Professional Practice in Paramedic, Emergency and Urgent Care, First Edition

Health policy changes from 1997 set out to modernise the NHS through the
delivery and continuous improvements of high-quality healthcare services
that was designed around the patients. As a result, demand-driven, highprofil
services such as emergency and urgent care, saw the implementation
of national standards to reduce waiting times and improve access to
emergency and urgency care services. This led to dramatic changes in new
ways of working, role redesign and changes in skill mix to redesign service
delivery. Like the NHS, ambulance services in England are also playing an
increasingly wide role in the NHS in response to national policy changes.
Traditionally, ambulance services have been designed around delivering
resuscitation, trauma care and cardiac care to patients who are critically
ill. Eighty percent of training to front-line ambulance clinicians has
been focused on this. Today, 90% of patients do not fi into this category.
Ambulance services have changed their traditional approach and are now
more embedded in urgent care as a whole to provide a mobile healthcare
service for the NHS. Added to this is an increase in public expectations,
advanced medical and information technology, an ageing population and
chronic conditions has put even greater pressure and demand on emergency
and urgent care services. This has been a positive move towards roles
of nurses and paramedics, perhaps politically driven but also out of the
desire to enhance patient care, improve access, reduce unnecessary attendance
to emergency departments, provide care closer to home and unlock
and utilise nursing and paramedical potential.
The current provision of emergency and urgent care services, roles and
responsibilities of nurses and paramedics are continuously evolving and
increasing in the UK. Patients are now accessing and seeking care at the
point of delivery. As a result, the front-line practitioners have to consider
options for referral and the use of alternative care pathways. Paramedics
and nurses working in this sector need to be educated and trained to deal
with the mixed case they see both at the pre-registration education and
continuing professional development. They must have the underpinning
knowledge and skills which will enable the correct clinical decisions to be
made, which are demonstrably in the patients’ best interest. This can only
be achieved in a clinically safe, professional and lawful manner (Nursing
and Midwifery Council 2008; Health & Care Professions Council 2012).
This book is intended to provide the underpinning theoretical knowledge
of the issues that you encounter on a daily basis when working
in the pre-hospital, emergency and urgent care environment. This will
hopefully enable you to develop a comprehensive theoretical understanding
of the issues underpinning professional practice which is fundamental
to everyday clinical practice. The chapters will provide clinical exemplars,
discussion points and critical thinking points throughout. This is intended
for you to reflec on your own experiences in order for you to link and apply
the theory to your own area of practice. Illustrations given will also
demonstrate how the theory is applied in practice to increase your understanding
of the concepts explored in this book.
The firs three chapters are focused on patient assessment which includes
history taking, consultation and communication skills and clinical decision
making. These three chapters are inextricably linked and cannot be viewed
as separate subjects. Therefore, all three chapters should be read in conjunction
with each other in order for you to gain a comprehensive theoretical
understanding that will enable to justify your decision making when assessing
and managing patient care.
For the remaining chapters, it is inevitable that the subject areas
discussed and explored in this book are integrated with each other and
therefore there will be some overlap in each individual chapter. Wherever
possible, these have been cross-referenced to chapters where it is discussed
more in detail.
As the book title suggests, it is intended for paramedics and nurses
working in pre-hospital, emergency and urgent care. Chapters 3, 6 and 7
predominately focus on paramedic practice; however, the principles of professional
practice are transferable and therefore can be applied to all areas
of healthcare practice.
Paramedics and paramedic practice is an emerging profession and therefore
the literature predominately relates to the clinical aspects of practice
with very little relating to the professional aspect of practice. Therefore,
the literature used throughout this book has been drawn from other disciplines,
predominately nursing. It is important to understand that regardless
of this, the theoretical knowledge and skills are transferable and will
apply to all healthcare practitioners.
It is hoped that this book will enable you to develop a broader and deeper
knowledge base of the theoretical issues that underpin professional practice
and how this is applied to everyday clinical practice. I hope you enjoy
reading this book as much as I have enjoyed writing and editing this book.
Val Nixon