The uncertainty of Brexit causes discomfort. For frontline staff facing job-related stress on a permanent basis, this could be the tipping point. If and when Brexit goes ahead, many Europeans will likely return to their countries of origin. There has already been a significant increase in EU personnel leaving their jobs at ambulance service trusts since the 2016 referendum, exacerbating the shortage of paramedics nationwide. This inadvertently puts additional pressure on the staff who remain and try to meet their service's response targets.
Whether you are a British or European citizen, this situation affects patient care directly and indirectly. Even if employers try to reassure their EU staff, one cannot stop wondering on a daily basis how and when the tide will turn, even while they are treating patients. Some of these patients may be expressing compassion towards the EU paramedics as they discuss points of view and personal matters on their way to hospital—quite an ironic potential situation—while others will make it clear that according to them, it is only right that people should return ‘home’ to where they were born. This is the ‘Clash’ of remaining or Brexiting—should I stay or should I go?
For those thinking of moving, why not also consider a slight clinical practice change with less variable elements? In the current issue of International Paramedic Practice, Clarke et al explore the role of paramedics in the emergency department of a busy Canadian emergency and trauma centre and the challenges they initially faced. By virtue of being prehospital care professionals, hospital acute care services can leverage paramedics' relative broad scope of practice and ability to work independently or as part of a team. Other key attributes are their inherent versatility and adaptability, and this article demonstrates this very well. The use of the ‘department paramedics’ has been greatly beneficial to the trauma centre, especially because of the paramedics' significant autonomy, their vascular access and airway management skills, and above all their ability to perform procedural sedation and administer analgesia, saving time for the physicians to perform other tasks. Having staff who can transition to work wherever there is a need in a department during a clinical shift helps improve patient flow, but can initially be wrongly perceived by health professionals who are resistant to a new approach of care.
Another key article in this issue by Mitchell et al focuses on the teaching of applied pharmacology to paramedic students using a multi-phase approach that takes into account adult learning principles. The authors present an innovative approach that involves teamwork, self-directed study, collaboration, presentation skills, taking part in a scenario with a simulated patient, and receiving feedback about their performance.
Although this relatively structured problem-based learning approach allows learners to develop their clinical reasoning skills, the activity could be further improved if the review phase adopted a learner-centred debriefing model, less directed on feedback being given and principles being highlighted by the lecturer, but rather getting learners to explain their decisions and actions, and to report their lessons learned. Such practice takes more time than directive feedback but an inquisitive discussion would promote greater reflection among learners and further deepen their learning.
Like the rapidly evolving paramedic profession and the chaos provoked by Brexit, educational practices are in constant flux—and whether you choose to stay or go, the IPP will remain a constant uniting paramedics around the world.