A recent conversation on Twitter around the lack of focus on social determinants of health in paramedic education highlighted to me the reality that we still do not understand or appreciate the broader role that we play in society. In an editorial last year (Batt, 2019), I outlined that in order to fully understand our role, and in order to guide it in future, we need to explore what it is that paramedics do, and be prepared to evolve in response to changing societal needs. In recent issues of International Paramedic Practice, authors have highlighted the link between social determinants of health and the impact on paramedics and patients. A number of publications in recent years have explored and highlighted areas where paramedics are poorly prepared to support patients experiencing intimate partner violence, homelessness, end-of-life issues, and mental health concerns to name but a few. This does not begin to address the many areas of practice that we have yet to explore and understand such as caring for refugees and Indigenous populations, and our role in public health.
It is with these broader conversations in mind that I am pleased to read Wilson and Hill's review in the current issue related to modern slavery and interactions with health professionals. A $150 billion dollar (USD) a year industry—construction workers, workers on fishing vessels and in factories, prostitutes, domestic workers—over 30 million people, most of them women, many of them children, in forced and bonded labour…these are modern-day slaves. While we might think of slavery as a historical problem, or one that exists ‘out there’, the reality is that, although illegal, slavery and human trafficking are still significant societal issues in almost every developed country. Paramedics in developed countries likely interact with victims of modern-day slavery on a regular basis, much of the time, unbeknownst to them. This represents a ‘hidden’ area of practice where paramedics could have a significant positive impact—if only we knew more about it.
Wilson and Hill go on to recommend education for paramedics in relation to modern-day slavery. This recommendation is echoed by authors researching slavery and human trafficking such as Donnelly et al (2019) and Charron et al (2020). While I fully agree with the call for more education on these issues, perhaps it is time for more joined-up thinking than we have demonstrated previously? Rather than identifying these issues post-hoc and designing education to address them, perhaps we need a ground-up rethink of what it is that paramedics do and therefore need to know. At the risk of repeating myself, maybe what we do is something we don't yet fully understand. In either case, I applaud Wilson and Hill, and others who are exploring these ‘hidden’ areas of our practice; doing so may help us to find—and help—those who are hidden within.