Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services

Emergency medical services

Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

 and include paramedic

Paramedic

A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...

s, emergency medical technician

Emergency medical technician

Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

s and emergency care support workers. Although there is tendency for the public to refer to all ambulance staff as 'paramedics', the term is protected by law and strictly regulated by the Health Professions Council

Health Professions Council

The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....

.

Emergency medical personnel most often work in an ambulance

Ambulance

An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...

 alongside another member of staff. Typically, an ambulance will be crewed by either a paramedic with another crew member (technician or emergency support worker), two technicians or a technician with an emergency support worker. No NHS ambulance trust in the country currently offers a paramedic on every ambulance, although some trusts are moving towards this.

The majority of emergency medical personnel are employed by the public ambulance services of the National Health Service

National Health Service

The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

s, although many are also employed by private ambulance companies and the two voluntary aid societies (British Red Cross

British Red Cross

The British Red Cross Society is the United Kingdom branch of the worldwide impartial humanitarian organisation the International Red Cross and Red Crescent Movement. The society was formed in 1870, and is a registered charity with over 31,000 volunteers and 2,600 staff. At the heart of their work...

 and St John Ambulance), either providing private services such as event medical cover, or providing support to the NHS ambulance services under contract.

As part of a cost-saving exercise NHS is in the process of phasing out the ambulance technician/emergency medical technician (Band 4 on the Agenda for Change

Agenda for Change

Agenda for Change is the current National Health Service grading and pay system for all NHS staff, with the exception of doctors, dentists and some senior managers...

) role from the services and replacing it with the Emergency Care Support Worker or Emergency Care Assistant roles (Band 3 on the A4C), and most services are no longer training staff at technician level, although a large proportion of staff in the trusts remain at technician level.

Levels of staff

The specific skills performed by each group of emergency medical personnel will be dictated by a combination of training, the legal framework and the policies of their employer. The most homogenous group is the paramedics, as the framework of practice is largely dictated by their status as registered healthcare professionals, although local policy differences are still in effect.

The other grades, including technicians, support workers and emergency care assistants do not have legal status as health care professionals, and their skill sets and permitted interventions are governed by their employer. This has led to significant differences in training and skill between staff in different services with the same or similar job titles, especially within the private sector.

There are standards in place for all ambulance staff, written by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), which is a body made up of representatives from a number of expert organisations including medical, nursing, allied health professional and ambulance communities. JRCALC publishes guidance based on the principles of evidence based medicine

Evidence-based medicine

Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...

 and best practice

Best practice

A best practice is a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark...

, but adherence to JRCALC is not mandatory, and organisations and individuals can choose to deviate from it.

All ambulances services, as well as the provision of treatment by health care professionals (paramedics), whether public, private or voluntary are regulated by the Care Quality Commission

Care Quality Commission

The Care Quality Commission is a non-departmental public body of the United Kingdom government established in 2009 to regulate and inspect health and social care services in England. This includes services provided by the NHS, local authorities, private companies and voluntary organisations -...

, and they control the operation of all services.

Paramedics

Paramedics are expected to work utilising their own clinical knowledge to make decisions, and as registered health care professionals, carry full responsibility for their actions.

Traditionally the only route to becoming a paramedic was to join an NHS ambulance service and work towards the position from non-emergency patient transport

Casualty movement

The casualty movement is the procedures used to move a casualty from the initial location to the ambulance....

 roles through to the emergency division as a technician, and after a period of time, it was possible to internally apply for paramedic training.

Although offered at ambulance service training departments, the curriculum and certification were awarded by an organisation affiliated with the Edexcel

Edexcel

Edexcel, a UK company, is one of England, Wales and Northern Ireland's five main examination boards, and is wholly owned by the private-sector Pearson PLC, a UK-based media and publishing conglomerate. Its name is a portmanteau word derived from the words "educational" and "excellence"...

 examination board

Examination board

An examination board is an organisation that sets examinations and is responsible for marking them and distributing results. Examination boards have the power to award qualifications, such as SAT scores, to students...

, called the Institute of Healthcare Development (IHCD). Such paramedic training was usually a 10 to 12 week course with some of this time spent in a hospital emergency department, coronary care centre and operating theatre

Operating theatre

An operating theater was a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery...

, assisting the anaesthetist and performing airway management techniques such as endotracheal intubation

Intubation

Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...

. Completion of the course allowed the paramedic to register with the then legislative body.

It was nearly impossible for non-NHS employees to access such courses, some private ambulance companies provided their own training. Prior to regulation and closure if the title, the term "paramedic" was used by a variety of people with varying levels of ability. After the incorporation of the Health Professions Council

Health Professions Council

The Health Professions Council is a statutory regulator of 210,000 health professionals from 15 professions in the United Kingdom. It was set up in 2003 under the National Health Service Reform and Health Care Professions Act 2002, to replace the Council for Professions Supplementary to Medicine ....

 (HPC), the term became legally defined and applicants to the paramedic register were given an opportunity to have their training and experience reviewed against the new standards. Existing paramedics applied to the register via a grandparenting scheme which ended in 2007.

Eventually the IHCD began to accredit a few non-NHS training establishments, allowing them to teach their curriculum. In the mid 1990s some universities started to offer para-medicine diplomas and degrees, in association with local Ambulance Trusts. By necessity these included all of the practical skills found in the IHCD curriculum and allowed applicants to apply for registration with the HPC.

Within the professions regulated by the Health Professions Council, paramedicine was the only one not to have an extant professional body, and the British Paramedic Association was formed in 2001. This later became the College of Paramedics

College of Paramedics

The College of Paramedics, formerly the British Paramedic Association, is the United Kingdom professional representative body for paramedics in the United Kingdom. The college has representation with the Health Professions Council , the Department of Health, the Joint Royal Colleges Ambulance...

 and this is now an important representative group for the paramedic profession. Unlike some other professions, membership of the college is not mandatory in order to be a registered paramedic.

In 2010, the IHCD route to becoming a registered paramedic was largely deprecated, although is still recognised by the Health Professions Council, and anyone successfully completing the BTEC Level 5 qualification will be entitled to register as a paramedic. This leaves the university route as the primary training method for new paramedics, with a number of universities offering qualificaitons which can lead to registration, both as full time courses for new students (although they must also be accepted for the practical element of the training by an ambulanceservice) and part time courses for existing ambulance staff.

Paramedic practitioners and emergency care practitioners

Although 'paramedic' is the only protected title for the profession, some paramedics undertake further training or higher educational programs in order to work as advanced practitioners. These may be known as community paramedics, paramedic practitioners, critical care paramedics and emergency care practitioner

Emergency Care Practitioner

An Emergency Care Practitioner may come from either a paramedic, nursing or allied health professional background and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard...

s.

These advanced paramedics vary in the scope of their practice throughout the country but can be found offering unscheduled care where the patient does not require transport to hospital, instead of summoning a GP. Some of these roles are very similar to those carried out by specialist nurses, thus, blurring professional boundaries. Some roles like advanced practitioner courses and the emergency care practitioner courses are offered to both professions as interchangeable skills are present.

The College of Paramedics

College of Paramedics

The College of Paramedics, formerly the British Paramedic Association, is the United Kingdom professional representative body for paramedics in the United Kingdom. The college has representation with the Health Professions Council , the Department of Health, the Joint Royal Colleges Ambulance...

 has published a framework for paramedic education which details the attainable clinical grades of UK paramedics as below:

• Ambulance clinician, technician, or student paramedic (Certificate of Higher Education)
• Paramedic (Foundation Degree, Diploma of Higher Education, BSc)
• Paramedic Practitioner or Specialist Paramedic (BSc Hons)
• Advanced Paramedic Practitioner (Post-Graduate/MSc)
• Consultant Paramedic (M.Sc and above, with minimum 10 Years Paramedic Experience)

Ambulance technicians

Ambulance technicians, or emergency medical technicians form a large proportion of the workforce in emergency medical care, although the title lacks formal definition or protection, and there is no restriction who can use it. Generally, ambulance technicians can work either autonomously, making their own clinical decisions within their training and remit, or as assistants to a higher skilled paramedic.

As part of a cost-saving exercise, the NHS is in the process of phasing out the ambulance technician/emergency medical technician role (Band 4 on the Agenda for Change

Agenda for Change

Agenda for Change is the current National Health Service grading and pay system for all NHS staff, with the exception of doctors, dentists and some senior managers...

) and replacing it with the Emergency Care Support Worker or Emergency Care Assistant roles (Band 3 on the A4C), and most services are no longer training staff at technician level, although large numbers remain operational.

Technicians within the ambulance services generally completed the Institute of Healthcare Development (IHCD) ambulance technician award (awarded by Edexcel

Edexcel

Edexcel, a UK company, is one of England, Wales and Northern Ireland's five main examination boards, and is wholly owned by the private-sector Pearson PLC, a UK-based media and publishing conglomerate. Its name is a portmanteau word derived from the words "educational" and "excellence"...

) which is a course lasting around 12 weeks, including 3 weeks of emergency driving. This qualifies the person as an trainee technician, and after a period (usually around a year) on the road, a plenary examination is taken to complete the training and become a qualified ambulance technician (QAT). Whilst now deprecated by the NHS services, the qualification is still available as a BTEC level 4, and can be trained by the ambulance services or a number of private providers.

Alternative qualifications exist, especially in the private sector, although there is no set standard between qualifications. Other qualifications include the Emergency Care Technician award from the Royal College of Surgeons of Edinburgh

Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of Edinburgh is an organisation dedicated to the pursuit of excellence and advancement in surgical practice, through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical workforce...

 and numerous in-house qualification courses offered by individual providers.

Emergency care support workers

Emergency care support workers or emergency care assistants are trained to a basic level, and do not have clinical autonomy, relying on a paramedic or technician to make clinical decisions. Their role varies widely between services, but they are normally expected to perform driving duties, and to assist the clinician in their work.

Other titles

Paramedics or pre-hospital care providers in the UK may also use other titles such as:

• Critical Care Paramedic
• HEMS Paramedic
• Immediate Care Practitioner
• Flight Paramedic
• USAR Paramedic - Hazardous Area Response Team
  Hazardous Area Response Team
  The Hazardous Area Response Team initiative seeks to provide medical care to patients in hazardous or 'Hot' environment. They utilise special vehicles and equipment. Hazardous Area Response Teams originated from a 2004 report on the feasibility of Paramedics working in the inner cordon or hot zone...
  
  
• HART Paramedic - Hazardous Area Response Team
  Hazardous Area Response Team
  The Hazardous Area Response Team initiative seeks to provide medical care to patients in hazardous or 'Hot' environment. They utilise special vehicles and equipment. Hazardous Area Response Teams originated from a 2004 report on the feasibility of Paramedics working in the inner cordon or hot zone...
  
  
• MIRG Paramedic - Hazardous Area Response Team
  Hazardous Area Response Team
  The Hazardous Area Response Team initiative seeks to provide medical care to patients in hazardous or 'Hot' environment. They utilise special vehicles and equipment. Hazardous Area Response Teams originated from a 2004 report on the feasibility of Paramedics working in the inner cordon or hot zone...
  
  
• Paramedic Lecturer Practitioner
• Clinical Practice Tutor

Professional organisations

There is currently no single organisation representing the interests of pre-hospital workers in the UK, although a number a organisations represent different interest groups. The College of Paramedics

College of Paramedics

The College of Paramedics, formerly the British Paramedic Association, is the United Kingdom professional representative body for paramedics in the United Kingdom. The college has representation with the Health Professions Council , the Department of Health, the Joint Royal Colleges Ambulance...

 represents paramedics on a number of fronts, including with other professional bodies and setting training standards, although a large number of paramedics are not members, and their representation of other ambulance workers is limited.

The British Association for Immediate Care

British Association for Immediate Care

The British Association for Immediate Care is a registered charity which aims to encourage and aid the formation and extension of Immediate Care Schemes and strengthen and develop co-operation between schemes providing Immediate Care and the statutory emergency services...

 (BASICS) and its constituent bodies also accept paramedic members, although it is primarily focused on pre-hospital care by doctors and nurses.

The Ambulance Service Institute (ASI) is an independent institute whose membership is open to all operational employees of NHS ambulance services as well as voluntary sector groups or individuals involved in pre-hospital care.

The private sector has two bodies, although membership of both is very low, the British Ambulance Association and the National Association of Private Ambulance Services (NAPAS).

Paramedic drugs

The drugs paramedics are allowed to administer are regulated in UK Law with other bodies, such as JRCALC, providing clinical guidance on when they should be used.

Drug list:

• Amiodarone
• Atropine
• Adrenaline
• Aspirin
• Benzylpenicillin
• Chlorphenamine
• Clopidogrel
• Diazepam
• Dicobalt Edetate
• Entonox
  Entonox
  A mix of nitrous oxide 50% and oxygen 50% is a medical anaesthesia gas, commonly known as Entonox or Nitronox, or colloquially as gas and air, and is frequently used in pre-hospital care, childbirth and emergency medicine situations by medical professionals such as doctors, nurses, midwives and...
  
  
• Frusemide
• Glyceryl Trinitrate
• Glucagon
• Glucose (Oral and IV)
• Heparin (LMWH)
• Hydrocortisone
• Ipratropium Bromide
• Ibuprofen
• Lidocaine
• Metoclopramide
• Morphine Sulphate (Oral/IV)
• Nalbuphine Hydrochloride

Midazolam

• Naloxone Hydrochloride
• Oxygen
• Paracetamol
• Reteplase
• Salbutamol
• Sodium Chloride solution
• Sodium Lactate solution
• Sodium Thiosulphate
• Syntometrine
• Tenecteplase
• Tramadol.

Emergency Care Practitioner drugs

Drugs given utilising a Patient Group Directive (PGDs) by Paramedics with advanced training.

• Amoxicillin
• Benoxinate
• Cephalexin
• Chlorphenamine maleate tablets 2 mg/5ml
• Chlorphenamine maleate tablets 4 mg
• Chlorphenicol 1% eye ointment 4g tube
• Co-amoxiclav 125/31 suspension
• Co-amoxiclav 250/62 suspension
• Co-amoxiclav 375 mg tablets
• Co-Codamol
• Diclofenac
• Erythromycin antibiotic 250 mg
• Flucloxacillin antibiotic 250 mg capsules
• Flucloxacillin antibiotic syrup 125 mg/5ml
• Flucloxacillin antibiotic syrup 250 mg/5ml
• Fluroescein 1% eye drops minims
• Fucithalmic
• Ibuprofen suspension 100 mg/5ml
• Ibuprofen tablets 200 mg
• Instillagel Lidnocaine (pre-filled syringe)
• Lidnocaine Hydrochloride
• Oxybuprocaine 0.4% eye drops minims
• Paracetamol tablets 500 mg
• Prochlorperazine
• Prednisolone
• Tetanus/Diphtheria
• Trimethroprim

Paramedic intervention

• Manual defibrillation
  Defibrillation
  Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
  
  
• Automated bi-phasic defibrillation
• Trans-thoracic pacing (local agreement)
• Laryngoscopy / removal of foreign bodies
• Endotracheal intubation
• Naso/oro-paryngeal airways
• Laryngeal masks
• Valsalva manoeuvre
  Valsalva maneuver
  The Valsalva maneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut...
  
  
• Carotid sinus massage
• Phlebotomy
• ECG monitoring
• Acquire and interpret 12-Lead ECG
• Cardiac auscultation
• Autonomous thrombolysis
• Pulse oximetry
• Capnography
  Capnography
  Capnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratory plotted against time, or, less...
  
  
• Intraosseous access
• Cannulation
• Needle cricothyroidotomy
• Needle thoracostomy
• Surgical thoracostomy (local agreement)
• Pulmonary ventilation by intubation
• IPPV using BVM or mechanical ventilator
• CPAP
• 'T' piece ventilation for asthmatics
• Combat arterial tourniquets
• SMART CLIP drug testing

Paramedics and EMT

Emergency medical technician

Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

s in some parts of the country are now able to diagnose ST-Elevation Myocardial Infarctions and bypass the closest Accident and Emergency Department to transport the patient to a hospital able to provide percutaneous coronary intervention

Percutaneous coronary intervention

Percutaneous coronary intervention , commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques...

.

All paramedics in the UK able to legally carry and autonomously administer thrombolytic medication to patients suffering ST elevation myocadial infarction in the pre-hospital environment. This is known as Pre-Hospital Thrombolysis.

In some parts of the country paramedics and EMTs are able to bypass Accident and Emergency Departments for specialist units with patients suffering from a stroke

Stroke

A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

. Currently the FAST-Test is used to determine a patient's suitability to be transported directly to a specialist unit. On admission to the specialist hospital the patient should rapidly receive a CT scan of their head, to guide treatment. Paramedics may routinely assess transient ischaemic attacks (TIAs or "mini-strokes") for clinical risk, treat and refer direct to TIA clinics or Emergency Departments as appropriate or give advice and leave the patient at home.

Road traffic collisions

Currently all NHS paramedics in the United Kingdom generally receive advanced driver training to drive vehicle under emergency conditions. In spite of this, road traffic collisions do occasionally occur which involve ambulances and other blue light vehicles.