, we need to provide the tools to ensure that they can thrive within their working environment.


In conclusion, it is vital that clinical reflection is utilised within our profession in all clinical settings. However, we all have a duty to support and set the example to our colleagues on how to reflect healthily. There needs to be a focus on learning from the negatives to create a positive mindset and we can do this by working together to pinpoint these positives and share learned experiences. This will break through the common isolated mindset and will support our newly-appointed colleagues.

Let us come together to change this cultural barrier and start organising our mental filing cabinets to create a positive learning environment in clinical practice.

Body-Worn Cameras 



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.

Normal or Numb 



Normal or numb: that is the question but what is the answer?
By Carl Betts MCPara, Aspirant Specialist Paramedic and Quality Improvement Advisor at Yorkshire Ambulance Service.

It is 9pm on a cold winter’s evening. I am at my local emergency department (ED) restocking some supplies for the Rapid Response Vehicle (RRV), when I receive a message from my control room to attend a Category 1 incident. It simply reads, “? Deceased, no bystander CPR in progress”. As I arrived on scene I was joined by a fellow RRV responder.

On entering the house it became clear that it was neglected. Proceeding upstairs I was directed to an attic room, where a clearly deceased man was laid prone, surrounded by used needles, syringes and improvised tourniquets. Little could be done other than complete our paperwork and wait for the police to arrive.

As we waited, my colleague and I discussed what we wanted for dinner. Eventually settling for a Chinese takeaway, to be picked up returning to the ambulance station. As I left the residence, I started to feel guilty about discussing our plans for dinner with a deceased person in the room. To us it had become a simple incident to manage – walk in, assess patient, confirm death, inform police and complete paperwork.

Questions started to cross my mind. How could I be so unaffected? As a member of the public just a few years ago, I would have been appalled at the sight of a dead person. Now I was able to continue as if nothing had happened. What had happened to me? Was it a healthy response or something that could in time lead to mental harm?

These questions returned to me, whilst dealing with a varying patient complaint list over the following couple of days. Any one of the incidents attended would have prompted an emotional response to an untrained person, yet for me and other ambulance service staff, these scenes are commonplace. The longer I work in this field, the further I seem to move away from responding emotionally like an untrained person. This then poses the question of whether this is healthy.

Of course, the answer isn’t cut and dried.

Without some form of coping strategy and the development of resilience through training, there is a real potential for burnout to occur and also a perception that staff are brash, uncaring and unsympathetic individuals.

Our employers, and the patients in our care, demand a high level of service. However we all come with human fallibilities having good and bad days both physically and mentally. Unfortunately, we still have to work despite not being in the best place at times, risking both our professional reputation, as well as the organisation’s.

If asked how your day has been and you un-emotionally reel off a list of incidents you have dealt with, most listeners would be shocked.
So the questions I have asked myself are, am I normal, numb? How is my mental health affected? And does the ambulance service attract people with particular characteristics and mentality whose level of perceived normality is slightly different from the start?

One of the significant issues with crew mental health is the incremental evolution of stress. Over time you may learn to build coping strategies including becoming numb or detached. Becoming numb or detached from the situation may also be the mind’s response, allowing us to deal with the issues we are faced with.

Suffering a decline in our mental health, affects our work and family life. Family life should be our number one priority, but it can become strained or in some cases destroyed. In many instances it is difficult for an ambulance person to open up, unless there is a family member who understands why it is all going wrong. Opening up can be very challenging, being twofold in nature. Firstly to protect the family from hearing about some of the experiences we deal with and secondly they just may not be able to understand or comprehend the issues that need to be discussed.

Mental health is personal. From my own experiences starting work as a newly qualified paramedic, I am aware that my stress level rose very sharply at first. Seven years in, I know that my stress level trajectory has eased off, but I am now becoming aware that the upward curve has still been progressing. Sadly, as with all aspects of mental health, I have no idea where my tipping point or cliff edge is. I am aware however that we all need to manage our stress curve as the upward motion of compounded post-incident stress and pre-incident anxiety continues to gnaw in our minds.

I can now visualise my own stress curve. How does yours look? Have you thought about the build-up effect? Not every person in the ambulance service will have a breakdown of course. I am aware, however, that there is a significant chance that we are exposed to enough 'stuff' to cause our personality to change thereby not being the same person as we were when we started our career. Our personal lives can also contribute to a negative mind set. Change is part of the rich tapestry of life, but it is concerning to see close friends and colleagues’ crash and burn as a result of our role. I have been struck by people asking the question “When did it all start going wrong?”.

This is a poignant question and one of the reasons why I have chosen to share my thoughts. As ambulance service staff, we still wait too long before we acknowledge or act on a deterioration of our mental health state.

I truly believe the world of ambulance work is bad for all of our long-term mental health and I do believe that we do become numb to many things and detached from situations, in order to protect ourselves. Following my time of reflection, I believe I am numb to many things, both good and bad feeling, I am looking at the world from behind a glass wall. Numbness and detachment are defensive walls allowing me to be disengaged from the reality of other people’s situations. Currently I feel like I am a long way off falling off a cliff on my current trajectory but it is anyone’s guess as to how much any person can take.

As a leader/manager, I strive to listen and encourage the frontline staff that have decided to disclose their mental health difficulties. I always find it a bizarre, and an incomprehensible concept that an employer will quite happily pay to have a member of their team off work with stress, increasing the isolation and so becoming more and more distant from their colleagues, rather than keeping them in the fold and allowing them to do alternative duties on a flexible personal plan. Staff should not be pressurised to accomplish tasks but should rather be given support to manage what they can do thus phasing in a return to normal duties. This has the potential to keep that person protected by their colleagues and be surrounded by people who understand and can empathise with the situations they find themselves in.

So what can we do to make things better? In very simplistic terms, watch out for your friends and ask them to watch out for you, and as a friend please speak up if you are concerned. The last person to notice or accept things going wrong is often the person themselves. I strongly believe that we are all potentially only one incident away from never working on the frontline again. It is imperative to keep a check on yourself and be honest. Sometimes acceptance is the hardest realisation, but with acceptance comes hope, and with hope comes positivity, and with positivity comes a willingness to open up and strive for personal change.

I hope this little article is thought provoking and opens up positive conversation for you and your colleagues.

Thoughts from Health Psychologist, Esther Murray

“This is an excellent piece, Carl has captured the way numbing out is necessary but it numbs out everything - not just the bad... I think it's hard to be as honest and clear eyed as Carl is so I am really grateful to him for sharing here.

We often talk about psychological wellbeing in terms of end points, as if you were either sick or well and that was that, but it isn't. We all have mental health, just like we all have physical health, and over time and for all kinds of reasons the things that we experience affect us. Just as if you ran a lot of marathons and over years of running you developed sore knees, by the time that happened you would have learned a lot of tricks for soothing sore knees. It's not your fault, or your knees' fault or the marathon's fault that your knees are sore, it's just what happens.
I think our mental health is the same, but we haven't really been taught much about how to look after it. If you're into sports you're probably surrounded by a community of fellow enthusiasts who have lots of tips about how to deal with physical injuries and wear and tear, and there are lots of experts you can learn from on the internet and so on. Our mental health ought to be the same, we ought to be surrounded by people who are open about how to look after it, and to have easy access to advice and support.

Things are changing, that's for sure, and the pandemic will make them change faster. There is already a huge community of people who live with all sorts of mental health problems who know exactly how to manage because they have learned it, just like the marathon runners, and I think we will see more openness about it as time goes on. Sharing our experiences and learning to listen to one another knowing that we don't need to fix anything for each other, only be there, is a fantastic start. When more help is needed, there are professionals for us to talk to. There's nothing shameful or unusual in that, we're only bringing it out into the light just now, that's all. And it's about time."

HCPC Hearing: A Member’s Perspective



A member of the College of Paramedics shares their experience of receiving notification of an FTP allegation from the HCPC

I’ve been a member of the College since its inception and had the privilege of being a member of the Governing Council at an early stage. I’ve watched with interest as the range of member services and benefits have developed over the years but never dreamt that I would be in urgent need of the expertise and support of the legal services team.

I’ve been in the profession for 44 years in military and civilian paramedic roles and at all levels of the Ambulance Service from road staff and HEMS to senior management. I’ve been fortunate enough to be recognised nationally and internationally and had never had a concern or complaint raised against me. In early 2020, I became concerned at some issues in the management of the organisation I was working for and raised them through correct channels as I had a duty to do.

Within a very short space of time, my world imploded! I was suspended and became the subject of an investigation with serious allegations made against me. As this was initially an employment related issue, I was represented by my trade union and one-by-one the allegations against me were withdrawn, except one. I was offered a settlement package with strings attached that I could not accept and resigned.

As if these few weeks weren’t stressful enough for my family and I, as I’m planning what to do next I open my email to find an email from the HCPC informing me that an allegation concerning my Fitness to Practise had been made. I cannot describe the feeling of dread and stress that immediately ensued and with a sense of rising panic I called the College of Paramedics legal helpline. Andrea James (from Brabners Solicitors) called me back within 30 minutes and I just burst into tears; she was fantastic, calmed me down and asked me to explain what the allegation was. I went through everything in detail and Andrea was as incredulous as I at the basis of the allegation and told me how to proceed.

Having waited for the ‘triage’ stage of the HCPC process, my depression and mood just darkened when the HCPC decided to investigate the allegations as it fell within their scope. The only positive news at this stage was that the case officer had decided that there was no requirement for an application for interim conditions whilst the investigation proceeded. Frustratingly at this stage of the process, my legal representatives could only advise to wait for the HCPC to decide if the matter would proceed to an investigation panel who would in turn decide if the matter should go to a final hearing.

The next seven months were sheer hell; I heard nothing from the HCPC and my physical and mental health deteriorated to the point where I needed professional counselling which was fortunately arranged by the College via TASC. I cannot begin to explain the effect on my family and I and contacting the HCPC for an update proved fruitless; the regulator has no interest in the affect that their processes have on the registrant and this was apparent.

After seven months, the HCPC advised me that the matter would go to an investigation panel and required a detailed response from me within 14 days! I had had no contact from them for seven months or the opportunity to have any input from my perspective and now they wanted a response within a few days. I contacted my representatives at Brabners and a firm email was sent to the HCPC who granted a month’s extension.

Brabners provided me with very clear advice on what I needed to submit and how to construct it and they pulled the information together into a pack for submission to the HCPC with a covering statement summarising our response to the specific allegations and my points of rebuttal.

The outcome: after the worst and most stressful one year, three days and 16 hours of my professional career, as it was, I received a polite and brief email to advise that the investigation panel had met that day and decided that I had no case to answer and the matter was closed. My wife and I just burst into tears.

The effect on my mental health and personal and professional confidence have led to a position where I have had to leave a service, a role and career that I have loved but feel unable to continue in and I am now practising in a different environment.

The allegations and the subsequent HCPC process absolutely felt that ‘guilty until proven innocent’ was the starting point. Without the support of the College, Brabners and TASC I may not have come through this; there were some very dark times in the night-time hours but knowing that a friendly voice was only a call away and that there were those on my side was invaluable.

I’ll never forgive those behind the referral in my case or their motivations, and I cannot encourage strongly enough all Paramedics to join the College, it literally was a life saver for me and I’ll be forever grateful.

Don’t think ‘it won’t happen to me’ or underestimate the massive effect that a referral will have upon you, even if you think you’re confident you have nothing to worry about. The combined impact of an allegation and the subsequent HCPC process will lead to you needing all the help, support and professional representation that you can get. Only the expertise of the College and their legal team can provide this for you.

HEE Announce New Road Map to Advanced Practice in Primary Care



Paramedics have, for many years now, been choosing primary care as the pathway for their professional development. This new initiative from Health Education England (HEE) will build on the strong foundations created by those paramedics who already work in a variety of roles across primary care.

The educational training pathway to Advanced Paramedic Practice in primary care will first see clinicians develop the clinical pillar of advanced practice, either by a portfolio route (for those with existing competency and education) or by a taught route in partnership with Higher Education Institutions.

Following completion of initial paramedic education and a period of consolidation in professional practice, the paramedic aspiring to work at advanced practice level in primary care will first work towards becoming credentialled as a First Contact Paramedic (FCP). Credentialling as an FCP will use a portfolio or taught route to evidence achievement of clinical competency in two stages, as outlined in the First Contact Practitioners and Advanced Practitioners in Primary Care: A Roadmap to Practice (Paramedics). Credentialling and a register of clinicians who achieve each level will be overseen by the HEE Centre for Advancing Practice.

First Contact Paramedics will work in a diagnostic role, seeing a broad range of undifferentiated and undiagnosed conditions as the first point of contact. Clinical knowledge will be developed at academic Level 7 (Stage 1), and clinical expertise will be evidenced by Workplace Based Assessment (WBA) undertaken with clinical supervisors in primary care (Stage 2).

The table below provides information as to the differentiation between First Contact and Advanced Practice for paramedics working in primary care:

Progression to Advanced Practice in primary care will, for most, follow a taught route via a Higher Education Institution, achieving an MSc in Advanced Practice (or equivalent). Alongside continuing to develop as a clinician, with supervision and ongoing development – credentialing as an Advanced Practitioner requires the individual to demonstrate competency and capability in education, leadership and research (Four Pillars of Advanced Practice).

The College is supportive of this framework, which provides paramedics with a clear pathway to achieve their aim of working in primary care. The framework also offers those currently working in primary care with guidance and clarity for clinical supervision and opportunity to evidence their education, training and core competencies in order to credential via the portfolio route.

The College of Paramedics is actively working with HEE and the Centre for Advancing Practice to determine the role of professional examinations, such as the Diploma in Primary and Urgent Care offered by the College, to support paramedics to credential as Advanced Practitioners in primary care.
Click here to read the New Road Map to Advanced Practice in Primary Care.

Enquiries should be sent to and a member of the team will be in touch.


Perform or Panic? Challenge or Threat?

By Joanna Train


Picture: Roger Brown 

Reappraisal strategies for improving performance in a stressful situation.
Joanna Train is currently an MSc Sports Psychology student with an interest in applying sports psychology performance strategies to supporting emergency responders deal with high pressure situations. Click here to read Joanna’s piece.

The Paramedic Case for Safer Streets

By Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney



An ambulance response car uses a protected cycle lane to bypass general traffic. Picture: Cyclingmikey

As the Covid-19 pandemic continues, one big change for residents of towns and cities has been how we get around. With public transport capacity reduced, many took to private cars to avoid the guy wearing a mask under his chin while sitting opposite you on the train. Unfortunately, if this trend had continued we were heading towards long-term gridlock - so urgent action was needed to enable alternatives like walking and cycling.

Fast forward a few months and we’ve seen Low Traffic Neighbourhoods (LTNs) and pop-up bike lanes appear across the country, following new government guidelines. LTNs use filters to calm residential streets - preserving vehicle access to all addresses but removing through routes (Living Streets, 2020) and improving space for social distancing - while protected lanes make cycling a safer (Lusk et al, 2011) and more attractive (Hull and O’Holleran, 2014) transport option. These trials started with public consultation running alongside rather than before them, unusually, and have not been without controversy.

A recent headline read “Top paramedic warns bike lanes are holding up ambulances in traffic jams” - with the newspaper describing them as “paralysing Britain” - while concerns over the emergency services are often cited by LTN opponents. I suspect many have horror stories of emergency responses being delayed by the sheer weight of traffic, dodgy parking, and questionable drivers - but these seem to be accepted as inevitable. Our field strives for evidence-based practice, so I’d like to examine the evidence for bold changes towards safer, healthier streets.

We know how time critical certain calls are, this is reflected in the College’s concern that LTNs and bike lanes could delay ambulances, but well-designed infrastructure can actually enable quicker response. In Walthamstow, London since a series of LTN-like schemes were installed in 2014 - Fire Brigade response times actually went down (LFB, 2020) while King’s College (2018) researchers found that life expectancy for local residents went up. Both of these changes are likely to be, simply, the result of fewer vehicles on the area’s roads.

With cycle lanes, as well as encouraging people out of cars and onto more space efficient bikes for shorter journeys, wide segregated lanes can be accessed by ambulance vehicles to bypass traffic. Narrower lanes that replace parked cars with bendy bollards, meanwhile, make it easier for drivers to pull aside and well-designed LTNs have seen emergency services able to fly through streets that previously suffered localised gridlock.

A London ambulance passes through an ANPR traffic filter. Picture: Oval LTN

It’s fair to say that recent changes have been of varying quality. Some LTNs use Automatic Number Plate Recognition (ANPR) filters to ensure rapid emergency access via any route, while others have cheaper unlockable bollards and specific unfiltered routes for emergency vehicles - which are sometimes defeated by outdated ambulance navigation systems.

The use of ‘hard’ point closures like bollards and planters often forms part of the design mix, but unlocking bollards if the standard entry/exit points are unsuitable takes time - so permeable ANPR filters at key access points would likely be preferable for response driving. Though there is a lack of published research on the interaction between emergency responders and LTNs, ambulance services are among the consulted bodies who must be involved in a scheme’s design. Many UK cities have historic LTNs (Laker, 2020), with no documented emergency access issues for these areas.

Since the advent of apps like Waze, traffic using minor residential streets has increased by around 20 billion vehicle miles in ten years (DfT, 2020a), with every mile driven on a minor urban road posing a greater risk of pedestrian injury than if it was on an A road (Aldred, 2019). Residential streets cannot safely cope with so many drivers following satnavs along any available shortcut, so LTNs reduce this overflow of the main road network.

A graph showing the increase in traffic on minor roads, from

Main roads will often see some initial increase in vehicles as a result of LTNs, where volume traffic had previously been displaced onto unsuitable minor roads. As alternatives to driving are made easier and short car journeys made harder through infrastructure changes, residents tend to reduce their car use (Aldred, 2020). This paradoxical phenomenon of evaporating traffic (Cairns et al, 2002) has, in previous schemes, seen main road volumes level out or decrease over time - with a large overall reduction in traffic across an area (LCC, 2020). The resulting drop in traffic numbers frees up road space for those of us who need it.

In public health terms, air pollution has been called this country’s “largest environmental risk” to health, linked to tens of thousands of annual deaths (PHE, 2019). In London, for example, vehicles are the single biggest cause and our children lose around 10% of their lung capacity to pollution (TfL, no date). Considering the particulate emissions from tyres and brakes, a shift towards electric vehicles alone cannot negate this harm. LTNs reduce air pollution in residential areas by stopping ‘rat running’ and discouraging driving short distances - while infrastructure for alternatives to driving facilitates this broader ‘modal shift’ away from cars.

A lot of work goes into improving outcomes from trauma, the world’s leading cause of death and disability for under 40s (Krug et al, 2000), but we must also look at root causes. According to injury data, a third of major trauma in the UK is still caused by Road Traffic Collisions (Kehoe et al, 2015). In 2018/19, adult and child pedestrians and cyclists made up 37% of those killed and seriously injured in British collisions (DfT, 2019), showing the need for safer street design. This is reflected in the fact that all of London’s Major Trauma Centres have previously called for more protected bike lanes in the city (Kenyon, 2014).

We are also in an obesity and inactivity crisis, with physical inactivity behind one in six UK deaths, childhood obesity on the rise and our population’s movement levels declining over time (PHE, 2016). So-called ‘active travel’ is an important solution, incorporating exercise into daily life, and has been shown to significantly improve health (Celis-Morales et al, 2017). There’s an abundance of evidence (CeGB, 2020) suggesting the main barriers to active travel are safety perceptions. A recent government survey found 66% of English adults felt "it is too dangerous for me to cycle on the roads" (DfT, 2020b). Compare this to the Netherlands, where protests over children killed by cars were a catalyst for protected infrastructure - and cycling is now commonplace (van der Zee, 2015).

Such are the strengths of the health arguments in favour of street design interventions, many of which were also called for by NHS leaders to help their staff travel safely during the Covid pandemic (Kelly, 2020), that healthcare providers are now getting involved themselves in creating new schemes. There are three newly proposed LTNs in deprived parts of South London which are to be part-funded and studied by Guy's and St Thomas' NHS trust’s charity - to help tackle childhood obesity and air pollution around local schools (Salisbury, 2020).

New schemes need to be bold to be effective, and need time to work, but have already shown their worth. Paramedics see the harms of traumatic injury, preventable illness and congestion every day. We have an important voice in the future of our streets - which are now changing rapidly.

We must be part of the conversation, ensuring the needs of the emergency services are a key part of new designs, but the evidence suggests we should avoid joining the chorus of voices that stand against change altogether. The status quo isn’t working, so let’s stand up against preventable harm, and for better public health.

Author: Jules Mattsson, Student Paramedic and committee member of the London Cycling Campaign in Hackney. Twitter: @julesmattsson

Reference list:

Aldred, R. (2019) 'Motor traffic on urban minor and major roads: impacts on pedestrian and cyclist injuries', Proceedings of the Institution of Civil Engineers - Municipal Engineer, Volume 172 Issue 1, pp 3-9. Available at: (Accessed: 17 November 2020).

Aldred, R. (2020) 'Low Traffic Neighbourhoods: what is the evidence from the mini-Holland interventions?', Rachel Aldred, 1 September. Available at: (Accessed: 18 November 2020).

Cairns, S, et al. (2002) 'Disappearing traffic? The story so far', Proceedings of the Institution of Civil Engineers - Municipal Engineer, Volume 151, Issue 1, pp 13-22. Available at: (Accessed: 18 November 2020).

Celis-Morales, C, Lyall, D, et al. (2017) 'Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study', British Medical Journal, 357 (j1456). Available at: (Accessed: 17 November 2020).

'Barriers to cycling' (2020) Cycling Embassy of Great Britain Wiki. Available at: (Accessed: 17 November 2020).

Dajnak, D, Walton, H, et al. (2018) Air Quality: concentrations, exposure and attitudes in Waltham Forest. King’s College London. Available at: (Accessed: 17 November 2020).

Department for Transport (2019) Reported road casualties in Great Britain: provisional estimates year ending June 2019. Statistical Release. Available at: (Accessed: 17 November 2020).

Department for Transport (2020a) Road traffic statistics. Available at: (Accessed: 17 November 2020).

Department for Transport (2020b) Walking and Cycling Statistics, England: 2019. National Travel Survey. Available at: (Accessed: 17 November 2020).

Hull, A and O’Holleran, C. (2011) 'Bicycle infrastructure: can good design encourage cycling?', Urban, Planning and Transport Research, 2(1), pp 369-406. Available at: (Accessed: 17 November 2020).

Kehoe, A, Smith, JE, et al. (2015) 'The changing face of major trauma in the UK', Emergency Medicine Journal, 32, pp 911-915. Available at: (Accessed: 17 November 2020).

Kelly, J. (2020) We need StreetSpace. Available at: (Accessed: 18 November 2020).

Kenyon, J. (2014) 'London’s Major Trauma Centres: ‘Build protected cycle tracks across London’', CyclingWorks, 8 December. Available at: (Accessed: 19 November 2020).

Krug, E, et al. (2000) 'The Global Burden of Injuries', American Journal of Public Health, 90 (4), pp 523-526. Available at: (Accessed: 17 November 2020).

Laker, L. (2020) 'Smashing the tyranny of the status quo: 10 of Britain’s historic hidden-gem LTNs', Zag, 6 October. Available at: (Accessed: 20 November 2020).

Living Streets (2020) Low Traffic Neighbourhoods. Available at: (Accessed: 17 November 2020).

London Cycling Campaign (2020) Waltham Forest’s mini-Holland schemes, the evidence. Available at: (Accessed: 18 November 2020).

London Fire Brigade (2020) Fire Facts Incident response times 2019. Available at: (Accessed: 17 November 2020).

Lusk AC, et al. (2011) 'Risk of injury for bicycling on cycle tracks versus in the street', Injury Prevention, 17, pp 131-135. Available at: (Accessed: 17 November 2020).

Public Health England (2019) Review of interventions to improve outdoor air quality and public health. Available at: (Accessed: 17 November 2020).

Public Health England (2016) Health matters: getting every adult active every day. Available at: (Accessed: 17 November 2020).

Salisbury, J. (2020) 'Guy’s And St Thomas’ Charity Will Fund New LTNs Over Health Benefits', Southwark News, 18 November. Available at: URL (Accessed: 18 November 2020).

Transport for London (no date) London's air quality - how bad is it?. Available at: (Accessed: 17 November 2020).

van der Zee, R. (2015) 'How Amsterdam became the bicycle capital of the world', The Guardian, 5 May. Available at: (Accessed: 17 November 2020).

Preparing for Winter 2020 - Why you should have the flu vaccination

By Sammer Tang, Public Health Registrar, Gloucestershire Hospital NHS Foundation Trust ; Public Health Lead, College of Paramedics, Kirsty Morgan, Assistant Director of IPC, NHS England and NHS Improvement - Midlands Region



Amid the COVID-19 pandemic, another flu season is upon on us. Every year, Influenza kills an average of 8,000 people every year in the UK. This is not your average common cold.
Influenza or 'flu' is a respiratory illness associated with infection by influenza virus. For most people, flu is just a nasty experience, but for some it can lead to more serious illnesses. The most common complications of influenza are bronchitis and secondary bacterial pneumonia. These illnesses may require treatment in hospital and can be life threatening, especially in the elderly, very young children, and people with underlying health conditions.

Why should I be vaccinated?

It’s impossible to predict the impact that flu and COVID-19 will have this winter. The common symptoms of COVID-19 are very similar to those of influenza, including: fever, cough, sore throat and fatigue, this could make differentiation between the two difficult. In addition, it is well known that frontline healthcare workers are more likely to be exposed to Influenza virus and it has been estimated that up to 1 in 4 healthcare workers will become infected with influenza during a mild influenza season, this is considerably higher than the 5.44 in 100 people in the general population1.

70.2% of frontline ambulance clinicians in the NHS Ambulance Trusts in England were vaccinated against seasonal flu compared to 75.4% of healthcare workers with direct patient contact in Acute Trusts in 2019-2020. Although this is an increase of 4.7% across NHS Ambulance Trusts since the previous year2, this is short of the ambition of the Secretary of State for Health’s ambition of 100% of healthcare workers being vaccinated, unless they have a “very good, essentially clinical reason” not to be vaccinated.

While the seasonal flu vaccine won't protect you against COVID-19, it will reduce your risk of influenza. By protecting ourselves with the flu vaccine, paramedics not only reduce the risk of spreading flu to patients and our own families, but reduce the risk of service disruption, which is particularly important throughout winter where increased pressure on services is common. There is no such thing as natural immunity against the flu virus and healthcare workers are encouraged to have their vaccine annually to ensure they are protected.

What to do next?

The year flu vaccine is a quadrivalent vaccination which contains four inactivated influenza viruses3,4. It is considered to be the best protection against an unpredictable influenza virus and has a good safety record, therefore we should all be vaccinated to protect ourselves, our patients and our families, unless there is a clinical reason not to be vaccinated. This year is particularly important for you to be vaccinated as early in the flu campaign as possible, this will reduce the burden of flu related admissions as well as ensuing that paramedics and all frontline ambulance staff are able to have the COVID-19 vaccination should it become available.

In addition to frontline healthcare workers, the flu vaccine is also offered to at risk groups, as part of making every contact count paramedics should be encouraging the uptake of vaccination in these patient groups5:

• All children aged two to year 7 at secondary school.
• Those in clinical risk groups and aged between six months and under 65 years
• Pregnant women
• Those aged 65 years and over
• Those in long-stay residential care homes
• Carers
• Those on the shielding list for COVID-19
• Close contacts of immunocompromised individuals and household contacts of those people on the shielding list for COVID-19


1. Kuster et. al. (2011) Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis

2. Public Health England (2020a) Seasonal influenza vaccine uptake in healthcare workers (HCWs) in England: winter season 2019 to 2020 [Online]

3. Tang S. & Morgan K. (2020). Seasonal flu, vaccinations and COVID-19, Journal of Paramedic Practice. 12(9): 346-348 [Online]

4. WHO (2020) Recommended composition of influenza virus vaccines for use in the 2020 - 2021 northern hemisphere influenza season [Online]

5. Public Health England (2020b). National flu immunisation programme plan

My Experiences of Living with Racism All Around Us

By Islam Faqir



From my first ever recollection of experiencing racism, I feel at times, talking to people that they just don’t get it, mainly around how it feels, the thoughts that pass through your mind, the effect it has on you and your family, the resulting apprehensiveness and the impact on your social interactions. Whilst speaking to friends and colleagues, they offer sympathy and empathy, but I ask, do they really know how it makes someone feel, and the cautious behaviour it results in?

I thought I would write this to give context and feelings to my experiences which I have titled,

Have you ever experienced and felt…

My very first recollection centres around playing in the school playground and being called a paki, at that point being a juvenile and not really understanding what the slur means, being at a school that was 96% white… I would just put my head down and carry on playing, but feeling like I was different as it was pointed out my skin colour was different. Of course, going home, I never shared these experience’s because I just didn’t, I can’t really give a reason…

I think back and I can remember being stood in a queue with my dad and a white individual hit my dad in the legs with a trolley and said, "Get of out the way paki." I turned around and swore at the individual, I was in my early teens but I felt protective of my dad. My dad turned to me and said, "Son ignore him, this is something I have experienced many times." I was really angry and asked the individual, who seemed to be a bit older than me, to say it again and I would, well I think you get the picture… My dad again calmed me down and did not rise to it. First, I thought ‘wow my dad has the resilience and calmness to just be a bigger person.’ I now think my dad’s generation just accepted it and that was because to them that behaviour was normal.

As I grew and joined the working world, at times work colleagues would ask if I wanted to go out socially and I would say yes. However, I found after queuing up with my colleagues, I would be pulled out of the queue by the doorman and searched. When my colleagues asked, "Why are you picking on him?", the reply would be because I was black and looked like most drug dealers; ‘Black’. I would eventually get into the venue and try to enjoy myself, but afterwards it would affect me because I would be embarrassed to go out in case this happened again. After joining the ambulance service, this was even more so, I would feel different, I would worry what people may think and how it looks!

BREXIT and how things changed. Not so long after the vote whilst leaving a supermarket, I was walking passed an individual who just blurted out, "You’re all out now.", puzzled I said, "What do you mean?", the reply was or how I translated it, as a result of Brexit I or all people who were not white could return back to where they came from. I did say "Well, where is that?", the reply was "Where you were born." I replied "That would be here then…", the man looked puzzled!

The holiday season is something we all look forward to. There were occasions where I went away with work colleagues, and it would be standard that I would be picked out of the boarding line for a plane, and asked questions. My work mates would laugh and take the mick, which I would laugh along with. However, these experiences would leave me embarrassed and dreading the journey home, as it would often be a repeat.

I had the same experiences catching a flight to the USA with family and we got a lot of looks from fellow passengers. At times I would say "Well they are only doing their job.", but as my partner would point out to the people asking the questions "Why are you only picking on him?". Well we know why, I do not have white skin and I have a Muslim name. I do believe in keeping everyone safe, however, this treatment becomes tiring and I feel weathered by it, as it’s the same over and over, and over.

Other things that leave you demoralised are: 
Sharing with a colleague your interest in a job role, and hearing them tell you the name of the person they already know will get the job. 
Not having people that look like you that you can aspire to be.
Being racially abused at work whilst you are trying to help the person that called for your help, but doesn’t want you to put your black hands anywhere near them.
You go home feeling demoralised and asking yourself where you fit in society and why you are doing the job you are doing.

Being pulled over by the police because you are driving a nice car, being searched before getting on a train whilst on the way to a conference, because they say you looked suspicious (must have meant the case I had with me). I am always polite, as I think ‘they are doing their job’ but it does rile me when they ask what I do and when I say paramedic their tone and behaviours change to, let’s say, a little more professional.

Being described as a terrorist, accused of actions based on what I can only call inhuman ideology, becomes tiresome, hurtful, unwanted and undervalued, being compared with animals, who are only similarity to me is the colour of their skin.

Living with racism is something most people of black, Asian and minority ethnic backgrounds face every day, it is all around us. It does not have to be just name calling, it is behaviours, actions, assumption, jokes. Mostly, people do not realise the impact it has on our thoughts, emotions and mental health. The examples above are only a few of many I could write about, these were just to give substance in how my experiences have affected me.

Islam Faqir
Chair, College of Paramedics Diversity Steering Group

The HCPC and Paramedic Self Referral

Learning From the Past for a Better Future


The year is 2002 and paramedics have not long been registered with the HCPC. Having not been qualified long yourself there are certain colleagues you look up to, paramedics that you want to be like one day. One particular paramedic is Chris. Chris is tall, striking looking and an exceptional paramedic. Chris always seems to be able to deal with any situation the two of you had been in, whether that was cannulating a shutdown trauma patient trapped upside down in their car in the rain, or compassion for an elderly lonely patient, or even looking after you and your patient in the middle of a pub brawl. Always with a calmness and confidence that you and many others aspired towards.  

Like anyone who works in an Ambulance Service, you know all too well the regular patients that you encounter time and time again. In 2002 there is one particularly longstanding, regular caller, a man called Brian. Brian is in his 40s and calls 999 at best, daily, and at worst a lot more often. Brian lives alone in a state of chaos and neglect, he is alcohol dependant and does not work. He can often be verbally aggressive and sometimes inappropriate, particularly towards women. In fact, there is a flag on his property that double female crews should not attend. Brian always calls 999 complaining of chest pain but will very rarely travel to hospital, usually refusing to go anywhere. Brian has Angina and a GTN spray as he has had previous MIs. Colleagues never want to go to Brian as he is challenging to know what to do with and you know that at some point he will die and one of you will be the last person to see him alive. 

One day, it is Chris that gets the call to respond to Brian’s address. Brian is particularly aggressive, shouting and threatening violence, the police have already been called by a worried dispatcher due to his demeanour over the phone. Chris and the police try for some time to calm Brian down and understand why he had called 999, but eventually gave up as he wouldn’t let them anywhere near him, and was telling them in no uncertain terms, to leave his property. So, Chris, crew mate and police leave Brian’s house.   

Brian is found dead by a neighbour the next day. 

The Ambulance Service does not investigate but refers Chris straight to the HCPC. Chris is kept busy gathering evidence to show just how often Brian called 999, how he always rang with chest pain and how often he was abusive towards ambulance colleagues. Chris collects evidence and testimonies to demonstrate outstanding clinical expertise and excellent character. Chris has a huge blue folder with all the comprehensive statements and official documents ordered perfectly for ease of reference. Little did you know at the time that this was not at all what the HCPC wanted. But you knew no better. Management knew no better. Nobody around Chris knew any better.  

Several months went by, the hearing came. Chris got struck off the register.               

How could this happen to someone like Chris? A solid paramedic that anyone would want at their side at a bad job, and someone you would want to turn up if your family was in need. You just can’t understand it. Everyone is shocked. The news spreads at a speed usually reserved only for the juiciest of gossip! And so does the fear, the fear that this could happen to any of you, at any moment. 

The fear had consequences. After a while nobody knew what was fact and what was fiction in Chris’s story. Stories were told constantly, and myths were created surrounding the HCPC - the HCPC is punitive, they’re out to get you. It is better to self-refer, because it will look better on you rather than coming from the Ambulance Service. These stories becoming ingrained in ambulance and paramedic culture. The Ambulance Services increasingly used the HCPC instead of their own investigative process. They would wait to see what the HCPC said before they decided what to do. There is no doubt that this happened across many of the Ambulance Services at the time, there were more than 30 back then.  And so, the scene was set for the following years… 

The aim of this piece is to raise awareness and understanding about a hugely unnecessary self-referral rate, how that came to be and how we can reduce it by thinking and behaving differently. The College of Paramedics is working with the Association of Ambulance Chief Executives, the national Directors of HR and Trades Union organisations to ensure a full awareness of the current situation regarding paramedic self-referral rates and to drive changes that will support and benefit individuals and the paramedic profession in the future. 
For more information on Fitness to Practice self-referral and legal representation click here  

Liz Harris FCPara
Head of Professional Standards, College of Paramedics

Being a Muslim Paramedic during the COVID19 Pandemic - Beards, Ramadan and Eid

By Shumel Rahman MCPara, North East Ambulance Service



At the beginning of the pandemic I had a big decision to make! Ambulance front line staff were asked to shave off their facial hair, for the FFP3 face masks to fit. I had a religious dispensation; however, I had felt a huge sense of responsibility to protect and safeguard people. I also wanted to do the right thing when it came to my faith. 

After a lot of thought and much deliberation I decided to shave my beard off, to allow the respiratory equipment to fit properly.

This is not a step I took lightly; my beard is not just part of my identity, it is not there just to look cool, even though it does, but it is part of my religion. I have had a beard for well over a decade and I cannot remember the last time I shaved. I consulted many Islamic scholars and teachers, locally and nationally, sought advice from fellow Muslim healthcare professionals and very helpfully from the BIMA British Islamic Medical Association. This was not a simple yes or no answer, however these are exceptional circumstances, totally unprecedented and a unique situation.

I shaved off my beard to protect my patients, colleagues and my family. One of the greatest acts is to save someone’s life. This simple act may help do that.

My faith is something very personal to me and it is not something I often talk about at work unless someone asks me about it. Being a Muslim is an integral part of my life and identity. My faith is like a shield that protects me, it gives me focus and balance, gives me a code to live my life by, a belief system, provides me with important values such as respect, it gives me peace, not just a belief in God.

For a Muslim, Ramadan is a very special time, a time to treasure and looked forward to, a time to reconnect to Allah, a time to focus on my faith, a time for spirituality, a time to spend in the Mosque, a time to spend with family, a time for charity and giving, a time to reflect on what we have got rather than what we have not, a time to think about those less fortunate than ourselves, a time to think about all those who are suffering around the world or who are in despair. It is a time for discipline and centering yourself. A time for family, for friends, for community and for coming together. Oh, it is about fasting too, but the other stuff is just as important if not more so.

What many people misunderstand, is that Muslims fast not out of obligation, but because they want to. I think many people who are not Muslim do not quite understand Ramadan, often people see fasting and Ramadan as a chore or period to get out the way or we cannot be bothered with. For Muslims it is an incredibly special time, that we actually look forward to, a very important time for us, that we love.

This year was exceptional; never have I experienced a Ramadan where we were unable to go to the Mosque, to enjoy Iftar breaking the fast together, spending time with our family or friends. This Ramadan was vastly different, we could not do the things we would normally do. We still had a rewarding and spiritual Ramadan staying at home. This year has been strange, it was completely different. It felt like Ramadan, but then at the same time it did not, if that makes sense.

I was working on Eid, so missed out on some of the celebrations. Normally I would go to Eid prayers, we have outdoor Eid prayer in a local park in Newcastle. Unfortunately, we were still in lock down on Eid, so that got cancelled and I ended up doing my prayers in the back garden. I live with my family, so we managed to celebrate the occasion and ending up having a virtual Eid online with the rest of the family all over the country. I was really hoping we would be out of lock down but unfortunately that was not to be.

I am very pleased to say that just before Eid, the Trust provided me with a respirator hood, that goes over my head and is able to work with facial hair. It is similar to what you see in the movies, like ET. Having the hood allowed me to start growing back my beard just in time for Eid, you could call it a little Eid Ramadan gift.

It has been an extraordinary year for everyone, particularly in the realms of equality & diversity. We have seen the impact of COVID19 on black, asian and minority ethnic communities and healthcare professionals, disproportionately high COVID-19 death rate among BAME people and the effect on BAME colleagues is very scary and concerning. We’ve also seen the brutal killing of George Floyd and the mass mobilisation of the Black Lives Matter movement, globally demanding justice for George Floyd and eradication of institutional and systemic racism, and the conditions which have given rise to racism, which is potentially interlinked with the disproportionate number of BAME COVID19 deaths.

It has been a very strange year so far, Eid Mubarak & stay safe.

Bullying, Harassment and Discrimination in the Paramedic Workplace

By Duncan Lewis, Emeritus Professor of Management, Plymouth University 



Darkness and Isolation

By Izzy Faqir MCPara, Clinical Pathways Manager, Yorkshire Ambulance Service 



I am an NHS Paramedic and a father to 5 children.  I had recently been successful in being appointed as a Clinical Manager for Pathways and started in early February 2020, after trying for a number of years to progress. I identify as disabled, due to an organ transplant, and come from a BME background and I have faced many challenges in my career as a result of both (maybe my next blog will be about that). When I started my new role, I felt like I had a new direction and purpose and was, after a long time, really happy with my life at home and work. 

It was at this time that I started to hear, on the news, how in East Asia a new illness was taking lives and having an impact on so many people. I remember thinking we were all so lucky to be so far away, and never for a moment thought it would bring its devastation so close, and affect my world, as much as it has. Gradually though, I began to see the destruction this disease was having on people, like a darkness spreading from East to West, from North to South. I started to think, would it reach these shores, surely not? I had seen SARS and MERS, but this seemed different. This disease seemed to hold no mercy, particularly for those with health issues.

In March, I was asked to help with the increasing workload, which involved working within 111, and I happily agreed, after all, these were unprecedented times. The dark cloud had reached our shores. As I assisted people; taking their histories and listening to their stories, fears started to rise in the back of my mind, about the fact I am immunosuppressed. I also had rising fear for others around me. One caller, had travelled, with symptoms, from Italy to the UK, by train! All those contacts! I visualised again the darkness spreading and engulfing the world.

Pressure for the ambulance trust to respond effectively to the pandemic increased, of course, and I was told I would have to return to my substantive role in the Emergency Operational Centre. I was becoming really anxious now; going back into an environment with 60-70 people, working within the same room, left me feeling vulnerable and fearful for my own health, and the possible implications that it could have on me and my family. 

Thankfully though, government guidance and discussions with managers confirmed that, as I was in a high-risk group for severe disease if infected, I should be shielded and isolate. 

Well at least I could be safe; however, isolation was just that, I am living in one room in my house, isolated from even my wife and children. I of course wanted to help, I wanted to do something as part of the NHS family of 20 years, I wanted to do my bit. Unfortunately, due to some issues around IT this became a problem and not possible. It should never be underestimated how work brings normality, and as time went on, life without family and work became less and less normal. Time leaves you to think, and while thoughts can leave you happy, more often can be quite depressive as its only you that can snap you out of it.

I certainly did not realise the effect of being on my own; wanting just a cuddle from the kids but this was not allowed, having to watch them play in the garden and not being able to do be with them. All the things we take for granted now were not possible and this weighs quite heavy on your mind, I think back a few months ago and now it seems the world has tipped itself upside down. 

I was also reminded of when I was having dialysis at home and how I felt quite alone then, as I do now. The thoughts and the emotions came back to me. Some days were better than others, but nothing can really prepare you for the cloud that hangs over you. On one hand I was safe, on the other I longed for normality.

I had some contact from work colleagues and those who I can call my friends, such as Gary, Kirsty and Imogen and it was whilst speaking to Imogen, when I said I am grateful that I am safe but this is heavy going, she replied that, in most instances, isolation was deemed a punishment. This allowed me to accept it was understandable that I was finding my situation so difficult, but I also felt guilt. I felt guilt as I was safe, yet my friends were out there and there were colleagues that had passed away. I felt quite upset hearing of these deaths, all deaths of course, but these were people I knew well, that had been taken far, far too soon. Why? For carrying out their duty, for doing what we all set out to do when joining any NHS trust, to help others. My thoughts and prayers go to each and every person who has lost someone to this dark cloud. 

So how to I cope? I think a lot about how fortunate I am in this. I have support in my family and friends, but what about those who do not have that. No school, no face-to-face contact with family or friends, no workplace, no shopping, no clubs and societies. I am paying this price, I am isolated, but I am not fully alone.

I also try to keep myself occupied, catching up on reading, passing the time with boxsets. I started by watching lots of the news to keep up with what’s going on in the world, but now I try to avoid this, for several reasons; it seems to consume you, and as for watching politicians giving advice across the world, in most instances it’s sensible advice, but in others…, well I will just leave that out there…….

I also hold onto the thought that, as with any darkness, there will always be light at the end of this. I know we can do this, but we need to look after each other and care for our mental health. This does not stop us feeling darkness at times, after all we are all human, but we can stand together. My message is to be kind to each other, to the Ambulance family; STAY SAFE.   


Covid-19 shines a spotlight on inequalities

By Gemma Howlett MCPara, Senior Lecturer in Paramedic Science at the University of Gloucestershire


We have lost more people than I am able to comprehend and there is a sadness that hangs over me whenever I think about it, as I am sure it does many of you. We have lost colleagues on the frontline, and our thoughts are with their family, friends and colleagues. Stand down and rest in peace. I fear by the time this blog is released we will have lost more colleagues in green. Such a devastating realisation and something that no one should even have to consider when they sign up for the role. Thank you for all that you have done and continue to do. Thank you also to our colleagues across the NHS where we have again lost people who were trying to help us all. It is a sad time in our history and one death would have been too many, so the true scale of the loss is devastating. 

Amongst the sadness of this crisis, it is true that we have seen some amazing acts of kindness. Major Tom is just one instance of people doing everything they can to help others. We have seen people setting up community support groups, we have seen people donating generously with time, resources and produce to foodbanks. We have seen the beginning of brilliant initiatives like clap for carers, various community initiatives to support vulnerable neighbours and widespread donating such as food or hotel spaces for NHS staff. Our NHS, postal workers, delivery drivers, refuse collectors, teachers are all continuing to work and keeping the country going during this pandemic. There is lots to make us smile in these horribly sad and distressing times. But the sadness is overwhelming, this crisis has highlighted inequalities like nothing else has done for many years. 

The thing that I find simply inescapable and truly horrifying is the startling inequality that the virus has shone a spotlight on. The longer this crisis goes on the clearer it becomes that with what, and where, you started this crisis, will have a huge effect on how well, and indeed if, you come out of it the other side. This stark social and economic divide, and sections of society having such poorer health outcomes than others is not a society we should accept. Inequality is allowing the virus to sweep through these communities in far higher numbers than anywhere else. There is also a shocking difference in the number of deaths in BAME communities, which is startlingly high, both in the figures for NHS deaths and the wider community. As the news breaks of another death, you see another black, Asian or minority ethnic face. Nurses, doctors care workers, no area of the NHS appears to be unaffected. And then you see the news stories that feature others that have died, those not in the NHS or on the frontline and again the visual is clear yet more people from BAME communities, making up a startling amount of the numbers. The first ten doctors to have died of Covid-19, and two thirds of the first 100 health and social care workers, were from ethnic minorities. That translates to 64% of the deaths being BAME staff members, which is significantly disproportionate as only 20% of NHS are from ethnic minority backgrounds (Kings Fund, 2020).

I urge you all to open your eyes to this, to see these stark problems that exist both within our beloved NHS, but also society as a whole. There is a brilliant Guardian article that I urge you all to read that really highlights this issue. It is called “Coronavirus exposes how riddled Britain is with racial inequality”. The Guardian project that looks to stop and remember each of the health and care worker deaths, a look through the photos a startling reminder of the inequity that we are encountering. The amazing video called “You clap for me now”, urging people to not forget that lots of BAME community and NHS staff put their lives on the line too to help us through this crisis. Enlighten yourselves about these issues, seek to understand what is at play. Ignoring it and believing that everything is okay and equal for everybody is not an option anymore. Help change this path, help ensure that this inequality can no longer exist or thrive, do not let those in power let this matter disappear into the archives of history, but pressure on them to make meaningful change.

This is a systemic problem that is complicated and multi-faceted undoubtedly. But each and every one of us can start to open our eyes and start to accept that this is all our problem. “It may be hard for white people to accept that we are part of the problem. Almost all of the us as individuals will say we are not – It’s other white people, but in reality, we are all part of the problem and we should all be part of the solution” This, from the Kings Fund, reflects what I have written in my articles on diversity in Insight, and I’m sure to write again in further blogs. But the standard you walk past and ignore is the standard that you accept. We must all no longer just walk past. This applies to all inequality and discrimination, we can all be part of the solution, part of the change for the better. 

Stay safe and be kind to yourself and others, and #bethechange

Also read, in the June 2020 issue of Paramedic INSIGHT, Coronavirus, a health inequalities pandemic by Gemma Howlett and Imogen Carter.


HCPC Hearing: A member’s perspective 2019

A member of the College of Paramedics shares their experience of receiving a letter from the HCPC.


Earlier this year I was informed of allegations against me made by a former employer. The relationship had broken down between us so no local resolution could be made. The allegations were forwarded to the Health and Care Professions Council (HCPC).

I was braced for the first letter to land on my doorstep to inform me that the HCPC had received allegations and they were now going to test the evidence to decide if a fitness to practise hearing was indeed needed. The letter stated at this time I could continue to practise unrestricted. I informed my current employer as advised in the letter. 

Nothing could have prepared me for what happened seven days later.

A second letter landed in the morning and I did not read this until the evening after I returned home. It stated that, on the basis of the seriousness of the allegations, the HCPC had seen fit to request an interim suspension order. 

I was devastated! How would I work? How would I feed my family? My reputation of 20 years would be tarnished for ever. I would be humiliated and the source of ridicule.

I contacted the College of Paramedics, of which I am a full member and have been for several years. I was not prepared for the next few minutes, hours or days.

As soon as I contacted the College, I was given names of responsible people who would support me through the process and recommended to phone the legal helpline.

I dialled and left a message. Three hours passed and I called again and got through to the legal team.

They listened for half an hour and advised me of the next step. They would have to speak to the College before confirming they could act on my behalf.

Hearing my concern, they referred me to The Ambulance Service Charity (TASC). 

No sooner had I hung up from the Legal helpline I had a call from an Advisor at TASC who turned out to be a godsend. She reassured me that they would step in and help me with whatever they could, financially and emotionally. My grief turned to shock at the kindness of a charity I had never heard of before, but they were to be there to support me and my family.

A day later I was informed that the College would provide me with legal assistance. 

I did ask myself just how they would manage this as I had only six days, including the weekend, before I had to appear before a HCPC hearing.

The phone calls and emails were coming quick and fast and involved evidence gathering and the background information needed, not to mention a CV, CPD and testimonials.

I was informed on the Monday, with 48 hours to go that the College were not only providing me with a solicitor, but also with a barrister to defend my case.

On the day of the hearing I met the team in a small room at the HCPC Tribunal Service in London and we poured over every angle of the case. They asked points that I would never have thought relevant or necessary with the result when I went to the hearing that afternoon that I felt protected, represented and heard. I said nothing but to confirm my name.

Everything that needed to be said was said by the QC representing me. The result was no interim suspension nor any restrictions in practice. The relief brings me to tears even now.

You would never go into a situation without your Personal Protective Equipment (PPE) be it helmet, hi-vis, ballistic protection or even gloves. If you are practicing in our field and you do not have the protection of OUR College, you are operating without some of the best PPE.

I thank the College of Paramedics for their swift action through which I was provided with a fantastic legal team who protected me and my family when we needed it most. 

Please join our College and strengthen it as the main voice for our profession, so that when and if you ever need them, it will continue to be the strongest support available for both defence and advancement.

Name and position withheld for purposes of anonymity

Factors affecting the retention of paramedics within the Ambulance Services

Liz Harris FCPara, Head of Professional Standards for the College of Paramedics writes a short blog based on the presentation she delivered at the Association of Ambulance Chief Executives, Ambulance Leadership Forum in March 2019 detailing the findings of a study on ambulance service retention carried out in 2016.


The methodology for the study included a Literature Search, a review of several national publications and a selection of Human Resources Management texts. Specific data from four sources of secondary data was also used, including the College of Paramedics Recruitment and Retention survey conducted in 2015 (unpublished). This survey had 977 responses of which 238 were from individuals who had left an Ambulance Service in the preceding 24 months. 

Four key themes emerged that could potentially impact on an individual’s intention to leave their employment: 

The College of Paramedics survey asked what would contribute towards the ability of ambulance services to retain existing staff? Improvements in career progression, training and access to continued professional development were mentioned by the highest number of respondents. The lack of training and development has two main consequences; Firstly, paramedics are leaving to pursue development and new opportunities outside of the ambulance service, which is reducing the qualified and experienced workforce numbers. Secondly, the paramedics that remain are experiencing a change to the type of workload that they most consistently experience but are not historically trained to deal with, this without any ongoing training and development is negatively affecting their confidence and job satisfaction. 

Paramedics take a great deal of satisfaction from the job that they do and are proud of the care that they can give but the intense pressure, increasing workload, including shift over-run and shift patterns also left them feeling exhausted. Mopping up was mentioned, when other areas of the NHS are struggling, the Ambulance Service always responds and attempts to pick up the pieces. This leads to a feeling of ‘lack of respect’; being undervalued. Another challenge was mentioned, that some paramedics had come to the conclusion that dealing with and coping with difficult and/or mediocre colleagues had just become a way of life and to a certain extent accepted as the way it is. It was better to keep your head down and keep off the radar that raise concerns. A move towards peer review and supportive clinical supervision that allows a safe space for positive sharing of experiences and learning would have beneficial effects on staff’s work experiences. Communication was mentioned frequently in the literature and from all the data sources, poor communication was at the top of the list for workplace features that were reported most frequently as having a negative effect on staff’s well-being.  Email communication seemed to be the preferred method used by employers, but this was not at all sufficient and there was no time for operational staff to read them. Only 12% of staff reported having good communications with senior management.

Lack of management support was the reason given for leaving an Ambulance Service by the greatest number of respondents in the College of Paramedics survey. Unsupportive management was one workplace feature in particular that had the most significant detrimental impact on staff well-being. Historically management within ambulance services is geared towards vocational ambulance staff that has stayed within the same service for their whole career. Now new paramedics join ambulance services directly from academic institutes, they are young and a more mobile workforce, with less loyalty towards their employer. This change in workforce represents a challenge for some existing management cultures within ambulance services. Staff reported that promotion occurs ‘through the ranks’, with a focus on achievement of performance targets not on delivering clinical quality. An additional complexity is the expanding clinical and professional context and the increasing autonomy of the modern paramedic clashing with traditional command and control management cultures. A lack of formal management training may contribute to what is perceived as inattentive behaviours of managers and a lack of employee engagement. 

Much of the Human Resources Management text discusses pay and the impact of salary on retention at length, but the evidence in the papers, reviewed within this study, specific to emergency personnel suggests that pay only becomes an issue when other aspects of the job are impacting negatively upon the individual or when job satisfaction is low. Pay, was highlighted in the College of Paramedics survey as a reason for leaving and as a potential tool for retaining existing staff. Evidence from Australia indicates that the new graduate paramedics will seek out employment that suits their professional aspirations and their personal needs such as flexible hours and adequate pay. It is therefore necessary to get pay appropriate for the role, but the benefits will be short-lived without improvements in the other three key themes discussed within this study. 

To conclude…
Job satisfaction has been high for paramedics for many years due to the nature of the work, and pride in a job means that people tend to stick with it. Now, however, it appears that the negative impact of some of the other issues are having an effect on how paramedics feel about themselves, their work, their role and their employer. Paramedics often rely upon camaraderie to reduce the innate stresses of the work but due to the increasing workload and changing work practices this coping mechanism is now in short supply. Moving from an environment where underachievement of performance targets is constantly highlighted with blame apportioned, to a culture where learning is shared and people and positives are celebrated, would greatly increase staff satisfaction and wellbeing, and potentially subdue any intention to leave. Arguably Ambulance Services have relatively little influence on the external pull factors that cause paramedics to leave but can certainly work towards reducing the internal factors that push paramedics towards the exit, in particular by investing in their staff’s wellbeing and ongoing professional development. The impact of managers on staff wellbeing and their desire to leave an Ambulance Service should not be underestimated. All the findings within this study highlight a situation that links unsupportive managers with dissatisfied staff. This is a key point, not least because supporting managers to improve their knowledge, skills and behaviours is within the capability of all Ambulance Services.

Liz Harris
Head of Professional Standards, College of Paramedics

#itsoktotalk about Mental Health and Well Being

Andy Elwood MCPara shares his personal experiences of mental health.


I’m no stranger to testing times and traumatic incidents after 20 years in emergency services, beginning in Northern Ireland Ambulance Service, but mostly as a paramedic on search and rescue helicopters. I have also served on the RAF Medical Emergency Response Team (MERT) battlefield helicopter in Afghanistan. I have experienced the full range of emotions from euphoria, after risking my own life to save another, through fear during a flashback and the depths of despair when attending many suicide incidents. I have been affected by the cumulative effects of my career, but even more so by the growing pressures of 21st century living in my personal life.
I have learned resilience through my military service and search and rescue career, but my mental strength has been tested most in my personal life through divorce, bereavements, building my own business in my spare time, whilst also changing full-time employment and multiple home relocations.

I became a mental health campaigner in 2016 with a video campaign online, which involved the coastguard helicopter and other 999 services doing press-ups. Our final video broke down some stigma around mental health, with over 45,000 views, but what was really important for me was that I didn’t feel alone anymore. The widespread support from other 999 colleagues made me realise that depression, anxiety and stress were just as common for 999 personnel as for wider society. 

TaIking has been an incredible help to me at critical points in my life. This has allowed me to share the burden of my worries and fears, gain another perspective, see a way forward and realise that I was just being human. This worked for me when I spoke to a psychiatrist after a traumatic incident, during which a patient vomited blood into my eyes and mouth; and also when I talked to my wife after having a flashback to a patient in Afghanistan, five years later, whilst on holiday in France. 

My bravest move v’s Self-Stigma
The largest stigma I have had to overcome, however, was my own self-stigma, when I spoke to my GP last year and admitted I needed some time off work. Burnout had led to depression and a loss of my self-esteem from the cumulative build-up of life stressors since childhood through the Northern Ireland ‘troubles’ and caring for elderly relatives, bereavements, moving home, new job with promotion and running my own business in my spare time. 

The bravest thing I have ever done in my life was to take time off work to rest, reset and then rebuild myself!
I now believe I will save more lives through mental health campaigning, sharing my experience that #itsoktotalk and by delivering Mental Health First Aid training, than I would if I was still dangling under a helicopter, as a paramedic.

Early warning signs
Have you ever noticed any of these in yourself or a colleague?
Irritability, aggression, tearfulness, inability to concentrate, indecision, loss of confidence? Perhaps this could be coupled by increased consumption of caffeine, alcohol, cigarettes or sedatives and some unplanned absences from work… 
Many of us may experience some of these feelings occasionally, which is normal. However, when these feelings start to affect someone’s participation in everyday life or their ability to function safely at work, then we should reach out with support. Mental Health First Aid is just as important as physical first aid. Would you know how best to approach a colleague or loved one, assist them in a crisis and listen non-judgementally?

Simple tips for improving your Wellbeing
I take a minute each morning and evening to note 3 things I’m grateful for, which gives me a positive focus at the start and end of each day. This allows me to focus on what I have, rather than what I am missing. I have an object on my key ring which also reminds me to be grateful during the day, if I’m feeling low. 
Try it and feel the difference yourself.
I also recommend the Five ways of wellbeing, based on research and recommended by the NHS (1), as a simple guide to improve your mental strength and wellbeing by realising it’s important to: 

-Keep learning
-Take notice
-Be active

The beauty of these simple categories is that you can tailor them to suit yourself and what you enjoy doing. I love the outdoors and nature, so meeting a friend for a walk or bike ride enables me to connect, be active and take notice of the beautiful countryside as we chat and enjoy ourselves. Giving can be as simple as sharing a smile with a stranger… it’s surprising how infectious smiles are, in a good way! 
To keep learning, I have challenged myself to make a short film about a trip, in my classic Land Rover, (#AndysLandie blog) around Scotland this summer to assist the introduction of the UK Search and Rescue Wellbeing & Resilience framework for Mountain Rescue Volunteers in Scotland. I’ll be meeting some amazing people on the journey and some of them are joining me to talk about wellbeing and mental strength from my passenger seat, which will be part of the film. Please get in touch if you’d like to be part of the film or if you’d like to invite me to your base as I journey from the Peak District to Scotland.

Work brings a lot of health benefits through a sense of purpose, fulfillment, being part of a team, especially in our line of work. However, mental ill health is usually caused when pressures at work become more intense, coupled with factors outside work; eg. financial pressures, relationship problems, greater caring responsibilities from an ageing population etc. If the workplace is not supportive at this stage, then mental ill health can be triggered into common conditions such as depression, anxiety or stress-related disorders.

Organisational culture can change for the better, as Mind Blue Light Programme (2) recently highlighted with these research key findings from their targeted support:

-staff improved their mental health, resilience and confidence to seek support
-managers & trainers had more confidence supporting staff in difficult situations
-stigma and lack of awareness still exists, but is improving
-sustained change requires practical investment, commitment, enthusiasm at all levels

Why not do something positive to start the conversation on mental health where you work? Or perhaps you could share some of this information with a colleague to promote some wellbeing in team999?

I’m part of the Paramedic Mental Health & Wellbeing Steering group for the College, a Mind Blue Light Champion and I write a blog called ‘Andy’s Landie’, which discusses Mental strength and Wellbeing. 
You can follow me on twitter and Insta @4ndyElwood
Stay wonky and remember #itsoktotalk
1. Five ways to wellbeing. New Economics Foundation. 2008. 
2. Mind Blue Light Programme Research Summary 2016-18. London: Mind. 2018.

Mental health crisis and the emergency services - Helping you help me

Liv Pontin, a service user in mental health shares her experiences and contact with the emergency services.



From 2016 to 2018, I experienced a long period of mental health crisis, with multiple experiences of contact with police officers and paramedics, including being detained under the Mental Health Act and on one occasion receiving CPR from police. This article is based on a blog post I developed to share some thoughts on what can help from the emergency services attending to a person in mental health crisis.

We’re here to help”
Firstly, even if you are with an individual who has been in crisis before, emergency service involvement is terrifying. I fear being in trouble, I am terrified that you think I am attention-seeking or wasting your time. Please reassure me that you are here to help me. Remind me that I am not well. This may seem obvious, especially if someone is diagnosed with a mental health problem, if you ‘know’ somebody who you see regularly, or if somebody is clearly distressed. But in crisis, we can lose insight. Please keep reminding me that this is my illness talking, and that I need some help to get well again. I may need to be told the same thing multiple times in order to take it in, but it does stick with me later.

Self-harm and suicidal thoughts
Self-harm and suicidal thoughts/acts are generally not attention-seeking or ‘cries for help’. For many, they are deeply private and shameful, and even for those cases which are ‘attention-seeking,’ serious help is still needed if someone is turning to harming themselves. ‘Attention-seeking’ is not in itself necessarily a bad thing. We all desire human contact and interaction. Whilst many can communicate effectively with words, others may not be able to do so and may communicate their distress in other ways. We never know what has brought a person to that point, and those who need medical treatment as a result of a mental health problem deserve the same care, empathy and treatment as anyone else.

Suicide may seem objectively ‘selfish,’ but to a person in that state of mind, it often seems like the only option. Please do not try to make me feel guilty. Having said that, talking about the impacts on others – including the police or paramedics who are called out to deal with this – can be a very effective way of halting the intention to act on these immediate urges for some.

And thirdly, please do not ever tell somebody that ‘If you really wanted to die, you’d have done it.’ It is not the case, just as it is not true that ‘Truly suicidal people don’t talk about it.’ Sometimes it simply means that somebody is taking every step to help themselves. I have always promised that I will do everything I can to avoid acting on my thoughts. It doesn’t mean I didn’t want to die at those times. But I didn’t want to want to die.  

What it can help to say
In emergency situations it can be tempting to deal with things as quickly as possible and move on. But in mental health crisis, adopting a slower pace, being patient, taking the time to listen, understand and build up trust helps. That rapport is so important. Use that rapport as much as possible: for example, allowing the person who has got that rapport to accompany the individual in the back of an ambulance or to explain decisions.

One thing that can really help to build a rapport is just to talk about ‘normal’ things. We all have likes and dislikes, hobbies, interests, a sense of humour. These are the things that make us who we are, but sometimes it is hard to remember them in crisis point. Where appropriate, use your sense of humour. If you can make me smile, you have got me engaged. Remind me that there is hope, that I have a future and am a worthwhile person. Where appropriate, self-disclosure can also be beneficial. A lot of people suffer from mental health problems at some point, and it is so reassuring to know that people can get through these and find something they love in life.

Two of the most helpful phrases I have heard from police officers are ‘Focus on my voice’ and ‘I’m not going to let you hurt yourself.’ The sound of a calm, caring, firm and direct voice can help me to feel safe and grounded, to listen to your voice and to know that someone is in control of the situation. 

Please try to give me options where appropriate and try to guide me towards making the ‘best’ choice. However, please also be aware that at times I am so consumed by my illness that I need you to take control away from me and make the best decision, even if I can’t see it at the time.

And finally, always remember the difference you make
The impact you have will stay with someone forever. I know at times it is frustrating for you, particularly if there are repeated incidences and nothing seems to be happening as a result, and particularly where the system is clearly failing. It may take time for me to get well. It is likely to be a slow journey with many ups and downs. But you are making a difference. I will remember the care you provide to me, be that good or bad. The words you say will stay with me forever. And I cannot put into words how grateful I am to you. 

We are deeply saddened by the tragic news about Liv Pontin.
Only recently Liv chose to write a powerful & emotive piece for us to help paramedics and those experiencing difficulties with their mental health. For this we are extremely thankful. Our sympathies go to those that knew her.
A JustGiving page has been set up in her honor.

The College of Paramedics is thankful and honoured that Liv has shared her story and insights with our members in this article.

For anyone needing support or advice:
The Ambulance Service Charity 
0800 1032 999 

MIND Blue Light Infoline 
0300 303 5999 (local rates)    
Text: 84999

24-hour helpline: 116 123

British Association for Counselling and Psychotherapy (BACP)
01455 883 300
For local practitioners

Cruse Bereavement Care
0808 808 1677

Rethink Advice And Information Service
0300 5000 927 

My Mental Health and How I Manage it

Gary Strong MCPara talks about his experiences of mental health and what he does to manage it.


In my family history, there are persons who have suffered, and continue to suffer mild, moderate and - in one case - severe mental health issues. Apart from the severe case, much of this was never diagnosed. As children we were told that such and such a person was ‘bad with their nerves’. My parents’ generation didn’t talk about such things, which only made matters worse. I guess all this puts me ‘at risk’. 

This didn’t even occur to me when I joined the ambulance service and applied to become a paramedic. But after some years of being out there ‘on the road’, I came to realise a couple of important facts. Firstly, there are many, many families that have to contend with mental health issues on a daily basis, and some of these issues are utterly soul destroying. If I am at risk, so it seems is much of the population. Secondly, being a paramedic can be good (as well as bad) for my mental health. Let’s put it this way: in what percentage of the calls we attend is there somebody there who is really pleased to see us, and very grateful for all we have tried to do? The gratitude of patients, families and the general public, in my experience, far outweighs the abuse we get. 

These days in practice, when I frequently find ways of keeping folk out of hospital, it seems to me they are even more grateful! All this is psychologically positive and has a great impact on my personal sense of well being. We all need to be ‘stroked’, say the psychologists, and alongside this positive affirmation, there is a great deal of job satisfaction in making a good referral. But what of the downside of the job? Maybe I’ve been lucky over the years. Compared to some of my colleagues, I haven’t seen too many mangled bodies, and the biggest major incident I’ve ever attended was a county-wide flooding which went on for a couple of weeks. But those severe mental health incidents in the middle of the night, they unnerve me. They are just a bit too close to home sometimes, which leads to another important realisation: we are all vulnerable over something. In some ways, to do this job, you have to harden up. If every messy injury or sad social situation gets under your skin, then you are probably in the wrong job. But no matter how strong you are in yourself, you are human, and there is always the risk that one incident you attend will find your weak spot and hit your mental health where it hurts. Fortunately, nowadays, it is ok to say that you are not ok. 

For the many paramedics who move ‘off the road’ into another role, the risks to your mental health start to appear from other directions. In primary care, the patient that turned up late with a seemingly intractable problem, when you were already feeling mentally drained, well they may have left your clinic, but they just won’t leave your head. In education, it might be the pressure to take on more students or inflate grades. In management, you can have a great day, successfully completing the tasks you set out to do, then that one little email on top of all the others, whoever it is from, whatever it is about, that’s the one that punches a big fat hole in your resilience and wrecks you for the rest of the week. What do you do about all this? What do I do about all this? Think back...what is the first thing you are taught to do when approaching a scene? ‘Check for dangers.’ If you don’t do this, you may become a casualty and then we have a bigger problem. But how many of us check for dangers in our own lives? 

These days I am much more aware of the dangers, and there are a few things I do that might be termed ‘preventative medicine’. They could equally be called: ‘switch off, focus on the positives and enjoy life!’ I love playing guitar, mostly bass guitar, and although I am not particularly proficient, playing in a band means having to concentrate and forget about work for a while, and being a paramedic helps in some ways: if I play a few bum notes, or we have a bad gig, well, well nobody died did they? After all, it’s only rock’n’roll. Recently I have been learning to sail dinghies, and again, I have to concentrate, or I am going to fall into the river. Most importantly, for all I said about mental health issues, I have some very positive relationships with family and friends, and here’s a tip: no matter how much you love this amazing profession, make an effort to keep up with your friends outside of work. They will still be with you when work becomes a thing of the past, and they will help to keep you sane. Finally, for me, there is a lot to be said for having an energetic dog. Like most of my patients, he is always pleased to see me, and on a miserable wet days like today, he insists I get some exercise! 

Gary Strong
National CPD Lead (Education), College of Paramedics

A Personal Account of Mental Health

By Rory O'Connor MCPara, Northern Ireland Trustee and Paramedic with Northern Ireland Ambulance Service.



Mental health and wellbeing are important topics both for the wider public, but also for members of the paramedic profession and wider health services. Unfortunately, an online poll carried out by MIND in 2016 found more than one in four (27%) people had contemplated taking their own lives due to stress and poor mental health while working for the emergency services, while nearly two thirds (63%) had contemplated leaving their job or voluntary role because of stress or poor mental health. This is allied to the fact that the Office for National Statistics has found that the paramedic profession has proportionally one of the highest rates of suicide.

Behind each of these statistics there are personal stories and experiences. For some, years of working in and dealing with hugely traumatic events can cause a gradual deterioration in their mental health, and for others single traumatic events can trigger a crisis. 

I have been working as a paramedic on a double crewed ambulance for six years. In this time, as is relatable to most of my colleagues, we unfortunately can experience events and situations which are tragic, traumatic, stressful, upsetting and on occasion all of these.

We all have our own experiences and thought we can turn to when our colleagues mention ‘bad cases’. But, whilst the causes are diverse, our experiences I have found are shared, acute and unique to those who work in a frontline ambulance.

After attending several ’incidents’ in a short space of time, my mood was low, I could not sleep, I was irritable with family and friends, had no time for my children whom I love, and became more introverted and closed off. However, I am a paramedic and this is what we do, so I soldiered on and continued to work. This was most certainly the wrong decision, but it is a decision many of us make in the profession for exactly the reasons I have outlined. I thought, this is the job, I need to be tougher, I need to keep going, this is what we signed up for and I need to just keep going to work and eventually everything will be ok. Whilst this is my own personal experience, and this how I rationalised going to work day after day whilst on the verge of mental breakdown, I have learnt and can assume that my reasons are not uncommon amongst ambulance staff who continue to go to work even when being acutely impacted by the work we do.
I had not recognised that in fact I was in the midst of a mental health crisis and was barely functioning on a day to day basis. I marched on and kept going until I had one bad incident too many and couldn’t march on and go on any longer. It all caught up with me like a tsunami and I ended up home from work in the middle of a night shift completely broken.
Once I could not go on and made the decision to go home from work, I experienced crushing lows which I had never experienced before. Day after day of struggling to get out of bed and go on. I sought help via the external counselling service offered by my employer, but initially found this of little benefit as I was not placed with a counsellor with any understanding of our job or how it can impact on us. Eventually, my extremely supportive line manager arranged counselling with a specialist trauma counsellor who recognised that I was suffering with PTSD. It was not PTSD like the movies, it was how we experience it in real life. Flashing images of tragic events, not sleeping, lucid memories of awful scenes and incidents, things that I thought were long in the past and dealt with coming back and causing me to doubt myself, my profession and my ability to ever do the job again.

Thankfully, the second counsellor I attended was fantastic. It was difficult confronting my issues, but with a wonderfully supportive family and appropriate help I did so, and managed after an extended period of sick leave to go back to full operational duties.

I work and feel comfortable being back at work. However, I am not the same paramedic or man that I was prior to this. I feel like I carry my experiences with me every day, and some days are good and some are not, but I am acutely aware of the warning signs and dangers of my own mental health. 

My advice is, we are not super human. We should not soldier on. We should not keep on going regardless. Don’t just say this is the job and I have to do it. Don’t feel worthless or like a failure. Don’t worry what anyone else will think, you will find that almost all of your colleagues will be supportive, understanding and will want to help you. If you need it, get help. Get help from your employer, from your GP, from a confidential service, from any service you think will help. But ask for help, and if you don’t feel like it helped the first time ask again.

For further support: 
Blue Light Infoline: 0300 303 5999
Or, the Samaritans: 116123

Rory O'Connor
Trustee for Northern Ireland

Grief, a Personal Journey of my Mental Health

Bob Fellows FCPara gives a personal account of his journey with mental health.



It has been said that grief is the sudden breakdown of your life as you know it and then the challenge of trying to pick up the myriad of small pieces to be able to put your life back together or at least try. My grief didn’t start on the day of Helen’s death, it was already underway when I knew she was very ill with cancer. Some short-term false hope was offered by a hospital Doctor who told us it was eminently treatable by a hysterectomy, sadly not so. MRI and CT scans stated that it was so advanced it had escaped into the rest of her lymphatic system and across into her lungs. The shock of being told the final diagnosis immobilised me, yes, I was speechless, stunned, angry, who could I blame, who could be held to account. We clung to each other in a hospital corridor. Sod it, why us.

When you tell people, they say they are sorry, why? are they to blame? Reality is that we don’t know what to say to people. I didn’t even know how to tell people, let alone my children. So, the next question is, how long do we have? What treatments will make a difference? Who gets to decide?

Whilst all this is going, on you start to crumble, you cry, you struggle to exist, it’s all oncologists and discussions related to your journey into the dead. Did I handle it well? I don’t know, I made myself busy and very few people could get close, even Helen started to shut down. She cried the day she was told at the hospital and I only ever saw her cry once more. She was a woman with a very strong Christian faith, and she was fully convinced she would die, and her spirit would go to Heaven leaving the rest of us to deal with the discarded body via a ceremony and a disposal, her choice a cremation.

I was primary carer and my paramedic background gave me no preparation and, I am sad to say, I was soon so tired, I just wanted to sleep. Could I have handled it better, probably. Fortunately, the diagnosis to her actual death was 56 days, that is less than 8 weeks, the final three days were in a hospice.

It was only after she had died, did I truly let myself feel, I kept people clear as my broken mind was too intimate to share. I was still me, despite my mental health being shot to pieces, I wasn’t ashamed, I was just totally numb. I spent hours walking my dog trying to make sense of it. I wanted answers, I wanted to understand why, what had we done to deserve this. I briefly considered what it might be like to die and join her. Does that make sense, not if you consider it from the point of my children or my friends or even my dog. Death was not an escape, it was not an option, well not for me. I never took sleeping tablets or went on to antidepressants, I knew the journey ahead was very long, I needed to be fully awake. Not that I slept very well, alcohol suppressed some of the silence. I would cry at music, pictures, memories, I’d even cry at the loneliness and the emptiness of just being on your own. Deep down I was angry.

The funeral was tough, but necessary. I chose to speak, and I allowed anybody to speak who wanted to. Yes, it was in a church, yes it was very full and yes there was singing and a message of Helen’s faith. But it was a celebration of her short life (55 years) and what a joy she was to so many. Did it comfort me, no. But it wasn’t about me.

So, is my ongoing, but fading grief a temporary mental health condition, is it a form of depression. Do you know? Well I don’t care, I don’t want to know. It just crushed me for a season. How long was my season, is it over yet? Well I am scared, but no longer crushed, am I sad? Well sometimes, am I over it? I don’t know, what am I getting over? Please don’t tell me its early days, how would you know. Most of you haven’t trodden my path and even if you have experienced something similar, maybe you had it worse than me or maybe it had less impact. Don’t try to fix me, just be my friend, listen to me if I want to talk, laugh with me if I am laughing, don’t tread on egg shells near me, they are small fragments of me, its ok.

There is a sacredness in my tears, a silent language of grief and no pain is a great as the memory of joy in the present. I have three chairs in my life, I put them in a row. One represents the past, one is the present and one is the future. Did you know how uncomfortable it is to try to sit on two chairs at the same time. In the early days of grief, the present is too much so you sit in the past. Practically, you must switch to the present and then go back again for memories, tears and the experience of personal loss and pain. Funnily enough I can only measure the pain in the present. I avoided the future for a season (whatever that season is for you) and now I have spent a lot more time in the future planning a new season. I still have all three chairs, I will never get rid of them, they are part of my past, my present and a new hope in my future. My faith sustains me, it is stronger than ever.

I am not ashamed of my story, I hope it inspires you and gives you hope for your future.

Bob Fellows FCPara
Head of Education, College of Paramedics 

Stroke Mimics or Are They?

Sue Newsome shares her experience of her father being mis-diagnosed with a Stroke Mimic


My Dad had a Stoke on the 15th of June 2015, a date that will be forever etched in my memory. Dad phoned me and said ‘Sue I’m scared I’m having a Stroke, I know because I have watched the adverts on TV’. ‘My vision and my balance have gone’. Dad sounded petrified and his speech was slurred. I told him I would phone his neighbour to sit with him and I would call an ambulance and then head over. I live in Stockport, Dad lived in Huddersfield. I explained all of Dad’s symptoms to the call handler and then set off to Dad’s. I arrived at Huddersfield A&E about an hour and a half after Dad’s call. I had several missed calls from my partner so I phoned him. Paramedics had contacted him to say that they didn’t feel there was any reason to take Dad to hospital as he wasn’t having a Stroke. I was shocked and phoned them as requested at Dad’s. They informed me that he wasn’t having a Stroke, I explained that I thought that he was from his description of events, but I would leave the hospital and meet them at Dad’s. This was to be my first mistake. When I arrived at Dad’s he was confused and disoriented and his speech was slurred. They asked if he always spoke like that and I explained he didn’t. They told me that Dad was FAST (Face, Arm, Speech, Time) negative despite me reiterating Dad’s earlier description of his symptoms. I explained Dad was Diabetic and they told me he had AF as they had carried out an ECG. I would subsequently find out that these were both ‘Red Flag’ indicators to consider a Stroke. I was told Dad didn’t want to go to hospital, Dad never said this to me. Can someone who is confused and experiencing a Stroke be considered to have capacity? I reiterated I thought Dad was having a Stroke several times. I was asked to stay with Dad overnight and call his GP out the next day. This was to be my second and fatal mistake. I agreed to this reluctantly. Dad’s confusion worsened, I called his GP the following morning. He came out took one look at Dad and said he wasn’t right and he would arrange for Dad to go to the Stroke Unit immediately. I drove Dad to Halifax where his scan revealed he had experienced a Stroke. This led to Dad developing Vascular Dementia and dying after 15 months of devastating declining health. 

I am aware that there is some recent research into adding Visual and Balance disturbances into the FAST diagnostic assessment and I am keen for this to be developed. Had this been part of FAST when Dad experienced his Stroke the outcome for him could have been very different.

I would also like to discuss the current trend in Stroke research. I am aware that current research patterns to identify effective Stroke Pathways are focusing on ‘Stroke Mimics’. For the majority of people and HCP’s this is a positive step facilitating effective identification and ensuring the most appropriate care pathway using accurate clinical diagnostic tools. This therefore enables the person to be conveyed to the correct hospital or Regional Stroke Unit. It ensures the most effective use of limited specialist Stroke resources. 

Conversely to balance out the effectiveness of identifying Strokes and teasing out the Stroke Mimics there needs to be research conducted into the percentage of people who are identified as Stroke Mimics but are in fact having a Stroke. What is the cost financially both to them and to the NHS for their post Stroke care.  Also, the impact on personal lives and on families from a misdiagnosis. Effective diagnostic tools are essential if these Strokes incorrectly diagnosed as Mimics are to be minimised. The FAST test is not a fool proof clinical diagnostic tool and some Strokes aren’t identified using this diagnostic criteria. 

My concern is whilst the emphasis is on identifying Stroke Mimics is there going to be an increase in missed Strokes because they aren’t identified using FAST and are deemed FAST negative and consequently don’t receive treatment at a Regional Stroke Unit. As Stroke treatment is time critical there is very little time to waste. From personal experience misdiagnosing a Stroke as a Stroke Mimic has devastating life changing consequences. I would respectfully ask all paramedics to listen to their patients experiences carefully and their families accounts. I didn’t feel that Dad or I was listened to. It was ultimately my decision to agree for Dad to stay at home on the paramedics advice. This is a decision I will bitterly regret for the rest of my life. Had Dad been taken to hospital he may have been suitable for a Thrombolysis and his last 15 months of life would not have been experienced the trauma of Vascular Dementia.
University of Kentucky. "Study supports change to FAST mnemonic for stroke." ScienceDaily. ScienceDaily, 23 February 2017.

BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Aroor S, et al. Stroke. 2017. 

Sue Newsome

I’ve seen terrible things as a paramedic. The worst isn’t what you’d expect

Liz Harris FCPara talks about the worst thing she has seen as a paramedic


What’s the worst thing you’ve ever seen? Ask any paramedic and they will have been asked this question many times over in their careers. I’d never given myself time to properly think about the answer, until recently.

Is it having my fingers in the back of a teenage boy’s brain as my colleague and I lift his limp bloody body into a bag after he had flipped over his new car on a dark country road?

Is it looking upon a small, wafer thin, dead child curled up on her Cinderella duvet after drinking her parents’ medication that they use to help with their addictions?

Is it the elderly man whose closed curtains had gone unnoticed by his busy neighbours while he lay decomposing into his own carpet?

It is none of these.

My answer starts at 6.10am one morning many years ago with a callout to an elderly man who is struggling to breathe.

We arrive at a slightly neglected bungalow where a frail elderly figure limps slowly to the door and greets us with an apology – she didn’t want to bother us. Her husband is slumped in the front room. I know he is not well and he needs to go to hospital. Mavis*, the woman who answered the door, is visibly shaken on hearing this news but she finds solace in starting preparations for her beloved husband, Bert, to leave for hospital. He needs clean pyjamas and a toothbrush, and after fondly rubbing his chin, he will need his razor too.

I give Bert some oxygen and start to think that if we don’t get him to the ambulance quite quickly he will collapse. Mavis returns tearful with her husband’s belongings. I talk to her to try to convey the seriousness and urgency of the situation. Bert is stoic in his responses, telling his wife he will be fine, but he is kind too, reminding Mavis of how much he loves her. Mavis is proud, they have been married for more than 60 years, she says, as she ambles away again.

I look around the room at faded photos of many generations of their family. Bert tells me they are all dead now, even their son who died young. I talk with him and reassure him that we will be going to hospital soon. She is the love of my life, he says, between tiring breaths; there has never been anyone else. I remember his soft slow words perfectly and the telling look in his eyes – he knows he is not coming home again. I worry that we are taking too long. Bert needs to be in hospital quickly; I don’t want him to die in my ambulance.

Mavis is elderly and frail herself, and accompanying her husband to hospital isn’t an option. I worry there is no one to come to help her when we are gone. My haste to get Bert out of the door and to hospital is abruptly subdued by the realisation that this is most probably their final moment together; they are about to say goodbye to each other for the last time.

I try to convey the gravity of the situation to Mavis. I think she finally understands when her eyes fill up. She limps back towards Bert, who is still protesting to her that he will be fine. Her hands cup his cheeks as her small stooped frame leans forward to give him a kiss. I pause momentarily, trying to be invisible, and then ask quietly if we can go. Mavis delicately flattens Bert’s hair to one side of his head, smiles at me and nods her head. I ask Bert if that is OK and he smiles and nods too.

Bert died later that day and I spent a lot of time wondering what happened to Mavis. I knew that I had cared for Bert and looked after him well, but I had deserted Mavis, I had left her all alone. I toyed with the idea of visiting her to check up on her. This felt right in many ways, but wrong in others too. I didn’t know what to do. I had prioritised Bert’s care but in doing so neglected what Mavis needed. I was left feeling I had failed her in many ways.

When thinking about my answer to the “What’s the worst thing you’ve ever seen?” question it didn’t take me long to remember this job, even though it happened many years ago. It is the job that I most agonised over. It is the job that stayed with me for the longest time after it was over. You might think it can’t be the worst thing I’ve ever seen, but it is definitely the worst thing I’ve ever felt.

I never did go back and check on Mavis.

Liz Harris
Head of Professional Standards, College of Paramedics

Paramedics Need Degrees? Why?

Richard Taffler MCPara discusses whether paramedics need degrees.

06 04 2018

On the 4th July 1996 I joined Royal Berkshire Ambulance Service (RBAS) as a direct entry technician, or trainee assistant paramedic as we were called by RBAS. Six weeks of ambulance training, three weeks of driving, a week of local training and I was out on the road responding to 999 calls. My first shift was at Henley on Thames and the only job we went on that night was a murder . . . . I’d never even seen a dead body before, let alone someone who had been killed! 

In my first (trainee) year I was asked at least three times by my mentor if I was sure if this was the right job for me. I was hopeless at talking to patients (well almost anyone) and the old boys (and girls) frequently commented that this was because I hadn’t served my time in PTS before becoming part of the 999 team. They were, however, very supportive, and helped me to survive the first few difficult years in such a challenging job. 

A year later I started my 12-week paramedic course and qualified as an IHCD paramedic around 18 months after that first fateful shift. At that time a training officer turned up on the last Friday of your a & e placement, shook your hand and handed you a set of paramedic epaulettes for you to wear on your next shift! I think I was just about safe, clinically, but it was about 5 years into the job before I felt remotely comfortable talking to patients. 

In those days, the only career pathway for a paramedic was within the ambulance service who also didn’t accept any non-ambulance qualification as any indicator of clinical or other competence. A career for life, or at least until your back gave out…

In the following 17 years I have completed a MSc in Advanced Healthcare Practice, spent 5 years in clinical management before returning to operational ambulance duties and was a clinical representative on the College of Paramedics Post Graduate Curriculum Guidance Group. I have three jobs: Specialist Paramedic (Urgent & Emergency Care) for South Western Ambulance Service NHS Trust, an Advanced Paramedic for Devon Doctors Ltd (our local OOH primary care provider) and I’m also joining the RAF reserves as a paramedic. And I think I’ve learnt how to talk to patients too.

There has been a lot of discussion, particularly on social media, about the HCPC’s announcement that they are soon only going to register new paramedics who have a degree, and is this a good thing for the profession? Surely, it’s people skills that are more important? So let’s discuss this, and I’d like to state that these are my opinions, not my employers’ or those of the College.

The paramedic profession is only about 30 years old in any form that we’d recognise today and ‘paramedic’ has only been a protected title since 2001. We are still a new profession, particularly when compared to modern nursing, which can be traced at least back to 1860 with the establishment of the nursing school at St Thomas’s in London by Florence Nightingale. 

We used to be regarded, and by ourselves too, as the emergency part of the NHS. Unique, out on a limb, not particularly well integrated. This has changed massively in the last 20 years: now we’re a young, small profession (Figure 1) in the wider AHP community. 

Even as a ‘frontline’ NHS paramedic, my role has changed massively in the last 20 years. Then it seemed to be about carrying people in and out of the ambulance as much as it was about clinical skills. Resuscitations often involved squirting large volumes of drugs down an ET tube while waiting for about 5 minutes for the defib to warm up. Everyone who was involved in an RTC was boarded, rapid takedown of patients who had managed to get out of their cars before we arrived were routine...Lidocaine for pulsed VT...IV tramadol for analgesia as we couldn’t give morphine. 

How things have changed. I think I’m now expected to know almost everything about almost any condition (Google is my friend!). The demographics of my ‘ambulance’ patients appears to have changed. Increasingly I see complex patients with exacerbations of chronic conditions and those that would have previously accessed the NHS via other services such as primary care or would have just looked after themselves. On the flip side, we now use increasingly technical and complex equipment and a wider range of medicines. Resuscitations now potentially involve chest compression devices, biphasic defibrillation, drugs administered IO and significant emphasis on post ROSC care. On top of my paramedic exemption drugs (as defined by the Medicines Act), I’m now expected to use a combination of 54 medicine protocols and PGDs. The traditional NHS paramedic role is significantly more technical and academic than it used to be and I believe that the transition to a degree requirement for new registrants appropriately reflects these changes and developments, and not just in my Specialist role.

NHS England and the devolved nation equivalents are quite rightly trying to standardise aspects of AHP roles within the NHS, including titles, initial training and education. This has been facilitated by professional bodies along with other stakeholders such as HEIs and employers, and this is gradually coming to fruition. This will give colleagues, the public and aspirant AHPs an improved understanding of NHS roles and how they relate to each other, while, hopefully, enhancing patient care and safety. These include:

New entry to the relevant professional register requires a degree level qualification;
Progression to a ‘Specialist’ role requires a post graduate diploma and the relevant skills, knowledge and experience;
Progression to an ‘Advanced’ role requires a Masters degree and the relevant skills knowledge and experience;
Aspirant AHP independent prescribers should be working at ‘Advanced’ level, they must have the support from their employer, a doctor as a mentor, a role where prescribing is relevant and complete an approved course of study. 

I know that not all Allied Health Professionals (AHPs) have achieved all of these aspects yet, and, please note, I am not talking just about paramedics, but AHPs in general. 
Therefore, if you meet a specialist nurse, you will have an understanding of their competency and skill level, while they will also, hopefully, understand your ‘Advanced paramedic’ role.

For us, the College of Paramedics has been representing our profession in these developments and one of the first aspects to be published was the Paramedic Post Registration Career Framework (now in its 3rd edition). The Framework Diagram is below:

This has been enhanced by the Paramedic Post Graduate Curriculum Guidance document [insert link], published in 2017, and the Paramedic Digital Career Framework which is jointly published by NHS England and the College of Paramedics. Please take the time to have a look at these documents, they affect you, your colleagues and your profession.

The public, our professional colleagues and members of our own profession sometimes think of a ‘paramedic’ as someone who works on an NHS ambulance responding to 999 calls. These days, I think that’s a very blinkered and ill-informed view, even though that’s where most of us started out in our careers. A search of NHS Jobs for ‘paramedic’ yielded the following results:

• Health Visiting
• Ambulance Service
• Primary Care 
• General Practice
• Emergency Services
• Community Health Services
• Forensic Services
• Adult Mental Health Services
• Administration
• Research
• Senior Lecturer
• Health and Safety
• Prison Service
• 111 Clinician
• Management
• Immigration Services

The number and diversity of these paramedic roles continues to increase as new employers recognise our individual and collective skills, knowledge and experience. For everyone’s benefit we need to ensure that paramedics as a profession and as individuals are highly regarded and valued. The HCPCs requirement for new paramedics to have a degree is part of this. Rather than kicking against this change we should be celebrating the increasing inclusion of paramedics within the wider AHP community and the consequential recognition of the paramedic profession within the NHS and beyond.

As far as the original question of ‘do you need a degree to be a paramedic, surely people skills are more important’? No, you don’t need a degree. There are plenty of non-degree paramedics working in many roles. But I have four riders for this:

1. No paramedic course has consistently produced staff with good people skills. Mine didn’t, and that’s something that I think some of us can only develop over time. Having a degree or not isn’t linked to people skills. A new geeky paramedic who’s hopeless with patients may develop into someone who progresses far in their career. I did!
2. There are a number of paramedic roles which have little or no patient contact, but are quite academic. Please don’t be blinkered.
3. While you might not need a degree to do your job at the moment, your profession needs to progress with common AHP standards, including education, for the benefit of future paramedics, patients and UK healthcare.
4. The paramedic profession is increasingly complex, technical and requires an increasing level of academic as well as experiential knowledge. The changes in the last 20 years are incredible. The next 20 years are only likely to increase the complexity of our work and we need to demonstrate that we are individually up to the task ahead. Academic achievement will only be one aspect of this.

If you’re still unsure about this progressive change for our profession, then please talk to your degree qualified colleagues and perhaps consider a top up of your existing qualifications. 

And no, personally I don’t think current degree courses reflect the needs of the profession moving forward. I’d like to see a greater congruence between the patients that we’re seeing, and are likely to see in our careers, and the content of undergraduate courses. I’d love to see consultation skills taught as compulsory modules in year one and two of all paramedic degree courses. That would potentially benefit every patient contact in our careers...and may address some of the ongoing concerns with interpersonal skills at the same time? And how about a module on ethics & risk management? Rant over, but HEI’s please note!

Remember, we’ve achieved in just over 30 years what it’s taken nursing about 160 years . . . [insert link] [insert link]

Richard Taffler MSc BSc(Hons) BEng FASI MCPara

People Like Us?

College of Paramedics Executive Officer, Liz Harris takes a look at the recent HCPC 'People Like Us?' report and considers why so many paramedics self refer.


Why does the paramedic profession have a disproportionately high number of HCPC fitness to practise cases against it when compared to the numbers of paramedics on the register? The ‘People Like Us?’ report was produced following research commissioned by the HCPC in response to several years of high numbers of fitness to practise cases against paramedics. In 2016-17 paramedics made up 7% of the Register and 13% of fitness to practise cases. You may think that these individuals are exceptions within the profession, that they differ in terms of their motives or behaviours but in fact they are just like us. They are people like us. The vast majority of referrals where ‘one offs’, did not result in any harm to a patient and only 18% of referrals came from complaints from the public. Public perceptions and changing expectations were factors highlighted in the report as reasons for referrals. These factors are also linked to the nature of paramedic practice, paramedics deal with people in crisis, at their most vulnerable time and in unpredictable situations.  

In the sample within this research, 46% of the HCPC referrals came from self-referral compared to an average of 26% across all 16 professions. 84% of the paramedic self-referrals resulted in no further action by the regulator. These figures suggest that the disproportionality highlighted in this research originates from a high number of self-referrals that do not meet the HCPC standards of acceptance for an allegation, rather than an indication of clinician impairment of competence. This statistic is at first sight welcoming, but on deeper consideration it is clear that a HCPC referral, whatever the outcome is most probably significantly psychologically distressing for the individual and their family.

It is important for us to remember the history of the paramedic profession when discussing the findings within this report. The professionalisation of paramedics began to occur following introduction of registration. Regulation of paramedics by the Council of Professionals Supplementary to Medicine began in 2000 (and subsequently by the then Health Professions Council (HCPC) in 2003. This regulation fuelled the formation of the paramedic professional body, the British Paramedic Association in 2001 with a name change to College of Paramedics in 2004. This situation is unlike some of the other professions regulated by the HCPC who had already established their professional status during many preceding years. 

In the early years of registration, paramedics were not prepared and fully informed of the processes and consequences of professional regulation. This combined with the effects of the cultures highlighted within the report has led to consequences that have perpetuated over the years and are still apparent today. These consequences are detailed in the full report through narrative accounts from working paramedics describing ‘fear of the HCPC’, a ‘big stick’ approach by Ambulance Services to tackling issues and complaints with the threat of ‘you better self-refer or else you’ll be struck off’ ringing true for many in the profession. These accounts point towards a notion that the paramedic profession could have had a much better relationship with the HCPC if Ambulance Service culture had been different. 

Ambulance Services could increase their support for paramedics in several key professional areas; complaints and investigation processes are a notoriously difficult time for paramedics to navigate, access to all appropriate documentation and expert statement writing guidance is vital; fitness to practice processes can be long and arduous and impact negatively upon the individual’s confidence; continuing to work whether under sanction or not can be clinically, ethically and emotionally very challenging; any clinical development following a return to practice must be robust and effective. Adequate professional and psychological support for paramedics and other frontline ambulance clinicians must make its way right to the frontline where it is needed most.  

The College of Paramedics welcomes the findings within this report and thanks the HCPC for its commissioning. Not only because now the situation is highlighted through a robust piece of research, we can look to understand the complex reasons and begin to educate to dispel the myths that still prevail and work towards reducing the number of unnecessary self-referrals that paramedics make. This report marks a moment in time to move away from what prevailed before and towards a different and much better relationship with our regulator and the employers of paramedics. The findings and recommendations should also provide further impetus for ambulance services developing more positive and transparent approaches to clinical issues and complaints with patient safety and professional learning at the core of any investigative process. 

Should you have any further questions or suggestions on how to tackle some of the points highlighted please email 

Liz Harris, Head of Professional Standards, College of Paramedics

Flu jab: it’s about doing the right thing, right?

College of Paramedics Executive Officer, Liz Harris reflects on why some paramedics are deciding not to receive the flu vaccination.


I have not been quiet recently about my opinions on the flu vaccination, I’ve promoted its benefits through social media, the College of Paramedics INSIGHT magazine, spoke about the potential consequences of not having the vaccination at the Emergency Services Show and facilitated vaccination opportunities for attendees at several recent CPD events.  

I also feel that I can’t remain quiet either on some of the responses and attitudes I have heard whilst doing all this. The responses look like this…‘It might make me ill and I’ve had too much time off sick already’, ‘I’m not having the flu jab in my own time, I’ll wait until I can get out of getting a job’, ‘I’m not helping the service get a load of cash for hitting targets’, ‘If I get the flu that’s alright cause it means I can go off sick then’. All of these reasons leave me uncomfortable and are difficult to digest, arguably for different reasons but do they highlight a prevailing culture that is not beneficial for staff wellbeing and patient safety. 

As registered health professionals, paramedics have a professional obligation to keep themselves healthy and their patients safe. For me, that means contributing to the reduction in the spread of a (to a certain extent) preventable infectious disease that kills thousands in the UK every year. There are good reasons for not having a flu jab but I have not heard any of these voiced recently and they are certainly not those I mention above.

These responses are unpleasant at best and at worst, corrosive. But they are a reflection of a culture that historically has not supported staff to develop, learn, achieve and inspire. I look forward to a time when the behaviours highlighted in the responses above are a thing of the past along with the command and control culture through which they were born, and a time when all ambulance services can achieve flu vaccination uptake numbers to rival the best NHS hospital trusts.  

Liz Harris, Head of Professional Standards, College of Paramedics

My experience of receiving a fitness to practise concern

College of Paramedics member Rebecca Connolly MCPara shares her experience of receiving a fitness to practise concern.



I have been a member of the College of Paramedics since 2013 and had little cause to use their insurance protection until 2015 when I received a HCPC fitness to practise (FtP) concern.

I’ve been a paramedic for four years, I’m proud of the job I do – and I’m good at it.  I pride myself on delivering exceptional clinical care and so to receive notification of the concern was a huge blow both professionally and personally.  I remember receiving a large parcel through the post with the Health and Care Professions Council (HCPC) logo on – I immediately knew it couldn’t have been good.  When I opened the parcel, there was a letter from the HCPC detailing the concern with all their evidence attached.  I didn’t receive an initial letter as some people do and it was like I’d been punched in the stomach. The crippling sense of nausea and fear was something that will remain with me. The contents of the HCPC’s letter and evidence was presented in such a formal and legal way, completely unexpectedly that I immediately felt guilty without even being given the chance to defend myself, against what appeared to be a malicious allegation.  I felt utterly vulnerable, and it honestly felt like I was on a criminal trial.

I started to try and put together a plan to deal with it and so contacted the College of Paramedics in relation to their FtP insurance.  Following the completion of a claim form I was directed via Abbey Legal to Andrea James of Knights 1759 firm of solicitors.  From the outset she reassured me, took everything on board and took full ownership of my case.  This was a hugely reassuring step because I didn’t feel so alone.  I still felt massively vulnerable due to the number of unknowns – we all want to remain in practice and so the mere possibility of being struck off remained with me every day.

She took the time to set up a meeting and asked me lots of questions, detailing my side of events, what happened and why.  My case was unusual in some respects but she formulated a detailed plan and confirmed that she could take my case for me.  From that point, I had little contact with the HCPC as everything was completed vicariously through her – and this was brilliant.  She advised me to continue to work as normal and try not to worry too much.  

During this period, I was asked to collate various pieces of information for them and obtain character and clinical references that would form part of the response to the Investigation Committee.  I was informed of everything every step of the way and I believe that Andrea – who is a partner at the law firm – went out of her way to keep in contact and reassure me.  The fact that she was my point of contact was a great relief – it wasn’t passed to a junior member of staff and I was never passed from pillar to post.  Any questions were answered expediently and nothing was too much trouble.  She appointed an expert to produce a report for me and all this was covered by the College’s standard insurance cover, which is part of full membership. 

Following the Investigating Committee meeting in early 2016 it was found that the case would proceed to a hearing and the HCPC’s rationale baffled both myself and the solicitor in that the presumption of guilt was evident from the outset with no regard to expert evidence submitted.  This was hugely stressful and I found that I lost further confidence in work – any letter that came for me was immediately met with panic attacks, I was so worried and it permeated into every aspect of my life.  When you’re passionate about the job, and genuinely care about doing it well, the thought of losing it has perhaps been one of the most stressful experiences of my life.

It was some relief to know that I was fully supported by my legal team, which at this point included Andrea and a very well-respected QC who was appointed to represent me at the hearing.  Another two experts were also appointed to conduct reports in preparation for the hearing.  The HCPC has guidelines and standards about times of hearings etc but mine took ages – well over a year.  This year was hell, and I don’t use that word lightly: I couldn’t apply for jobs as I had to declare the ongoing investigation which precluded me from most.  I was stressed about it, I lost sleep, remained anxious at any letter coming – in fact I remember receiving a letter from the HCPC to which I had a full-blown panic attack, and all it contained was arbitrary information about some changes they were making.  I lost so much confidence in my ability, and I was so worried about receiving another FtP issue.  I felt I was an awful clinician, that I would lose my job and that my life was essentially over.

By this time, I had got to know Andrea quite well, and she me.  I felt that she was personally invested in helping me professionally.  I genuinely felt like she wanted to do her best, not for anything other than because she cared.  This meant a huge amount to me and something for which I’ll always be grateful.  Both Andrea and the QC were very honest and upfront about potential outcomes and what would be reasonable etc and so I was never left in any doubt as to what was at stake – this is important for helping come to terms with it.

Eventually the hearing date came about, over 12 months following the Investigation Committee meeting.  By this time, I was quite looking forward to it: I just wanted it done and dusted so whatever happened I could move on with my life.  In the meantime, I had continued my work as a paramedic and obtained several commendations, so I knew that in any case I had done my best.  Every time I got frustrated at a late finish or something, I reminded myself that my job, my vocation was in jeopardy and I should be thankful that I could do it.

The hearing itself was extremely well organised and I cannot fault the HCPC in any way.  It was impeccable and fairly run.  Everyone was polite and the HCPC’s Presenting Officer was fair and decent in the way she presented her case.  The hearing was scheduled for three days but lasted for only two as the panel decided the allegation was not well founded.  This was a HUGE relief and something I’m still coming to terms with – over two years of stress had been resolved.

I cannot express in words how grateful I am to the College of Paramedics and to Andrea and her team at Knights 1759 who worked tirelessly to bring me the outcome I felt was warranted.  It would not have been possible had it not been for my membership of the College of Paramedics as the total fees I believe were likely in the region of £20,000 from start to finish.  I genuinely cannot imagine going through the process I’ve gone through without that professional support. 

I still get nervous when the Royal Mail van arrives outside my house, and any letter or email from the HCPC sends me panicking – it probably will for a while yet.  I still lack confidence in my practice and worry about decisions I’ve made long after I’ve made them.  The effects from my experience will stay with me forever, but I’m thankful that I’ve had them.  The experience with the HCPC has been mixed in that I felt ignored and presumed guilty from the outset, but from the Investigation Committee result onwards I can’t fault them.

I wanted to write this for many reasons:
1.    To express thanks and gratitude to the team of professionals who helped me, and to thank my colleagues and friends who submitted wonderful references;
2.    To try and offer some support to paramedic colleagues who may be going through the FtP process;
3.    To try and give more information about the hearing itself as to what happens, to provide reassurance;
4.    To urge every paramedic who reads this to join the College, if not already done so.  It is absolutely worth the £9.00 monthly fee, if only for the FtP insurance.  

The support I received far exceeded expectations.  The College were wonderful in dealing with my initial enquiry and the process felt built to help and support me.  We as a profession need to support one another and can only do this with the strength of one voice provided by the College of Paramedics.

Click here to join the College of Paramedics

Read the Blog: 10 Things you should know if a concern is raised about your fitness to practise

10 Things you should know if a concern is raised about your fitness to practise

The Health and Care Professions Council (HCPC) provides a list of 10 important things you should know about the process and the support available if you find yourself the subject of a fitness to practise allegation.



1. The fitness to practise (FtP) process is not designed to punish registrants for past mistakes.

Rather, the process is designed to protect the public from those who are not fit to practise. Finding that a registrant’s fitness to practise is ‘impaired’ means that there are concerns about their ability to practise safely and effectively. In 2015-16, only 1.07 per cent of paramedics were subject to an FtP concern; a very small percentage, indicating that the vast majority of registrants are practising safely and effectively.
2. What do we do when we receive a concern about a professional on our register?

We consider each concern individually to decide whether it meets the standards of acceptance. This is the level a concern about a registrant must meet before we will investigate it as a fitness to practise allegation. We may make further enquiries to help us make this decision. If we find that a concern does not meet the standards of acceptance, we will close the case and take no further action. In 2015-16, of the 239 concerns raised about paramedics, 162 cases were closed because they did not meet the standards of acceptance.

3. Your case will be allocated to a case manager.

If the standards of acceptance are met, and you find yourself the subject of a fitness to practise allegation, the case will be allocated to a case manager, who will remain neutral. They can explain how the FtP process works and what panels will consider when making their decisions. However they cannot advise you what to include in your response or how you should represent yourself.

4. We will give you an idea of how long our enquiries will take.

We understand that it can be stressful when an FtP concern is raised, and we will provide you with an idea of how long our enquiries will take at each stage of the process.

5. You can respond to the allegation in writing within 28 days. It is important to engage with the process so that you can give your side of events.

Once we have all the information we need, we will write to you with full details of the allegation that has been made plus copies of the documents we have collated. You are then invited to respond in writing within 28 days. If you need more time, your case manager can offer a 28-day extension, and if further time is required you can make a written application to the panel. 

6. You may find it helpful to get advice from your professional body, The College of Paramedics, your union, or a solicitor at the earliest opportunity.

They will be able to provide advice on what to include in the response to the allegations which will be provided to the Investigating Committee Panel.

7. You are entitled to be represented throughout the process.

If the case is referred to a hearing, registrants are entitled to be represented, or can represent themselves, throughout the process. Information and guidance on the fitness to practise hearing process is available on our website, and explained in this useful YouTube video.

8. Cases are scheduled up to four months before the actual hearing.

We try to give registrants at least 60 days’ notice of the hearing date. We will also give you the material that we plan to rely on at the hearing 42 days beforehand. We ask registrants to provide their material 28 days before the hearing date.

9. Details of the hearing and allegations are published four weeks before the hearing is due to start.

We put this information on our website as the hearings are held in public. We do not put the information on the website more than four weeks before the hearing date to make sure we are acting fairly and balancing your rights with our role of protecting the public.

10.  What are the possible outcomes of a final hearing?

If a registrant’s fitness to practise is found to be impaired, the final hearing panel will decide whether a sanction should be imposed. They may take no further action; caution the registrant; make conditions of practice that the registrant must work under; suspend the registrant from practising; or strike their name from our Register. Before making their decision, the panel will carefully consider the circumstances of each case and take into account all that has been said in the hearing. It is important to remember that the purpose is to protect the public and not punish registrants.

For more information about the FTP process download our brochure ‘What happens if a concern is raised about me?’ or visit our dedicated FTP pages

Further information about the work we do in considering allegations about the fitness to practise of our registrants can be found in our Fitness to practise annual reports


Stress in the sector: A member’s perspective

Adrian McGrath MCPara from Northern Ireland discusses perceptions of stress in the current paramedic role



My dream was to be a paramedic back then, in those days we lifted stretchers into ambulances as the troubles in Northern Ireland alerted my colleagues to something gut wrenching minutes away. Where casualty departments inspired me as I saw consultants and young doctors being taught and managing in a timely fashion the sick trauma or medical patient that had just came through the door. Inspiration is a little harder to come by these days in that context. I achieved one of my dreams and I've probably grown, matured and absorbed what I could over the years. Currently, stress has a strong penumbral edge to it, as the wide measure of society and its illnesses and those increasing accidents of life demand our skills and energy on a much larger scale than what was needed in the past, with fewer resources. So where do we (I) go from here?

Personally, stress can subtly tease out the unseen good or hidden ability in us, where that propensity to overcome and to adapt to unforeseen situations (or delayed time) on scene enhances one’s ability to cope. However, that said, there’s a fine line in that sticky medicine of service and self-balance, whilst caring for another in that acute phase of trauma or illness. To be your best you have to feel your best. This only comes from re-energisation of the self with careful gentleness in how you approach the busy mind, the mind which most likely has seen something nasty, as the sensory and visual response post-shift kicks in. This is a necessary quality we must fulfil and master, in order to live a long, mentally healthy and purposeful life, whilst we work on that escalator of fuelled adrenaline at times! I've considered a complete alternative to this new era and changing face of the pre-hospital world I inhabit...thou that is yet to be decided! However, there is something honest and pure in being able to help another in their hour of time will be my judge on that decision.

There is no quick fix here, the system is fractured and continually fracturing; and like any spiral fracture it can take a long while to heal itself, but undoubtedly it leaves its mark and weakness creating a fissure upon the system. My colleagues, who I admire give 100% everyday as they travel the highways and byways carrying out life-saving procedures at times whilst on route to hospital, whilst interacting with that multidisciplinary team of professionals we encounter each day; for that one, or perhaps multiple casualties we have to treat on the roadside, or in the various communities that we are invited into. The system is impinging on us and our response, in my opinion, is that we must be more visceral in how we react to this demand upon our physical wellbeing; and to recognise when we need to nourish the body as well as the soul, through our shared experiences, recognising when we need genuine time out. In order to carry on providing that cutting edge professionalism we offer to our patients.

We've got to try to hinder ourselves from becoming attached to that second victim syndrome, through that loading dose of stress which may be unresolved from previous calls, due to demand, or from re-living a terrible incident, where perhaps lethargy, mental fatigue or negative self-worth spirals our thought processes in these difficult, challenging and demanding times that we find currently ourselves in.

Maybe the periscope with how I see the world may need a new optic to recast and renew a fresh inspiration for me, as this New Year offers me its blank canvas of invitation and surprise. Other crises when one looks back into the history of turbulent times, would perhaps suggest at that time they also had to deal with such challenging structures of change in their communities, in accessing their necessary social or health needs; for life is merely passing through us and the only inherent gift we all have is to be resilient and kind towards our toughest challenges, to meet and filter stress with a fresh objective whilst we look after ourselves and each other, the best we can in these challenging times...

I don't want to lose any of my colleagues to terminal burnout or something even worse…

Adrian McGrath MCPara, Paramedic, Northern Ireland

HCPC Hearing: A member’s perspective

A member of the College of Paramedics shares their experience of receiving a letter from the HCPC.


In 2015 I made one of the best decisions of my career when I joined the College of Paramedics. If you’re not already a member, I urge you to do the same; you never know when you might need them.

I became a paramedic in 1996 after a distinguished career in the army. My 20 years’ experience includes specialised training, mentoring, and leadership roles with organisations as diverse as the Helicopter Emergency Medical Service and the London Ambulance Service. I’m also a previous winner of the Allied Health Professional Worker of the Year Award. 

As a paramedic, you dread the Health and Care Professions Council (HCPC) envelope dropping onto the doormat, especially when it’s not renewal time.

I remember it vividly. It was a bright and sunny morning when it came through, the gleam of the white envelope imprinted with the HCPC logo stood out on my dark and dusty doormat.

The hairs on the back of my neck stood up, ‘hmmm HCPC’ I thought, ‘what do they want from me?’

I carefully peeled back the envelope and withdrew the letter. As I slowly read through I realised my worst fears had come true, it was a complaint about my fitness to practise.

The wording of the letter I found quite petrifying; terms and phrases that were alien to me that I found quite intimidating given the situation in which I now found myself. I felt extremely vulnerable and quickly formed the impression that I had a guilty verdict hanging over me without even having been able to put my side of the story. What felt worse was it appeared they’d taken months to prepare the case and I had only seven days to respond.

As I took a step back, the magnitude of the accusation dawned on me. This one thing could ruin my career, which would also have a devastating effect on my family.

I sat on the bottom of my stairs, with my head in my hands wondering what on earth I should do next – ‘Where do I start? How do I start?’

As I sat there contemplating life, I remembered as a member of the College of Paramedics I receive fitness to practise insurance as part of my full membership.

I nervously picked up the phone and made the call to the College and was greeted with a supportive and sympathetic ear at the end of the phone who quickly calmed me down. I was advised to call the insurance company to lodge my issue. I called them straight away and again, I was greeted by a very friendly and supportive person. Whilst on the phone they sent me a simple form to fill in via email, which I sent straight back. I soon received a phone call from the legal team providing excellent advice and reassuring me that they would handle everything. Their first job was to contact the HCPC with a strongly worded letter for an extension to the time-frame they had given me to respond, which in their opinion as well as mine, was unreasonable. They also informed the HCPC that they would be handling my case, which took a huge weight off my mind.

I was given a list of things they required and a number at which they could be contacted on. This number was always answered, I was never fobbed off and if in a meeting they always called me back.

Both the solicitors and the College were excellent in providing support and guidance and keeping me informed at every step of the way. The solicitor put everything together and assured me that my case wouldn't even go to a hearing, they were surprised it had even got this far.

The file was duly sent and only four days later we received a reply of ‘no case to answer’. This was great, however, the whole process had taken eight months to conclude. The College and the solicitor were fantastic. I cannot thank them enough. For less than £10 a month, the support I received was second to none and I would strongly advise any paramedic to join the College, not just for the insurance but for the support of having someone at the end of a phone.
The views expressed in this article are made by a member of the College of Paramedics. 

The opinions expressed by the various contributors are not necessarily those of the College of Paramedics. The inclusion of a blog does not necessarily imply recommendation of its aims, policies or methods. The College of Paramedics will not be liable for any errors or omissions in this information nor for the availability of this information.