The paramedic profession: disruptive innovation and barriers to further progress

Abstract

The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity and became fully professionally recognised and regulated as allied health professionals, becoming an example of the phenomenon termed ‘disruptive Innovation’; this is something that creates a new market and value network while disrupting existing ones. The steep developmental trajectory of paramedics has not been mirrored by a comparable pace of reform and modernisation in NHS ambulance services which, in comparison, have lagged behind and also failed to adapt to significant changes in the pattern, quantity and epidemiological characteristics of patient demand. This has led to a mismatch between the capabilities offered by paramedics and the professional opportunities available to them in ambulance services, and hampered these practitioners' ability to make full use of their skills. The consequence of this has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover. Parallel developments in medical personnel deployment have increased the quantity of medical labour available to patients with serious or life-threatening injuries, with medical staff added to helicopter emergency medical crews. While many patients with urgent conditions would have benefited from general practitioners being available out of hours, proportionally fewer doctors are available to fulfil this role today and those that are attracted to working with the ambulance service often prefer to respond to cases involving major injury. For these reasons and given the reality that the ambulance service is morphing into primarily an urgent care organisation, de-emphasising the transport aspect of the service, changes are needed to its model of operation and to staff management and support.

Supporting the ambulance service to safely convey fewer patients to hospital by developing a risk prediction tool: Risk of Adverse Outcomes after a Suspected Seizure (RADOSS)—protocol for the mixed-methods observational RADOSS project

“…However, as the nature of the calls it receives has shifted towards non-life-threatening conditions, 2 services and the clinicians working within them have needed to evolve. 3 NHS England and Improvement has identified that ambulance clinicians require more support with their changing role. 4 Certain presentations continue to be 'over-conveyed' 5 and reductions in ambulance conveyance rates are stalling.…”

“…However, as the nature of the calls it receives has shifted towards non-life-threatening conditions, 2 services and the clinicians working within them have needed to evolve. 3 …”

Lord Carter's report into NHS ambulance service efficiency; will its findings make a difference and stimulate the service to escape “the mediocrity trap?”

“…This is a sad reflection of the current circumstances given that, as a professional group, paramedics have professionalised rapidly over the last two decades extending their capability and role since registration was introduced in 2000. They are a classic example of "disruptive innovation" in a workforce (Newton et al, 2020). Without the improvements in patient care that derived from a more capable paramedic workforce, championed primarily by the College of Paramedics, the ability of the ambulance service to provide any level of credible care would be far worse.…”

“…They are a classic example of “disruptive innovation” in a workforce (Newton et al , 2020). Without the improvements in patient care that derived from a more capable paramedic workforce, championed primarily by the College of Paramedics, the ability of the ambulance service to provide any level of credible care would be far worse.…”

Top 100 cited paramedicine papers: A bibliometric study

“…Paramedicine is emerging as a profession in many countries given the advent of university‐based education, registration, regulatory frameworks and increasing scope of practice 1 . Over the last decade, paramedics have gone from being viewed as a non‐profession, 2 through to now being recognised as a full health profession in countries like the UK 3 and Australia, 4 through national registration and widespread education including research training delivered at tertiary level institutions. One of the cornerstones that underpin a profession is having its own unique body of knowledge or theory 5 .…”