Things You Really Ought to Know
  • Never take a pair of gloves off expecting to be able to put another pair on right away. Sweaty hands make putting a new pair on very difficult. Sometimes it can be appropriate to ‘double glove’ (put two pairs of gloves on at the same time). Because if you get blood/something else on your first set, you can take them off and still have a pair on and ready to go. Always have an extra ‘emergency’ set or two of gloves on your person. You never want to be caught out without a pair to hand... (pun intended).
  •  Always take your fleece off when going into a care home (always too hot) or possible cardiac arrest (you’ll sweat and get blood/vomit/something nasty on it).
  • The ambulance profession is notorious for its dark humour. Many of the jokes and comments shared privately amongst ambulance crews could be offensive to many people ‘on the out side’. You may be shocked initially by what you hear, but you will get used to it. Do not feel a need to join in and do not feel bad about finding something funny. Often this morbid sense of humour is a form of discharge and a way of winding down after serious calls. Given the nature of this humour it is not a good idea to repeat what you hear, especially outside of the ambulance community. 
  • Blocking someone else’s personal car in at the ambulance station is a sure way to really get on the wrong side of someone. In the ambulance service finishing late unnecessarily is one of the biggest irritations to staff and if you are the cause because of your parking, you are in the bad books.
  • Look after your body’s joints from day one, especially your back. Always follow manual handling guidelines and never do a ‘bad lift’ because it seems easier at the time, it is not worth it for the health implications in the long run. Further to this, carry chairs are for carrying patients, as the name suggests, not for wheeling them any significant distance. Depending on the length of your legs and your back, and the design of the particular carry chair, you may be putting undue strain on yourself trying to hold the chair at the right angle to wheel the patient over flat ground. If there are no wheelchairs available at the A&E department and the patient is unable to walk inside, put them on the ambulance trolly, never use a carry chair for this. Don’t let other people pressure you into actions that could harm your back.
On Ambulance Placement
  • Make a good first impression, arriving early on your first shift is a good idea. In fact, aim to arrive with time to spare every shift, it saves you from unnecessary stress and reduces the chances of you being late. Your first shift at a new station can be daunting and scary, especially if you don’t know how to get in and end up standing outside for a while knocking on windows! Don’t worry, the majority of people in the ambulance service are friendly and welcoming, but it can take a bit of time for you to feel part of the station. It will happen, it just takes a little bit of time for people to start recognising you. Also remember that not everyone is at their most cheerful and friendly at 0600 in the morning...

 

  • When you are on placement, you are part of the ambulance team, get involved and play a part. Don’t sit on the sofa whilst your crew are checking the vehicle etc. Pitch in and help. 

 

  • Don’t take a bad mood or your personal life problems to work. Put them behind you when you leave for shift and focus on the job at hand. 

 

  • Observe others in the ambulance profession. You will see both good and bad attitudes, and good and bad practice. Try and take on board the good elements and take note of the bad elements to make sure you do not develop them yourself.

 

  • Try not to be too opinionated or outspoken whilst you are a student. It is too easy to get a bad reputation in the ambulance service and very difficult to get rid of one. Use your ears and develop a feel for the mood and dynamic at the ambulance station.  Your opinions are just as important as anyone else’s, but be tactful about how and when you express them, they may not align with those in ear shot. 

 

  • Mentors come in all shapes and sizes, as do students. Some mentors are better than others. Learn what you can from them and respect their experience.

 

  • Some mentors are great, you will look forward to your shifts and always feel you have learned  from them. Make the most of these mentors, they will leave a good and long lasting impression on you and the paramedic you become.

 

  • Sadly some mentors may leave something to be desired. If they are not a particularly good paramedic you may find the shifts easier if you think of it as a ‘what not to do’ example. Don’t be quick to judge, even if you don't ‘click’ with your mentor and find them difficult to work with, they will still have experience and you will likely still find many things to learn from them. Luckily situations like this are becoming rarer and rarer. The days of a student being put with any old paramedic without prior warning are mostly gone, usually now a mentor has specifically put themselves forward or has been approached to be a mentor, meaning that they have enthusiasm for their mentoring. 

 

  • Each mentor has a different way of working with students and each student has a different way of working as well. Often as a student it is good to adapt to each mentor’s way of mentoring to give you a range of experiences. Sometimes a mentor’s method will just not work for you, if this occurs it is usually better in the long run to try and have a positive talk with them about it and your learning style (at an appropriate time). Be open to what they say and listen to their thoughts as well. 

 

  • If you are having issues, with placement, your mentor, your progression or your academic workload, keep your tutors at university in the loop and get them involved early. Whenever possible use email, this acts as your evidence of what you told them  and when. 

 

  • Develop your own personal standards on professionalism. How you want to be and be perceived as a paramedic. Keep them to yourself, they are yours not anyone else’s, and stick to them, always. This is a key part in maintaining your registration and having a long and successful career.

 

  • Avoid using your mobile phone to text etc in front of patients or when on calls, it is just plain unprofessional and many would see it as rude.  Spending all your time between calls on your phone may also not give the best impression to your mentor, but this is down to you and your mentor.  Choose to be in the moment and focus on the shift, most texts can go an hour or two without a reply!

 

  • A lot of your patients will be from previous generations, and will see you as very young.  Put that with texting on a mobile and people could jump to ‘teenager’, which is probably not what you want them thinking seeing as you get told you look very young by half of your patients. So really, pocket that mobile.

 

  • If a job upsets you, if you find yourself thinking about a patient or situation more than you want to, or if you have had a traumatic or stressful job, talk to someone about it. Your mentor, course mates, friends and, of course, family. Most of the time a chat, a hot beverage and maybe a hug or a cry are all that is needed to discharge the emotion and move on. If something does affect you beyond this, speak to your tutors about possible counselling etc.  

 

  • The ambulance service is notorious for gossip and news spreading fast. Don’t be a gossip. Don’t spread rumours. Don’t give reason for you to be the subject of gossip. Keep your slate clean until you are at least established.
At University
  • When in lectures, pay attention. You cannot learn everything in the short time you are at university, but make notes so that you can go back and learn more things once you have finished the course. 
  • Get your essays and work for submission finished in plenty of time. Don’t let several deadlines for pieces of written work sneak up on you at once. Leave time for someone else to read your essay before submission, they can help point out spelling and grammar errors and give you feed back on the flow. Maybe agree with a course mate to read each others.
  • One hour of good effective studying followed by an hour of chilling out is much better than three hours of bad study where you procrastinate and feel bad for not getting much done. You cannot study all the time, choose to do work for a set amount of time, do effective work during that time, then do not feel guilty about doing something fun/relaxing afterwords. 
  • If you were a community first responder, first aider, lifeguard, nurse, fireman, etc, good for you! But you might not want to bring it up in every conversation and lecture, especially in your first few weeks when you are still making friends...
  • Thinking you know it all is dangerous, there is always something new to learn. Always take a chance to practice practical skills, don’t just sit back and watch everyone else. You will be glad you got involved when you need to use that bit of kit in an OSCE or put it on a patient for real months down the line, in the dark at the side of the road...
  • Save money, you don’t need to go out and buy every text book. Use the library, find which books work for you, then if you need to, buy those ones only. The last thing you want is to buy a book and have it on your shelf never used! 
Talking To Patients
  • Treat and speak to patients in the same way you would hope another ambulance crew would speak to your own family and friends if they ever needed an ambulance.
  • Don’t worry, over time you will develop your own style and gain confidence in speaking to patients. Your experience and ability to speak to patients is growing every shift. You may not see the changes right away but after a few months look back at how you have changed since your first week.
  • When you first get to a patient, be calm, smile (appropriately), introduce yourself and ask them their name. Then say their name out loud, this helps you remember it and in some cases allows you to make sure you are pronouncing it correctly. Try very hard not to forget patients names. 
  • If you do forget a patient’s name, it is ok to apologise and say “I am sorry, but I have completely forgotten your name”. It is a little less appropriate if you have to ask for someone’s name more than twice though... 
  • You can try and cheat by looking at the patient’s medication (prescribed meds usually have a full name on the packet) or by looking at the patient’s medical notes/care folder. Even better, write their name down the moment they tell you!  
  • ‘Love’, ‘Ducky’ etc are not appropriate replacements for a patient’s name. Sometimes a person who has been in the service a while will have developed a manor that allows them to get away with calling people these generic names. But it is not best practice. 
  • Most people new to the profession have difficulty knowing how to speak to certain patient groups but equally find it easy to speak to other groups. Think about what groups these are for you and why this is.
  • For a group you find difficult to talk to, listen to how your mentor and others speak to people in this group. Pick two or three ‘canned lines’ to use for this group if you are finding conversation difficult. These can be used until you become more confident speaking to people from that group. For elderly patients you will often here ambulance folk asking things like “so how long have you lived here”, “are these pictures of your grandchildren?” and “what did you do before you retired?”.  With children, depending on age, lines like “so what is your favourite toy?” and “what is your favourite cartoon?” can help build a report with them.  Often these days you will see plenty of branded clothing and toys that give you a clue as to what the child is into,  and they will commonly be very happy to talk to you about their favourite singing icey princess sisters with their snowman friend…
  • Some patients don’t want to make unnecessary chit chat, don’t push it. Become a master in tolerating awkward silences.
  • Other patients may talk so much you cannot get a word in at all. This can often be a sign of loneliness, many people, especially the elderly, do not get enough human interaction. You may be the first person they have spoken to today, or even all week. Even if you haven't been needed medically, your brief visit and conversation is likely to have done more good for the patient than you think. Sometimes though you do need to get on with the medical side of things and  phrases like “Just let me bring us back to todays problem, can you tell me more about this pain?” and “I’m really sorry, I need to finish this paperwork about your condition before we get to the hospital, but hold that thought and when we get there you can tell me all about your grandchildren whilst we wait for our turn to speak to the nurse...” might prove useful in coping with these patients when you are pushed for time. But if you can, take the extra few minutes to have that chat and make their day, especially if you are leaving them at home alone.
  • Sadly you will see some people in the ambulance service who are not ‘in the moment’, they know what questions to ask but they do not truly listen to the patient’s response. This leads to them asking the same question repeatedly and looking a little silly. The patient will be asked a question by the solo responder, maybe even the community responder first, then by the crew, the A&E triage nurse, the junior doctor, and then a senior doctor. With other nurses and medical students asking in between. The patient does not need to be asked the question two more times by the same person on the ambulance! 
  • Listening is your greatest diagnostic tool, listen to patients with your full attention, often they will tell you the diagnosis! 
  • Patients are not normally medically trained. Try not to ask them “so when did this abdo pain start?”  or “have you had an MI in the past?”  instead they are more likely to understand non medical equivalents “How long have you had this pain in your tummy/belly/abdominal area?” , “have you ever had a heart attack or problem with your heart in the past?”. It is frustrating to see people with good clinical knowledge but who cannot adapt their way of communicating based on each individual patient. Again this is where listening and observing the interaction will help with communicating effectively with the patient. 
  • When you are speaking to a patient about their condition, observe them and see how they react to what you say. If it looks as though they didn’t understand, try asking/saying it again in a different way.
  • Unlike ambulance staff, patients are normally not used to the situation of an ambulance arriving, a lot of personal questions being asked, and then being whisked off to hospital. Keep in mind that to a patient, it can be a daunting and intimidating experience to be faced with 2 (or 4!) people dressed in green, with big black boots on, standing in their house asking them a lot of personal questions. Try and put them at ease by reassuring them. “We’re just going to do some routine observations like your blood pressure whilst we ask you about your problem today, is that ok?” 
  • Confidentiality is paramount when speaking to other parties. Often people will arrive on scene and demand to know what is going on. Usually these people are friends or relatives of the patient and they can seem surprised or angered at being asked to identify themselves. You should do it politely and explain why, but you MUST check who they are before speaking to them. What if they are a nosey stranger or reporter? If possible you should ask the patient’s permission before disclosing any information to another party. And if the patient is not in a position to consent, only disclose what is absolutely necessary. You will also find that neighbours can be particularly nosey, a short, polite, vague response is usually best “don’t worry, nothing exciting”.   Again some people can get angry at not being given any information and a brief explanation can calm them “It is not my place to say, it’s patient confidentiality, sorry. It’s nothing to worry about though, thank you for your concern”.  
  • Avoid making promises you cannot keep. If you tell the patient that “we will take you to hospital to get it all fixed and they will do a scan of your head” then they will naturally expect this when they arrive at A&E. It is much better for the patient and your colleagues at the A&E to be honest “We’ll take you to the hospital, you will be seen at A&E and hopefully the team there can work out what has happened, though I don't work at the hospital so I cannot promise exactly what they will do.”  
Hospital Placements
  • Make the most of your time in these different clinical settings. It is a great opportunity to see how other health professionals work in different fields.
  • You will get a lot out of these placements if you put effort in. Ask questions, take an interest, put yourself forward for experiences. “Excuse me doctor, I am a student paramedic on clinical placement in this department, do you mind if I shadow you whilst you assess this patient?/observe as you carry out the procedure?” 
Accident and Emergency Placement
  • Whilst on placement at an Accident and Emergency department you can see the next steps in patient care beyond the arrival at the department by ambulance. You will be able to give patients a better explanation of what may happen when they arrive at hospital because you have seen it yourself. 
  • If you are allowed to cannulate at this stage in your training you should get many opportunities to practice. 
  • Be present in the resuscitation room for as many ‘blue light‘ arrivals as possible. Observe what actions, interventions and investigations the nurses and doctors carry out and listen to the handovers the paramedics give.
  • Paramedics generally get very little training or experience in mental health. If a patient is presenting in the A&E department with mental health issues, take the opportunity to observe and ask the nurses and doctors what is being done for the patient and why. 
Paediatric Placement
  • When on paediatric placement take the opportunity to get better at interacting with children.
  • Watch how nurses and doctors manage to assess the squirming baby or crying toddler. Learn their tricks so that you have a better chance of being able to carry out assessments on paediatric patients in future. 
  • Ask and learn about the differences in treatments for children based on age. Observe drug calculations and paediatric specific medical conditions and injuries.  
  • Unless you have children yourself or have grown up around younger children you may find them difficult to interact with and assess. This is common, the more exposure you have to paediatrics the sooner you will feel confident enough to assess even the most awkward toddler!
Maternity Placement
  • During your maternity placement you should hopefully get the chance to observe some babies being born. This may seem daunting, but you will be thankful for this experience when it comes to delivering a baby on your own in a house (or car, train, etc) once you are a paramedic. 
  • If you get the chance to observe a caesarean section (C-section) take it. It is rare for a person to have a chance to be a fly on the wall in such situations. 
  • Make sure to also observe the post birth care of both the mother and infant(s). 
  • Talk to your midwife mentor about assessing patients with pregnancy related complaints. If possible spend some time in the maternity assessment unit (where most patients brought in by ambulance go for assessment, unless they are in active labour). 
Anaesthetics Placement
  • Your anaesthetics or theatre placement  can be not only  one of your most useful and experience filled placements but also prove to be one of the most tiring and challenging. 
  • Take as many opportunities as possible to manage a patient’s airway. You can never have too many experiences of intubating a patient or inserting a supraglottic airway device. 
  • Don’t forget to also get very good at the basics; postural airway manoeuvres, ventilating patients, and insertion of oropharyngeal and nasopharyngeal airways.   
  • Take the chance to observe as many different types of operation as possible. It is a unique chance to see the inside of the human body. If you are lucky your placement may be in a hospital that performs thoracic and cardiac surgery. Never miss a chance to observe open heart surgery!
  • You can learn an exceptional amount from anaesthetists, but the theatre environment can be a strange place with unspoken rules on etiquette that can vary from hospital to hospital. The best you can do is be polite and show interest. Asking anaesthetists if you can join them to observe and maybe participate BEFORE the patient arrives in the anaesthetics room. If an anaesthetists says no to you participating, ask to observe so you can at least learn from their technique. You may find that after observing a few times the anaesthetists will then let you become more involved. 
  • Ask anaesthetists about anaesthetic drugs, capnography, and respiration and metabolism. Listen to what they say, they are very knowledgeable in these fields. 
Coronary Care
  • Your main focus in your coronary care placement is to learn about ECGs, myocardial infarctions and identifying what patients you, as a paramedic, can bring straight to a heart attack centre, cath lab or coronary care unit.
  •  You should get the opportunity to observe primary percutaneous coronary intervention(PPCI) being carried out. This is a great chance to learn about the structure and physiology of the heart as well as seeing what your patients may go through after you bring them to a heart attack centre. 
  • You are likely to have many gaps on the placement, take the opportunity to learn about other medical conditions that affect the heart / appear on ECGs. Most units have a folder full of ECGs, take the time to test yourself with them. Maybe even bring an ECG book to keep yourself busy.
Minor Injury and Illness Placement
  • Minor injury and illness placement is usually in a minor injury unit, walk in centre or urgent care centre and can sometimes come across as dull or unnecessary if thought of in the wrong way. But if you choose to involve yourself you can actually get a lot out of this placement. More and more of the frontline calls attended by paramedics are actually suitable for urgent care or primary care referral, knowing what the local urgent care centres can and cannot deal with will make referrals easier when you are back out on the road.
  • If you want to progress your career clinically beyond the level of paramedic, the developing paramedic practitioner role (Formerly and sometimes still known as emergency care practitioner, or ECP) is a common path to follow. They specialise in the assessment and treatment of minor injury and illness in primary and urgent care. If you go on to do paramedic practitioner training, you will likely have placement time in a minor injury unit, walk in centre or urgent care centre. If you have made the most of your placement as a student you will have a head start when you go back for this additional training. 
  • During this placement think and ask about what patients you can treat on scene or refer to a minor injury unit, walk in centre or urgent care centre. 
Driving and You
  • Always try and maintain ‘driving test standards’ whilst driving your own car. Every bad habit you develop is more work for you on the emergency driving course. 
  • Get your C1 license as early as you can, don’t let the deadline sneak up on you. If you can have it before you start your course then it is one less thing to worry about.
  • Take the emergency driving course seriously. Get enough rest. Learn your road signs. Give the driving your 100%. Pass it first time and move on. 
  • On your first few blue light drives relax and take it easy. You will likely be nervous/stressed/excited. Take this into account and don’t take risks. Get there in one piece!
  • Defensive driving, expect everyone ahead of you to do something stupid and be ready to react as such.
  • Driving a patient to hospital using blue lights and sirens is a completely different style of driving than driving on a blue light response to a call. Speed is not always appropriate. It is better to get there two minutes later than have a very shaken and stressed patient and a disgruntled (and possibly bruised) crew mate. Smooth and steady is key. Don't be pressured by cars building up behind you, if you need to go slowly on this road because of pot holes and speed bumps, go slowly, even with the blue lights on. The real time saving of the blue lights is through heavy traffic and crossing red traffic lights, not speed. 
  • Be double careful when reversing. Ask someone to watch you back whenever possible, and always if there are pedestrians in the area. But, never shy away from a chance to reverse and gain more experience from it. Most minor ambulance crashes happen when reversing, take it slow and be very careful.
  • Set yourself an unbreakable rule. Unless you are parked safely with your hand break on, your mobile phone stays in your pocket. Every time someone touches their phone whilst driving it is not only breaking the law but risking their whole career. Is it worth it to send a text a few minutes faster?  As a professional driver in a marked emergency service vehicle you should be setting an example to the public, how does it look when they see you stopped at traffic lights, head down, face lit up by the mobile phone screen? It is obvious and can be spotted easily by an observant person. Unprofessional, dangerous and illegal, it is never ok.  
  • Remember the first rule: ALWAYS be able to stop in a distance you can see to be clear by day or by night. 
Other Health Care Professionals
  • When speaking to a doctor about your patient; be concise, use medical terminology where possible, tell them briefly what you think the diagnosis is and why. If you are speaking to a GP on the phone, also tell them what you think is the next step in appropriate care for the patient and see if they agree with you.
  • Nurses can be great. Most A&E nurses are sharp and know their stuff. They can sometimes come across as grumpy or irritated at you, this is often because of their own stress to do with the busy department and not to do with you. But yes, now and again they are just grumpy. Luckily more often than not ambulance crews are met with a smile, you will meet and work along side many, many nurses. We are on the same side, they are our friends. 
  • Doctors have gone through 5 years of medical school, and then endured several more years as junior doctors. This makes them (generally) very experienced in their specialty and they can be a wealth of knowledge, don’t be afraid to ask doctors questions, there is much you can learn from them. This does not mean they are gods to be worshiped or that they are infallible. Treat them with respect but equally expect respect back from them. Many, in fact most, doctors could not deal with the situations ambulance staff deal with every day. But equally we could not jump in and do a doctor’s job. We have different roles in healthcare, we work next to each other. After all the prefix ‘para-’ in ‘paramedic’ means ‘along side’ or ‘next to’ and the word route ‘medic’ is self explanatory. 
Other Emergency Services
  • Although we don’t come across them every shift, we work closely with the police and fire service. At some point you will also come across an air ambulance, with either paramedics, or a doctor and paramedic on board. Depending where you are in the country you may also come across mountain/cave/fell rescue, pre-hospital care doctors, the Coast Guard, RAF search and rescue, the RNLI and voluntary ambulance agencies such as the British Red Cross, St John’s Ambulance service and St Andrew’s Ambulance service. 
  • The police and the ambulance service work closely as many of our calls overlap. The police call us for injured patients and for people that become unwell in police custody. We call the police when people are violent towards us or when we attend some types of calls that may present a risk to us. When ambulances and police vehicles drive passed each other, it is common for them to wave at each other. This maintains the bond that is shared with the two services. 
  • The fire service don’t wave as much, it doesn’t mean we shouldn’t still wave when they drive past! We see them less frequently but generally on more serious calls, such as car crashes and structure fires. Despite their lack of waving, we still work very well and closely with the fire service when we are on scene at an incident. If you ever get a chance to attend a joint training day with them, do so, it is a great experience in extracting patients from cars and working as a team. 
  • If you come across an ambulance crew from a voluntary agency or private company, remember they are either volunteering their time or a paid health care professional just like you (or like you will be once you finish uni). Don’t tar them all with the same brush just because they are in a different uniform, make up your own mind on the capability of the individual crew you are presented with on that day. Just like you do with people in the ambulance service. Some will be excellent, some may be lacking in certain areas, but remember they are all different, just like you.
  • Always remember to get and document the call sign / shoulder number of any other services on scene. Especially if you have handed over care to another medical professional (maybe the RAF paramedic is taking over care as the patient is flown to hospital?).
Your First Shift as a Paramedic (and a bit beyond)
  • Well done! you did it, be proud of yourself!
  • Always take oxygen and a defibrillator when leaving the ambulance to see a patient. You do not want to be caught out without them. If the location is a distance from the ambulance (across a field or 13 flights up in the lift) you may also want to consider taking your paramedic bag for calls that could potentially prove serious. Many of the ‘chest pains’ attended by ambulances are not immediately life threatening or in some cases even chest pain, but you do not want to get complacent or be caught out without the right kit to hand when you are faced with a sick patient. 
  • If you do make a mistake, especially a clinical one, don’t try and hide it. Most people make one at some point. Let your service know you made the mistake. If you hide a mistake you could lose your job and registration because it displays dishonesty. 
  • If you are the only paramedic in an ambulance crew, you have primacy of care  for the patient. Even if it is your turn to drive, you still hold overall responsibility for the patient until handed over to another health care professional. If you feel that the patient’s condition dictates that you travel in the back instead of your crew mate. Do it, it is the patient’s health and your career at stake. Most non paramedic ambulance crew are aware of primacy of care and will more than happily jump in the driver’s seat if needed. To make the rest of your shift easier I would suggest taking a polite and firm approach, “I think I’m going to have to travel in the back with this patient, you don’t mind driving to hospital do you? thank you”  
  • On your first shift, and your last shift, always, ALWAYS do what is in the best interest for the patient. Be it at the start of your shift or half an hour after you were supposed to go home. Doing what is in the patient’s best interests and documenting your actions along with the reason for the decision is the single best thing you can do to protect yourself and your registration. 
  • When you start working for an ambulance service, you may be placed onto a ‘relief rota’. This generally means you will be moved from station to station every shift to fill gaps in cover for the service, due to sickness, annual leave etc. You will be working with new people a lot of the time and this can end up feeling like you are ‘speed dating’. You will soon get used to having the same ‘getting to know you’ conversation at the start of each shift. Some people will jokingly say that the relief rota is equivalent to ‘slave labour’. Although this is of course not the case (because you will be getting paid...) it can be a challenging time for you. Many people on relief find it unduly tiring and stressful. Most people have spent a period of time on a relief rota, think of it as a right of passage, it won’t last forever (but it sometimes feels like it will). Periodically speak to your management team about opportunities  to escape relief and  get onto a better, more stable rota.
  • There are two main ways that an ambulance crew decide to share roles. The first is to do a ‘half and half’ or ‘split shift’ this is where you each take a turn to drive and attend for half the shift. The other way is to do a whole shift either driving/attending and then swap the next time you work together. If you are on relief you may not work with the same person again for months or maybe never again. It is generally a safer and fairer option to try and do ‘half and half’ shifts.
  • Some people buy their own diagnostic equipment for use on shift (specifically finger oxygen saturation probes). Most services are against this (except stethoscopes and pen torches) because, among other reasons, the quality of the equipment may vary and it’s accuracy of measurement is not guaranteed. Most diagnostic equipment within a cheap price range is not of medical quality or approved for diagnostic accuracy. Most devices that are at a suitable quality are far outside the price range of an individual. If you do choose to carry your own kit avoid making any clinical decisions based on the readings it provides. 
  • Never trust electronic diagnostic equipment alone. Take a manual pulse and see if it matches that on the monitor. You will often hear the phrase ‘treat the patient not the monitor’ (or something to that effect). This is very good advice. If a patient looks unwell, but the monitor shows good clinical observations, go with how the patient looks.  If you get a reading that doesn’t seem right or fit the patient’s presentation, ask yourself if there is any other factor that could affect the reading. Is the patient moving their arm during an automatic BP? If in doubt, check it again manually (where possible).
  • Learn your service’s policy on controlled drugs (Morphine) and make sure you follow it each shift. Some services have you sign out and in morphine from a safe at the start and end of your shift, other services keep it locked in safes on the vehicles. Services take controlled drugs seriously, avoid unnecessary hassle for yourself by not making mistakes in this area. If you do accidentally take your morphine home etc, be honest, and rectify it right away.  
Your First Shift as a Solo Responder
  • Different services have different rules and guidelines about when you are allowed to become a solo responder after you register. It is usually a good idea to give yourself at least six months of experience on ambulances before putting yourself in the position of solo responding. Some services will make you wait a whole year before you are allowed on a response vehicle. Although to some people this may seem excessive, all you can do is suck it up and you will be on the response car in no time. You have waited at least 2 years through university to become a paramedic, in many cases much longer than that, another six to twelve months isn’t that bad. 
  • Start the day as you mean to go on; turn up early to reduce stress and give yourself the time to check the vehicle thoroughly and make sure you have the seat in the best position for driving etc. 
  • There is a good chance you will get the nervous/excited  feeling you have already had on your first few shifts on the road and your first few emergency drives. Take a deep breath and don’t let it affect you. Soon your solo response shifts will become routine as well.
  • When arriving at a call location, think about the best place for the ambulance to park for loading the patient. Try and avoid parking in the way of the ambulance and  if needed walk the extra few car lengths back to the address. This is especially important in situations such as cardiac arrest, it is very tempting to dump the car and rush into the building, but that can do more harm than good if you make it difficult for the other responding vehicles to access the location.  
  • If you go to a ‘proper job’ get on the radio and ask for help right away. The sooner you let the control room know, the sooner they can get someone else en route to assist you. 
  • It is likely that you will not have driven such a powerful/fast vehicle under emergency conditions. Don’t push it when it comes to speed, get there in one piece. 
  • If you are presented with an ambulance crew of lower skill level than yourself, be it from the ambulance service, a voluntary agency or a private ambulance company, you need to make a decision on if the patient can be handed over to the lesser skilled crew or if you need to travel with the patient and crew to hospital. Whilst you are the most senior clinician on scene, the patient is still your responsibility, remember you have primacy of care.
You and Your Career
  • Try not to become negative about the job, don’t let other people’s negativity rub off on you. It is likely you have wanted to do this for a long time, if you do notice yourself feeling negative, think back to how much you wanted to be in the position you are now in. 
  • The paramedic profession is changing and advancing, aim to be the best paramedic you can be. Don’t be the person that gives a drug or treatment ‘because our guidelines say we should give it’. Instead be the person who gives or withholds the medication because you know what it does, how it affects the body and the benefits and drawbacks of its administration. To this end, try and stay on top of new research and treatments, read relevant journals and keep on top of new clinical guidelines from both your service and nationally. 
  • Think about where you want to go in your career. Do you want to progress to being a paramedic practitioner dealing with minor injuries and illness in the primary care setting? Do you want to go into academic teaching and lecturing? Do you want to follow the management pathway and continue your career in the ambulance service? These are some common options but the paramedic profession is continually finding new areas for career progression. Take a year or two   on the road post registration to really consolidate your practice and gain a healthy confidence. During this time you can think about possible career progression and look into what you need to achieve to work towards your goal.
Continuing Professional Development
  • Reflective practice isn’t hard. You reflect on your actions every day: “I did X, was it effective? did I do it well? How can I do it better next time?”.  After a call when you are talking about it with your mentor or crew mate, you are reflecting. Once you get the hang of putting a reflection down on paper and using one of the reflective processes, you will be fine.
  • Maintain a portfolio with different types of content. Go to conferences and study days. Look after the certificates and put them in the portfolio. Write up interesting jobs, reference them, keep your hand in with essay writing. The joy now is that there is no marking or word count, it can be as long or as short as you need it to be. Make a list of every medical thing you read or watch and the time you’ve spent on it, it all counts. 
  • Practical on the job experience and common sense is essential in surviving and becoming a good paramedic. But in modern times a paramedic also needs a firm underpinning base of theoretical knowledge and understanding. A great paramedic can use their theoretical knowledge to appropriately inform their practice on a day to day basis, whilst also being a good listener and having genuine human interactions with their patients and those in need, even when it is not necessarily a medical need.
  •  When you encounter a new condition or presentation, write it down and then find half an hour to research and read about it. This is how your knowledge will continue to grow.