In Switzerland, two training levels are available for ambulance crews: ambulance technician (federal certificate level professional examination), and paramedic with a higher education diploma (3-year course at a higher-level professional school). The first corresponds to an emergency medical technician (EMT) basic training programme (1800 hours of training), while the second is equivalent to that of paramedics (5400 hours of training). Requirements are defined at the federal level by a framework study plan, and training mainly focuses on acute, urgent and severe care. Professional algorithms are used to guide practices and support training.
There is however a discrepancy, as these intervention patterns only represent 15% of the work situations of prehospital teams. The population's demand in this field has changed significantly, moving from acute interventions to demands of a more social, psychiatric or minor nature (85% of interventions concern NACA scores 0 to 3). At the same time, current sociodemographics are such that a groundswell orients health needs towards an ageing population, chronic pathologies, and polymorbidity.
This evolution entails changes in the organisation of the prehospital health system. This concerns aspects as varied as health regulations; the possibility to send more varied means of transport; different levels of intervention; the possibility of interdisciplinary collaboration on the scene; and for public health services, the adaptation of regulatory foundations. It appears necessary to consider without delay reorienting the training in order to refine clinical and patient assessment skills, interdisciplinary work skills, as well as work on the appropriate professional stance.
Another discrepancy can be seen in the fact that some young paramedics are disillusioned by the contradiction between the practice model on which their training is based, and real practice. Students start this curriculum with the idea that the profession consists of saving lives, performing delegated medical acts, managing acute or even extraordinary cases (vehicle extrication, polytrauma, etc.) Disillusionment seems to contribute to the abandonment of the profession after only a few years of service (3–5 years post graduation).
Professional expertise acquired after several years of practice and used for the benefit of patients and future colleagues should be protected. This involves the study and promotion of strategies for keeping paramedics at work, for those who persevere in their activity. This constitutes the second reorientation line for the training, which should aim to contribute to changing representations on the profession, to take into account the management of factors keeping people in the profession and, prior to training, to modify the models used to recruit future professionals in schools.
There is an urgent need to rethink training from the traditional ways of managing acute and protocolled cases. Some countries have already addressed this issue. Significant developments have taken place in Scandinavian countries and, in Great Britain, the added value of advanced paramedics practitioners has been demonstrated in advanced and diversified practice skills.
However, another question arises in the medium term: will a framework study plan with an identical structure have the capacity to perform these changes? Which evolution should be given to the general design of the training? An in-depth reflection is necessary to determine how this can be achieved in accordance with the possibilities of the Swiss education system.