In the not too distant past, Paramedics would train as Ambulance Technicians before becoming Paramedics. It was almost the only way to progress up the clinical greasy pole, and a “right of passage” for many. Many argue (and I would be one of them), that being an Ambulance Technician first is vital experience and knowledge that is quite often lacking with the introduction of University-level qualifications. It’s something which simply cannot be taught or learnt from sitting an OSCE, yet as the profession rightly marches forward into the future of prehospital care, I think its important to take a fairly substantial reality check of who we are, what’s being asked of us, and just how bonkers it all is.

Look around you at medicine. Doctors, Nurses, Midwives, Physiotherapists; they are all specialists in one (sometimes a couple) of areas of medicine. There is little crossover into generalising, more often any less involvement in things which simply “aren’t their specialty”. There is little requirement for them to remember anything outside their immediately practiced sphere of medicine specialty, and changes that do come about tend to be small, slow burning and with a great deal of research and training behind them.

Once they’ve completed their foundation training in years 1 and 2, Doctors find themselves able to specialise in one (sometimes a couple) of areas of medicine they wish to work in. Some will go to Surgery (and then a sub-speciality after that), some will decide Geriatric Medicine is for them, others may choose Anaesthetics; the list continues. What you don’t find anywhere (except Accident and Emergency), is people trying to be Swiss army knives. Specialities allow Doctors to focus on one primary area of medicine; you won’t find a Cardiologist talking to you about your fractured femur, and that’s because it’s incredibly difficult (and most likely impossible) to be very good at many things all at once.

Specialists are there to exude confidence in the subject matter, and this enables exemplary practice, fantastic results, and huge amounts of patient confidence in the healthcare system they need and want. Accident and Emergency Doctors are slightly different as they’re dealing with “whatever comes through the door”, but even A+E Doctors have the privilege of calling on specialists, referring onwards to other teams, scans, bloods, teams of people around them at all times; in truth, they get it quite lucky.

So why mention all this? Why is it important? Consider your training. Consider your exposure. How does it compare? Seem like a level playing field? Do you experience “imposter syndrome”?

Paramedics at the point of registration with the HCPC are expected to be the world’s most ridiculous generalists. Almost every strand of medicine is featured in the prehospital setting, and from day 1 job 1, you’re expected to understand all of it, and in many cases, deal with the problems it can cause or present. Even a speciality Consultant in a hospital setting after 12 years training and experience isn’t asked to do that, and they’re surrounded by other specialities, machines, colleagues and more! A Band 7 Nurse very often wont have anywhere close to the independence, decision making and clinical autonomy of a Band 5 Paramedic straight out of University, and as a minimum they would have around 5 years of experience post-registration.

The role of the Paramedic is literally, bonkers.

Can you deliver a baby? Yes. How much training do you receive to do that? probably about 3 days plus an OSCE. Is this the most high-risk part of obstetrics? Yes. How does compare to Midwives who take 3 years to train? I’d say it comes up quite short.

How about someone in Cardiac Arrest. You’re first on scene; it’s you, an ECA, and a Community First Responder. You’re a Band 5 Healthcare Worker, and you’re meant to lead this resuscitation, make the “big decisions”, and be accountable for the process, treatment, and outcome throughout, with 2 other people. In hospital, there would be a team of around 8-10 people, many of which would be Speciality Doctors in Anaesthetics, Emergency Medicine, Resuscitation Officers, Senior Nursing staff; all surrounded by machines, scans, and limitless options for ongoing care. They will be vastly experienced, and selected due to that experience, clinical grade, and knowledge. Three people compared to 8. Speciality Doctors with likely over 25 years of combined knowledge and experience, compared to you as a registrant who has 3 years of training, a handful of preceptorship shifts under your belt, and a prehospital version of a Healthcare Assistant.

What’s the effect this pressure has on a new registrant? Is there any surprise that NQPs and students find the expectancy levels of them overwhelming and immensely challenging?

Can Paramedics be expected to remember everything? No. Is it likely that Paramedics will forget to do things, forget information they are given, and make mistakes? Yes. Is that their fault? In many cases, probably not. The amount they are expected to know, remember, and adapt to through one singular shift can be unparalleled when compared across the medical field. Your hospital Cardiac Arrest is on a bed, in a department, with perfect lighting and surrounded by “things” to help. The Prehospital Cardiac arrest can be upside down in a ditch, in a boggy muddy swamp, at night, in the rain; and that’s on a good day!

The level of clinical knowledge and ability expected of the Paramedic is vast. It is greater than any other healthcare worker in the UK at the point of clinical independence, and the pressures on students and newly qualified registrants can be unimaginable.

Paramedics will never be Doctors, and Doctors are a completely different breed of clinicians that many Paramedics would aspire to be, but there are plenty of doctors who wouldn’t want to be Paramedics too, and that should tell you how challenging it can be to be you.

The road to success can be long, scary, and frequently as a Paramedic, you cant see the end or the target your aiming for. Don’t let that deter you. Trust your instinct, go with what feels right. Don’t let the brisk Handover Nurse in A+E make you feel inadequate; they couldn’t do your job. When you “Blue” that patient into Resus and the Doctor asks why you didn’t do “XYZ”; remember they’re speciality trained, and probably have more years under their belt in A+E than you have out of High School; they couldn’t do your job. You are in a bonkers position, juggling 15 balls, whilst blindfolded and after one-too-many Jager bombs.

Don’t be deterred, and don’t feel embarrassed or ashamed if you forget things or find it difficult to deal with complex presentations. Everyone forgets things. The difference is everyone else is forgetting things in the one subject area they specialised in; you’re forgetting how many stripes Zebra 346 had in the stampede you saw 2.5 years ago. Be a sponge, learn things every day. Sometimes those newly-learnt things will push some older-learnt things out; but you’re a generalist, not a specialist; it’s okay to not remember it all!