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flobach.com

Contemplating life.

Who you gonna call?

My friend had a heart attack at a party we were at. We were all taken by surprise, and I dialled the paramedics as quickly as I could.

As his wife knelt by his side, she was frantically screaming

“How long is the bloody ambulance going to be!?”

“About twenty feet” is apparently not the answer she was looking for.

 

Moan and groan as much as you like – I had to laugh the first time I read this.

And now, before you strangle me because of my percieved bad sense of humour (you wouldn’t be the first one), hear me out. This has a serious twist to it.

What’s in a name?

A clear misunderstanding – the first person dials for medical assistance in the form of Paramedics, whilst the wife of the victim asks how long the vehicle will be.

Why?

Why is it so engrained in to the public mind that if you need medical assistance, you call for a big box on wheels with flashing lights and some bright paint splashed on the side.

If my house is being burgled, I don’t want a police car, I want police officers. If my garden is burning, I don’t want a fire truck, I want some firefighters. If my toilet is blocked, I don’t want a van with a tap and some tools in the back, I want a plumber. And so forth, I could carry on ad nauseum.

So why the fixation with our transportation device (which is in decline anyway, but Community Paramedicine, Paramedic Practitioners, treat and release is another story). Why the constant referral to our vehicle?

Any Paramedic is most likely to develop and burst an aneurysm very quickly if referred to as an “Ambulance Driver” all to often. We don’t like that. We do more than just drive the ambulance.

But no-one really bats an eyelid if the vehicle is called for assistance, without any proper regard to the professionals that actually staff the vehicle and perform the magic.

If you need medical assistance and call an ambulance, maybe the ambulance will help you get better. But since we don’t have vans that can drive autonomously, thats why we need “Ambulance Drivers’. They just drive the vehicle; they won’t attempt to help or heal you, the vehicle will do that. They just drive the ambulance.

Don’t believe me? Think I’m rabbiting on about nothing? Missing my point?

Untitled

At the Emergency Services Show 2012 (I wrote about it here and here) I came across many ambulances of all shapes and sizes. As you can see above, many things marked as an “Ambulance” had arms and legs, a torso, and a head on the top. But no flashing lights. Strange, since the Oxford Dictionary defines an ambulance as:

a vehicle equipped for taking sick or injured people to and from hospital, especially in emergencies

I doubt the bloke in the picture would really want to piggyback a sick or injured person all the way to hospital.

But the misnomers don’t stop there, oh no. What about “Ambulance Service”? Is this the local van dealership providing vehicles?

Here in the UK there is an organisation going by the name of NARU – the National Ambulance Resilience Unit. I suppose the splash very tough paint on the trucks, and maybe equip them with bulletproof tyres.

Then there is the AACE – the Association of Ambulance Chief Executives (also on twitter). When on shift, and I’m the clinically most senior person working, does that make me the Chief Executive on the Ambulance? What about when the ambulance is at the workshop? I take it the AACE are a bunch of people in charge of a lot of vans. Fleet managers I believe is what they call them.

Last but not least, the AACE have an “Ambulance Leadership Forum”. Sounds like an advanced driving course to me – how to lead my ambulance through heavy traffic, and around oddly placed cones on the ground.

I hope I have got my point across what we are not.

So then, if we aren’t a vehicle, what are we? Simple:

We are Paramedics.

We practice Paramedicine.

We study Paramedicine.

We (generally) work for Paramedic Services.

Canadians picked this up quickly (Ottawa Paramedic Services, Peel Regional Paramedic Services, to name a few). No matter what education, you are a Paramedic. Primary Care, Advanced Care, Critical Care…all just subdivisions: They are Paramedics. Some Australian states have picked it up in part (most notably New South Wales and Victoria).

I am aware of some of the legal minefields in different parts of the world (for example, the title “Paramedic” is reserved to those registered as a Paramedic in the UK, and anyone stating they are a paramedic without UK proper registration is committing an offence and can be prosecuted). But I will still refer to you all as Paramedics. You still practice Paramedicine.

Now its time for the rest of the world to wake up, and follow the naming guidelines from International Paramedic (I wrote about it earlier this year):

  • The Paramedic is the professional practitioner
  • Paramedic Service is the provider of emergency medical services staffed by paramedics; and
  • Paramedicine is the discipline and the area of medical study and knowledge.

What’s in a name? A whole lot. If we as a want to be taken seriously, we need to be referred to by our professional title. That doesn’t incorporate our vehicle.

It’s our profession.

I am a Paramedic.

Comments

bondsman says:

methinks your making much a do over nothing

flobach says:

Hi bondsman,
Why do you think so? If we as a profession want to be taken seriously and be able to have a strong voice within healthcare, we need to be known by our professional title, not our vehicle or anything else.
Transport the scenario to a business environment; it is Marketing and Communication 101 to have a proper brand and naming convention – the same applies to Paramedicine.

Ray Bange says:

In the past five years I have written 20 or more major submissions,on health care reform and EMS policy for State and National governments, Committees of Inquiry, and Investigative Reviews. I have met and spoken to Health Ministers, Shadow Ministers, Premiers, Opposition Leaders, Chief Medical Officers and Service Chiefs from the highest level down.to the grass-roots practitioner. I believe I gained a good understanding of what works and what doesn’t work at policy levels in communication terms.

As a policy strategist with a great interest in change management, language and communications the inescapable conclusion I have reached is that language and terminology has been a major barrier in identifying, understanding and promoting the role of paramedics. In many ways through imagery and language the profession projects a distorted view of paramedic practice that diminishes the health care and professional aspects of the role..

Let me hasten to add that I have the highest regard for the operations of paramedic/ EMS service providers.and strongly support the creation of an esprit de corps that will help boost morale and exemplary performance. However, that is not the same as paramedic practice,involving individual competency, accountability and fitness to practice.

As communicators projecting their professional role, paramedics at times are their own worst enemy. Flobach raises important points to consider when writing or speaking about paramedics and paramedical services. The difference is that he takes a proactive stance rather than just raise the issue. That’s the same as Paramedics Australasia.which for several years has worked actively to use more appropriate terminology in its corporate communications and publications.

These aspects of appropriate terminology that focuses on the practitioner as a professional go to make up what I have referred to in the past as ‘self-actualisation as a professional’. Language is not just important in a technical sense but is crucial to promote a better understanding of paramedicine as a field of professional endeavour.

tooldtowork says:

A now retired dispatcher I worked with responded to a police request to “push” the ambulance by telling the police dispatcher that we didn’t have to push them because they have engines.

Well, I thought it was funny, but the bosses didn’t.

johnwood237 says:

Hi Florian. I absolutely understand the point you are making. I too am an advocate of the paramedic profession and work as hard as I can to get the message across to paramedics and other healthcare professionals that we are a discreet profession and should be seen as such. However I think there is a difficulty in describing the current NHS organisations which provide emergency care ie ‘ambulance services’ as a ‘paramedic service’. The care provided by the current ‘ambulance’ service is not exclusively paramedic care. The ‘ambulance service’ who employs me at the moment has three work streams – Patient Transport Services (non emergency transport), Urgent Care Service (Out of hours service) and 999 service. Whilst some of the care provided within this is paramedic care other healthcare providers such as CFRs, ECAs, Technicians, nurses and doctors are also involved. I think the goal for our profession is to stand alongside other healthcare professions as equals and to be taken seriously. I feel there is a danger that during the process of asserting our independence and autonomy we are seen as exclusive and elitist. Perhaps a more appropriate title for the service should be something like ‘Unscheduled Care Service’ or even ‘Emergency Care Service’ rather than referring to a mode of transport ‘ambulance’ or a single profession?

flobach says:

Hi John,
I see your point – and see the complicated situations. You mention different levels and different naming of staff (technicians and Paramedics); if you go by the definition of International Paramedic, they are all Paramedics. UK legislation aside for a moment, the core staff of a Paramedic Service are Paramedics – well educated, trained and experienced healthcare professionals. They can be assisted by community first responders, patient transport officers etc, but the core service is to provide paramedics when the need arises (including urgent care services you mentioned). Doctors and Nurses are in their own profession respectively, but can still be employed or tasked by a Paramedic Service.

When you move home, you might employ the service of a Removalist. Whilst called a removalist service, they will pack your goods, remove them, transport, possibly store them, deliver them and unpack them. They may offer insurance or even clean your house. But at the core of their business, they are removalist specialists.

Agreed, there is a danger of being seen as exclusive and elitist in the process of becoming a more recognised profession – but as it stands, we are already exclusive (I would like to see healthcare far more inclusive of paramedicine). Elitist? We must self-police ourselves; as long as we approach other professions and healthcare with a holistic and inclusive view, I don’t think that should pose too much of a problem.

Paramedic Service. Two words. Terminology people can understand. Terminology that represents our profession correctly and concisely. One of many steps of advancing the profession, but an important and sadly often overlooked one!

john Wood says:

How could I be seen to disagree with someone with such a dedication to promoting the paramedic profession? I don’t necessarily concur with your point of view on this but keep up the great work. With regards to your answer to Michelle – did you mean to say the profession should not be protected by a single title? ‘Paramedic’ is the protected title – any other addition ‘Critical Care’ etc is a local add on to describe a role. The ‘College of Paramedics’ describes ‘Specialist’ and ‘Advanced’ Paramedics (Career Framework) with ‘Critical Care’ and ‘Paramedic Practitioner’ defined (with other specialties to follow). The plan is to open a specialist register (initially voluntary) to give some consistency to the described scope of practice / educational requirements of these roles. Perhaps in this way we can avoid some of the issues the nursing profession has experiences with defining specialist roles.

flobach says:

Feel free to disagree with me, as passionate as I may be – nothing wrong with a good discussion.

You are quite right, I wrote my thoughts a little unclear: ‘Paramedic’ should be the overarching title, and then below it the multiple additions – all protected of course. A specialist register would be of great benefit IMHO.

Nicole says:

I was driving a patient to hospital in an ambulance the other day and a family member was sitting in the front passenger seat. She answered her phone and said “oh yes I’m just on the way to hospital in the paramedics”. Not entirely correct but at least she didn’t call me am ambulance!

Ray Bange says:

One can smile at that – but the transposition of terms firstly shows how the public can confuse, the roles and secondly that it is not too difficult to lead a change in terminology with paramedic already beginning to be recognised. It just needs strategic positioning and a steady but sure approach since nothing will change overnight,

When promoting change you have to start sometime and somewhere, and not just complain about the situation. Mutual respect will be earned (and granted) when the communication barriers begin to crumble and people undertake inter-professional education and start talking to each other instead of in separate silos.

Michelle says:

I totally agree with your frustrations! But some good points have also been made above. In the UK in particular the current ‘ambulance’ services encompass much more than just Paramedic services. At present there are still Tech crews responding to 999 calls. And the term Paramedic, is rightfully so, a protected title. As it should be for a professionally qualified body of health care professionals!

More and more the initials EMS are used, so why not have a title for a service that does what it says on the tin, and call them Emergency Medical Services. Regardless of the qualification of the person providing the service, that’s what you’re getting when you make that call, an emergency medical service?

Just my opinion…….

Ray Bange says:

One of the reasons for a lack of recognition of paramedics as health professionals is that in the absence of registration and a structured nomenclature, individual employers have adopted a variety of titles with different scopes of practice.

For example, the paramedic practice roles in the Australasian region (replicated elsewhere) varies between jurisdictions, practice settings and engaging organisations. The different legislative frameworks in Australia and New Zealand also give rise to local variations in practice such as controlled substances legislation.

If you can’t articulate a clear definition of your occupation is it any wonder that it becomes difficult to be recognised by others.

The answer is that paramedics need to take ownership of their profession and play an active role instead of a passive or reactive (or even apathetic) role.

Paramedics Australasia has recognised the importance of professional identity and as part of the move towards registration in both Australia and New Zealand has developed a series of paramedical role descriptors for use within Paramedicine in the regiion. This innovative work by PA covers the broad classifications of professional, technical and communications streams of practice.

To read more about this development go to : http://www.paramedics.org.au/paramedics/what-is-a-paramedic/

flobach says:

Hi Michelle,
Thank for the Comment. See my reply to Johns comment as a reply to some of your questions as well.

I agree, our profession should be protected. By one title? No!
Well, not entirely. There are Advanced Life Support Paramedics, Basic Life Support Paramedics, Critical Care Paramedics, Paramedic Practitioners and so forth. All Paramedics at the core, but with different specialisations (see Paramedics Australasia)
Parallel this with the job of a Police Officer. Detective, Sergeant, Dog Handler, Armed Response, Highway Patrol, “Beat Bobby” etc…all Police Officers.

Paramedic Service – that is a title for a service that does what it says on the tin. EMS is part of a Paramedical Service – the response to emergencies within the community. But what about Primary Health? It is playing a bigger role within paramedicine now than ever before. A very interesting paper I can strongly recommend in this subject is the “EMS Chiefs of Canada – the Future of EMS in Canada” Especially Page 3: The Vision, they have a great diagram based on the 6 pointed star of life:
– Injury Prevention and Control
– Emergency Medical Response
– Community Health
– Training & Research
– Public Education
– Emergency Preparedness

Far more than just Emergency Medical Services!

[…] he’d observed at the Emergency Services Show at Stoneleigh, Warwickshire. He’s blogged about it as well. This is the use of ‘ambulance’ to define our profession. He wondered, […]

meditude says:

I was going to write a comment, I wrote a blog post instead!

Tj
@meditude

Meditude.WordPress.com

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