UK partner EEC has had detailed with paramedic trainers in the UK that suggest that changes are occurring in the work and role of paramedicine and paramedics. These changes can have implications for the organisation of the service and even implications for funding. Thus the role has developed from an initial transport one (‘ambulance drivers’) into a modern fully autonomous clinical decision system. Thus in the modern role UK paramedics are ‘first responders’ who, in the absence of a doctor, make clinical decisions and autonomously administer clinical procedures.
With this development of the role paramedic training has developed from vocationally oriented training of ambulance drivers to a critical professional and educational structure that combines theory and research as well as practice. At Wales’ sole paramedic training centre in Swansea University both the DipHE and the BSc, for example, are 2-year, full-time, courses. The curriculum of the DipHE includes subjects such as:
• physical sciences
• life sciences
• social health
• behavioural sciences
• health care policy
• ethics and law for practice
• communication and interpersonal skills
• patient assessment
• care delivery
• management of self and others (reflective practice)
As Medilingua partner EEC points out, this is important for the application of Medilingua to the UK. Thus, the vocational education and training aspects of the project (particularly using mobile technologies) is unlikely to be perceived as being to the foremost in modern UK-based paramedicine. Although the VET aspects of paramedic practice are emphasised in meetings with paramedic providers the education is generally more along the lines of practical simulation and training. Large items equipment are used (such as SCAS’ Simbulance) rather than the more ‘soft skills’ training using mobile technologies that can be accessed even while on the job.
As far as Medilingua is concerned, therefore, a potential development would be to introduce the mobile podcasting technologies into the pre-registration paramedic education as well as later into the vocational practice of paramedics. However, the podcasting scenarios being developed via Medilingua would likely need to be adapted to a student, rather than a practicing paramedic, audience. Techniques and practices, for example, might need to be considered for learners as opposed to experienced personal. As may other aspects of the curriculum outlined above.
Allocation of personnel
With the changing nature of the job, questions also arise regarding the use of paramedics within a modern, ‘front line’ service. Thus, with the rapid move towards paramedics being employed as autonomous clinical decision systems it is very often the case that the presence of a paramedic on call is not actually needed. Many of the calls made to the emergency services, these days, are routine and really just require either reassurance or transport to hospital where more appropriate treatment can be administered.
Having arrived at a ‘scene’, however, the paramedic’s training is to assess the situation (through communication – the purpose of Medilingua) and take appropriate actions. This takes time and the paramedic could be more usefully employed elsewhere. As far as Medilingua is concerned, therefore, its application could soon become more appropriate for call centre staff who assess the situation and send the ambulance (similar to the Portuguese situation) or for less qualified ambulance personnel who then deal with the situation. In such future organisational environments, again, the use of Medilingua and its scenarios may need to reflect more the knowledge and experience of the potential user.
Attitudes and perceptions
Following from the changing nature of the work and employment of paramedics in the UK is the issue of how the attitudes/perceptions of politicians and public has changed/is changing towards paramedics. Indeed, as with personnel allocation, attitudes and perceptions towards paramedics appears to have lagged behind actual practice. It may be a generational issue, but paramedics generally feel that the attitudes of the public and even politicians are still more embedded in the role of transport driver rather than autonomous clinical decision maker. Resource allocation, however, often goes hand-in-hand with perceptions and attitudes.