Talking to people, reading books and surfing the net, you regularly come across a statement when it comes to personal development: “Get out of your comfort zone!”
So I did. I got off the couch.
And proceeded to board a flight to Switzerland – and I must commend the pilot for one of the smoothest landings I have ever experienced. Very comfortable. As are swiss trains. And my friend’s spare bed where I stayed a night (thank you hpcpr!).
Why was I actually there? I had signed up for was an Advanced Cardiac Life Support (ACLS) course, at a small but great little Paramedic School near Lucerne. I had spoken at a conference there last year which left me a good impression, plus I knew one of the staff there…and thought to myself “wouldn’t it be great to get some clinical skills done in a different language, in a beautiful country?”
Now, having grown up speaking German, and lived in Germany for 17 years, I’m au fait with the lingo. But I a) haven’t lived there for 10 years now, and b) the swiss dialect is comparable to Scotsman having a raging throat infection whilst simultaneously suffering a stroke.
Needless to say, I had my work cut out for me.
The ACLS bit wasn’t too difficult. I had the handbook (in Hochdeutsch, equivalent to Oxford English), and most of the clinical stuff was (well needed) revision. But I still went home with a bit of a buzzing head after each of the two days. Listening to conversations, let alone instructions, in a tricky dialect does push you out of your comfort zone.
So – what do we learn from all of this? My take home message (literally, as I’m writing these lines on my way home from Gatwick Airport) is that getting myself out of my comfortable, well known and understood environment got me more than just an ACLS certificate. It got me a shift in a different ambulance service, it got me a relaxing holiday, it allowed me to catch up with friends…but most of all, it was a humbling experience. All my professional knowledge and expertise doesn’t count for much when you are (at times) desperately trying to understand what’s going on, and formulate a fitting response in a way that the others will understand.
Experiencing that humility every once in a while is vital. Not only as a paramedic, or a manager or a leader, but as a human.
So after countless hours of preparation, xprevaluation, frustration and procrastination, here I was. Das 1. Zukunftsforum Rettungsdienst, the ‘First Paramedic Future Forum’ was going to begin in a few hours, with yours truly about to give a speech on a bit of a provocative issue, not only within paramedic services. I have split the talk in to three blog posts: This one will present the “whos, whys and whats” about us, the next post will follow on our expectations, finally, the last post will be on how to bring it all together. As always, feedback (via social media or the contact form) is muchly appreciated.
Who are we?
Being a Gen Yer myself, I am writing this post in first person – I am after all talking about my generation, my peers, our (general) viewpoints and our issues! But firstly, why Generation Y? Because Y comes after X, simple. Additionally, we are Generation WHY? – more on that later. It is not clearly defined who is and isn’t Gen Y. Depending on your sources, it is roughly those born between 1980 and 2000.
Think back two or three decades ago. What was going on in the world back then was what shaped us. The big one was obviously the rise of computing technology – it was coming from academia and defence in to commercial applications, and quickly spread in to our personal homes (and continuing in to our pockets!). We are the first generation to grow up with computers – we are Digital Natives. We understand, use, and trust technology.
The rise of technology also meant the rise of instant access to tons of information – we know our surroundings much better than we used to, and what we want to know is just a few clicks away. The media has obviously grown with this; advertising and marketing means that specially selected information has bombarded us from an early age, mostly without any clicks necessary.
The removal of many boundaries and borders, geographical, economical, political etc, has made the world a smaller place. Trade has increased, giving us access to exotic goods. And if we want to find out more about whatever we fancy, the advent of available, cheap, and safe mass travel has enabled us to move around the globe much more easily than ever before. This is not a privilege for rich white men anymore either – think of how far womens rights have come in the past decades, as well as the recognition and support of various minorities, access for lesser abled, decrease of global poverty etc – all this has given us a different view of the world.
Our Traits & Characteristics
So what do our influences translate to in reality? What can one say about us? One major fact about Gen Y is our high education – we make up a higher qualified and skilled workforce than ever before. The number of university graduates has continually increased (see Australia, Germany, UK, US). We also know that with the attainment of our education, our dream job is often not around the corner. We are mobile, and happy to travel to get to the job we want, where we want it. To stay in touch with friends and family, we use technology, the same way we found the job in the first place. This also allows us to find out how the service in the next city, county, or country works. Maybe we should move there? Or even move to a different profession all together – we’re mobile in between industries.
This does show as less employer loyalty – but to many of us who have grown up with parents who dedicated years or even decades to the same employer, to be at best thanked with a sloppy handshake for all their toil, or at worst with ruthless redundancy when the economy folded, we have lost some faith in employers. After all, we work to live, not live to work! We like money, we want money (we want to express personality and individuality), but we want the flexibility to go away on holiday or more, to experience life from a different angle. Reading, watching, hearing about new places and things – that isn’t enough, we want to experience them! On top of that, we have an increased social and ecological conscience. We’ll do whats right, but also what is right for us (we’re still humans after all!).
I have often heard that ‘kids these days just sit in front of the screen’. Yes, we love our screens, but we use that as a connection with others – calling up another friends landline is outdated, and usually will be a fruitless exercise anyway because they won’t have a landline. With all the social media messaging services (and SMS prices dropping drastically) we connect online, digitally. It’s not necessarily better or worse, just different – with a whole world of new possibilities attached.
I digress a little…
Let’s get this edging towards the Paramedic side of things a little. Take a trip back in a time capsule, back to Station 51, riding along with Johnny & Roy in Emergency!
What were Paramedics Services then? Yes, correct: Ambulance services. Transport Services. Actual treatment was just beginning to be introduced. They really were, no disrespect, Ambulance Drivers.
Well, those Good ol’ Days are gone. Things have changed. But was everything really good? What has improved, what has become worse? Think about what kind of jobs we go to these days predominantly, and how many of them we attend. Paramedic services have moved, developing both clinically and operationally. Some of our interventions would have been doctor only 10-15 years ago, which is a strong nod to our increased capabilities due to increased education and knowledge.
What are we confronted with?
So now you know who we are. We’ve touched on where Paramedic Services have come from, but I believe we all know that we are not yet where we want to, could or should be (with very few exceptions).
Look around and you will see ossified structures, making it nigh impossible to implement change. And if you are lucky to get to the stage of being able to adjust and improve an issue, the tables are guaranteed to turn very slow indeed, resulting in something between frustration and capitulation. Let’s face it: we are working with outdated systems.
There is much to be changed and improved. The 20th century finished over one and a half decades ago. Let Gen Y help with bringing our profession in to the 21st century.
Earlier this week I travelled to Hamburg, a great city in the far north of Germany, with a rich history of trade and some beautiful views (especially in the snow), even if the general attitude of the folk there can be rather cool and direct…consider yourself warned 🙂
Hamburg, being a hanseatic city, thrived and thrives on trade through its port, which it has been relying upon for centuries. Knowledge, experience and wisdom has continually been passed down from one generation to the next in a move to keep the city, and the trade, at the top of its game.
What has that got to do with Paramedic Services, I hear you ask? And for the more established adults amongst you, dear readers, do I detect a hint of frustrations at us Young ‘uns, with all their Facetagram, Twitspace, Blogtube, glued to their screens all day and night? And for fellow Young ‘uns, I can hear your sighs when you think about those old guys who just don’t get what the net is all about.
Well, earlier this week I attended the 1. Zukunftsforum Rettungsdienst, the 1. Future Forum for Paramedic Services in Hamburg, to talk about just that: Generation Y – our expectations and demands.
There hasn’t been much happening here as of late. Much of that has had to do with my energy being channeled in to my last module of my uni course, which, as you can hopefully understand, is draining. But you know what? I handed in my final essay this week, and I can feel the tension and the pressure slip away – and all that energy being available for other good things. I have some plans for some interesting blog posts in my mind, so keep an eye out.
Actually, it meant quite a lot – so enough of the reference to 80’s pop music. I chose Vienna for my birthday destination because….well, I don’t really know. I had been before, couldn’t remember much – I believe I had not hit my teens yet, and as such it was a few earth rotations around the sun ago.
Vienna turns out to be a beautiful place, with spectacular old buildings, scrumptious food and a sophisticated yet laid-back cultured vibe. I can only recommend that you should visit it, and eat, drink and be merry there. I’m not one for much repetition, so I’ll leave you to check out my other halves delectable musings here.
Through conference attendances I had got to know some lovely Austrian Paramedic folk. As one does when visiting a country of foreign friends, one calls up (well, emails) in advance to organise a coffee together and the next thing you know you have a shift on an ALS response vehicle booked. Can’t help myself – and I count myself especially lucky as my other half is not only tolerant of such fun outings, but actively encourages me to do them (which she planned to turn in to some time to pursue her own interests, like watching some equine practice prancing. I might be losing some brownie points here, but I really can’t warm myself to horses. They have big teeth and don’t talk).
My alarm went off at 5am. Early? Yes. Girlfriend snuggled beside me on the mattress all warm and cozy? Tick. Could I have done with a bit more sleep? Indeed…but I was up and showered and ready to go in no time, excited by the prospect of experiencing another ambulance service!
After finding a little local bakery that mercifully opened early enough for me to buy all the danish (read: viennese) pastries within the city limits, I was fed and watered and awake to jump in to my Wiener Rettung (Viennese Rescue) experience. Now only to find out where I have to go…
As has often been the case in the past, someone saw me confused & pondering in front of the new building (the main building was closed and locked and dark), let me in and in a friendly manner pointed me in the right direction.
After a quick tour around the building (nice and modern, with beds, a comfortable communal, kitchen and outdoor area), and I am introduced to the Paramedic I will be following for half the shift. I say half a shift, as I only wanted to spend a coupe of hours to gain some insight, and not a whole day; it turned out to be a quarter of a shift, as the guys and girls in Vienna still do 24hr shifts, with the possibility of 15-20 jobs in that time frame. Phew!
I was going out on the ALS response car that morning, with a Paramedic driving, and an emergency doctor treating. When I say Paramedic, I mean a person who is trained in emergency care, and – at the highest level – can intubate and cannulate. Nevertheless, they are still very transport focussed, and paramedics take a backseat in clinical care, leadership and development – most likely because the system is so heavily focussed on doctors as advanced providers. Even worse, Vienna is the only city in Austria that has an entirely career based ambulance service – the rest of the countries ambulance services release heavily on volunteer input. Often, I was told, the ambulances are staffed with two volunteers with lower qualifications. Vienna is fighting this, and trying to bring forward the concept of a paramedic services within the country. They are doing a fine job it seems within Austria, but in an international comparison there are some areas where they are lacking.
But don’t write them off just yet, they have some interesting things to show to the world! They have just started a new level of Paramedic within the service. Qualified Paramedics are undergoing a three year course to further their knowledge and experience in such areas as critical care, primary care (community paramedicine), and field supervision (teaching and quality assurance), and they are building the course on input from a variety of international best practices – so hats off to them! I am looking forward to seeing them progress, and hopefully joining the international Paramedic playing field in due course.
I went out on three jobs all together, including a 20+ minute run to backup a cardiac arrest. Not only was the job on the other side of the city, but it had also just started snowing heavily – and with heavily I mean approximately 15cm (6 inches) of snow in one morning. A standing and sliding ovation to the Paramedic I was with who safely navigated the traffic that morning.
And now, a few impressions, facts a figures from my shift:
Vienna runs approximately 35 ambulances throughout the day, additionally 6 ALS response units staffed by a Paramedic and a Doctor. The ambulances are staffed with three people – a wheeler, a healer and a dealer (OK, I made that rhyme up…one person drives, one attends and one is an additional pair of hands). This can get quite cramped inside the van conversion ambulances they use – working on a sick patient, there were two paramedics, a doctor and myself squeezed around the patient, and we could barely close the door. The service is considering in to larger vehicles for the future I have been told.
The Wiener Rettung only do emergency work, all patient transport is done by private and/or not for profit organisations such as the Red Cross or the Samaritans.
In the event of a cardiac arrest, the closest vehicle is sent – including the above mentioned patient transport vehicles or as well as the police as first responders. They are backed up by an ambulance and an ALS response car. The fire brigade are not involved at all – they were apparently invited, but declined.
There are no response time targets to be upheld, but a unit that has been alerted from station must be mobile within 2 minutes during the day, and three minutes at night.
Joining the service is an interesting path, one that I had not heard of before, some interesting ideas. After being accepted, either as a rookie to Paramedicine, or even as a qualified member, you start off doing station duties. You get to work, put on your uniform, and you clean and restock vehicles, inside and out. This is to get to know how the station operates, picking up the culture (e.g. cleanliness) and where everything is kept in the vehicles. If there is a staff shortage on that day, you will also man the ambulance if need be. After a period of station duties, you then progress to permanent on road duties.
After five years as a Paramedic, one can apply to work in the control room – this is often done by those who have injured themselves on the job and cannot work on the road, or those who have done their decades of work and prefer the slightly more controlled environment. Calltaking (via AMPDS) and dispatch is done at the same desk by the same person.
I had a great time in Vienna, and being allowed to experience their ambulance system was the cherry on top of the trip. I would like to sincerely thank all involved for giving up their time in showing me around and meeting me, it was very appreciated.
Finally, I would urge everyone working in the field of paramedicine to consider visiting other services when they are on holiday. Not only do you get great insights and make some new friends, but you also get to see the area you are visiting from a local paramedics perspective – a view that is quite different than that of a tourist. Give it a go, I’d be very interested in your experiences.
I recently attended the Blue Light Collaboration Conference in London representing the College of Paramedics. I was initially a little sceptical, as I don’t have much to do directly with collaboration between services apart from direct contact with them as an on road paramedic, but then I thought this may be a good opportunity to meet new people, see different perspectives and get some other thoughts.
And it delivered. There were many delegates from various UK Fire & Rescue Services, plus a few paramedic, police and government representatives. Due to this, the main `topic was the collaboration between paramedic and fire services – co responding, emergency response, joint response…different names for basically the same thing: Fire & Rescue Services with their decreasing workload assisting Paramedic Services with their increasing workload.
There are a couple of different models how this works, but the most advanced and integrated (or overlapping?) model comes from Lincolnshire, in the East Midlands of England. There, East Midlands Ambulance Service (EMAS) and Lincolnshire Fire & Rescue Services (LFRS) have been working together in an official capacity since 1998, and their current setup is a natural progression of pure first responder type scheme: In a UK first, Fire & Rescue are actually manning three ambulances.
In my opinion, the pros outweigh the cons: The Fire & Rescue Service have capacity to spare. Their workload has gone down significantly over the past decades, but the public still deserve a good level of fire protection. In between fire and rescue calls, there is only so much training one can do – why not utilise their time for medical transport? Ideally, fire cover should not suffer from this model, but have a thought and compare: the risk of morbidity and mortality of medical origin (mainly cardiac) outweighs the morbidity and mortality of a fiery origin by quite a high factor. Both Paramedic and Fire & Rescue Services have one single task when broken down to the bare essentials: to serve & protect the public. Why not collaborate in order to maximise our efforts and outcomes?
This direction also got me thinking one step further: What if Ambulance Services (you may have noticed I have been avoiding that term) focus on their core strength of providing healthcare to the public, and “outsource” the transport side of operations to other services or suppliers?
A true Paramedic Service would take requests for help from the public, and point them in the right direction. If they can be helped at the point of their initial query and be referred on to more appropriate services (e.g. home care, GP, pharmacy), that works in favour of the public (accessing the appropriate care as timely as possible), and in favour of the service (only sending paramedic resources to the patient when appropriate). If a Paramedic is required at the scene of an incident, they can decide if transport is necessary. All this is already happening in some services around the world, but lets take it one step further: The Paramedic on scene then needs transport capacity, as they respond in mobile rapid response units (fancy speak for cars or minivans). Enter Fire & Rescue Service: they provide the transport capabilities, with basic life support dual trained fire fighters. Should the patient be stable and only need transport, they they can be transported. Should they need ongoing paramedic intervention and/or monitoring, the paramedic can hop in the back of the fire ambulance, and paramedic care can be given en route until handover at hospital.
Currently, there are only three Fire & Rescue (F&R) Ambulances in Lincolnshire supporting the Ambulance Service in a transport capacity. But if F&R took charge of the entire transport side of things, Ambulance Services could turn in to dedicated Paramedic Services, and focus on delivering high quality paramedic care to the community, without the overhead and distraction of not only fleet maintenance but number of other areas. F&R Service would be able to use their resources more effectively, and not have to close fire stations, thus keeping up fire cover for the public.
The above lines are only a thought experiment taking the Lincolnshire model one step further, but it is an option to be considered. The people behind the pilot programme in Lincolnshire are due to publish some numbers based on their facts and figures over the past month (the preliminary data, I’ve been told, is promising). It will have to be properly evaluated and adapted to local needs, but I believe this could be quite an exciting game changer. I will be watching these developments carefully and with a lot of interest.
…or Overload, Procrastination, Quiet Reflection, Structure, Time to shine!
I’ve got a lot going on at the moment, keeping myself busy in and outside of work. Too busy, it felt at times, and too uncoordinated. Overload, and with it, Procrastination (of the bad kind)
Time to simplify. Out with the unnecessary, focus on the big picture. Not always easy in the age of information overload and the ever luring presence of social media to get your procrastination fix, but it can be done.
Reflective cap on, time for some introspection, reflection, rearranging, reprioritising. What do I want to do, what can I do, where do I want to go, how do I get there, who do I want to be?
But first, get the basics sorted, daily life. Bringing in some structure: