Regardless of where we practice emergency medical services (EMS) we all have the same basic goal; to provide care to those who are sick or injured. Worldwide the paramedic profession is in a state of transformation. Change is occurring on many levels. Some big ticket items spring to mind:
To adapt and exploit change we need to define our professional role and understand where we fit into the healthcare delivery model. This is a complex question for paramedics due to the diversity of practice situations globally. Ultimately, this diversity of practice contexts could be our ‘Achilles heel’ which makes consensus difficult. Regardless of profession, clear vision is required to make true transformational change. Also required is the support of the people in the profession; the adjustment of the services on offer and the processes which are involved in the delivery of those services.
Pre-hospital emergency care services are stretched to capacity worldwide. Paramedics have become a valuable system resource with the potential of positively impacting the healthcare system by reducing emergency room attendances through initiatives like treat and discharge guidelines and recognition and treatment of the acute coronary syndrome patient.
Change brings opportunity and both professional borders and deeply held conventions must be constantly re-examined as new interdisciplinary ways of working are created. Currently paramedic practitioners practice in a range of diverse situations using a wide palette of clinical procedures. As a developing global profession, similarities in practice are emerging and the profession must now begin to truly connect, network and understand itself. Paramedics have a tremendous opportunity to develop their professional capabilities as the future will bring increased clinical decision making, critical skills and levels of professional responsibility.
Change can also bring fear; adjusting the status quo will always result in resistance. Much of this resistance will emerge from colleagues who may not believe in themselves; some will come from other sectors of the healthcare industry who may not be satisfied that paramedics have the clinical skills or professional maturity to warrant increased autonomy. In time, as our profession develops through educational initiatives and healthcare system support, then new ways of solving issues will become clear to all stakeholders, attitudes should change across the wider healthcare community.
How should a relatively new category of registered healthcare professionals respond to this change? Change theory logic would indicate that paramedicine needs to develop a clear vision of what our ideal professional future should look like. This analysis should drive further movement towards that identified space. There is a premise in management theory that the worst possible situation to be in is to have ‘responsibility without autonomy’.
As professionals we should embrace responsibility to operate at higher clinical level while resisting system pressure to do so without a corresponding increase in our professional autonomy. Let me be clear, I don't mean practice without guidelines; that would be foolish—independent collaborative practice will be achieved through embracing change; our practice should be benchmarked against best international pre-hospital practice guidelines that we create collaboratively through developing international forums.
The future development of paramedics is ultimately about the identification and alignment of our shared professional vision and values with the healthcare systems needs and the adjustment of our scope of practice within a regulated framework leading to increasingly autonomous professional practice.
As a professional pre-hospital emergency care practitioner, are you ready for that?