Paramedic Column

MCPara, National CPD Lead, chats to…

Gary: Tony, thanks for taking some time to chat, this is a great way for me and our members to get to know you better. You were recently appointed to this new role…can you tell us what it’s all about?

Tony Stone

MCPara, Head of Clinical Development (Emergency and Critical Care) at the College of Paramedics

Tony: Thank you Gary, it is great to chat to you. I started in this role at the beginning of the year – I cannot believe how quickly time has passed! The purpose of the role is to lead on all aspects of clinical development for members across the UK who are working in emergency and critical care settings. This will include development of educational activities, curriculum guidance and supporting relevant continuing professional development (CPD) opportunities. One of my biggest aims, working with colleagues and relevant stakeholders, is to create an approved national career development pathway for those who wish to specialise in critical care. Gary: Tell us about your career to date. Tony: Following a quarter life crisis in 2007, I retrained as a paramedic at the University of Hertfordshire. After graduation, I worked in the West Hertfordshire area where I undertook several roles as my experience grew. These included secondments as a rapid response vehicle (RRV) paramedic, clinical field operations trainer, education and training officer, in addition to a secondment in the ambulance control room, supporting triage of non-lifethreatening calls. In 2014, following a gruelling assessment and interview process, I was successful in joining Essex & Herts Air Ambulance (EHAAT) as one of their HEMS Critical Care Paramedics (CCP) – a career achievement I am exceptionally proud of.

In 2017, EHAAT created their Patient Liaison Manager (PLM) role, following the success of the role at London’s Air Ambulance. I was thrilled to move into this role, along with one of my much-respected CCP colleagues, Adam Carr. Together, we developed an effective patient and family liaison service – answering questions patients or families had about their pre-hospital journey, signposting them to appropriate support organisations (of which there are many) and learning about the patient or family pre-hospital experience and feeding this back into our governance process. I have no doubt that we have improved the postincident experience for many patients and their families, and I am glad that this role has now been developed by several HEMS and critical care services across the UK.

My role at the College is part-time so I am pleased that I can continue working at EHAAT, although now in a patient safety and quality role, as well as maintaining weekly clinical shifts. Gary: Emergency and critical care includes a spectrum of different roles, I think. What can you tell us about the different opportunities available to paramedics working in this space? Tony: Never has there been so many different opportunities for paramedics, and it is wonderful. It is impossible to list them all, but it includes pre-hospital roles (e.g. ambulance & RRV, specialist and advanced paramedic (critical care), HART, HEMS, BASICS etc.), in-hospital roles such as Advanced Clinical Practitioner (ACP) – with credentialing opportunities currently through either the Royal College of Emergency Medicine (RCEM) or the Faculty of Intensive Care Medicine (FICM), not to mention retrieval and inter-hospital transfer services, expedition medicine and of course the Armed Forces. I am sure there are more, and this doesn’t even take into account the primary and urgent care roles Helen Beaumont-Waters (Head of Clinical Development – Primary and Urgent Care) mentioned in the last issue of this magazine. It really is an exciting time to be a paramedic. Gary: Emergency care is what many would regard as ‘traditional’ paramedic work. Yet now, for the average ambulance paramedic, it represents only a small amount of their workload, and many feel under-prepared. How can we deal with this challenge? Tony: There is no doubt that core front-line 999 ambulance work has changed significantly over the years. Paramedics and ambulance service colleagues truly are a “Jack of all trades” and I have no doubt it is this adaptability that has paved the way for such rapid development of our profession. However, with often limited exposure to managing high acuity injury or illness, I understand why many members might feel under-prepared when they are tasked to such incidents. I feel that regularly embracing CPD and training opportunities (including physical scenariobased training), developing post-incident feedback systems and having consistent access to specialist or senior support will go some way to addressing this.

Gary: Many new entrants to the profession have ambitions to work at what they regard as the ‘high end’ of practice. What would you say to students who are really keen to head towards a career in critical care?

Tony: As I previously mentioned, opportunities for paramedics both in and outside of ambulance services are increasing. I strongly believe that, regardless of how someone wishes to specialise in the future, a strong foundation of core paramedic experience is essential. Many (but I appreciate not all) students graduate in their early 20s – therefore have the potential for a 40-year paramedic career. I would strongly encourage students not to rush into specialist roles and to focus on developing their core paramedic skills; it is these skills that will enable someone to excel in a specialist role.

I think it is fair to say, critical care roles are often hugely competitive to get into. I would encourage those interested to grab as many different opportunities as possible (teaching, research etc.) to build their CV (with the caveat in my previous statement). Also look to become involved with your local air ambulance or BASICs scheme (or similar) –many of which run training or governance days. Finally, it is important to develop your non-technical skills as these are often also tested during assessment stages for critical care roles. It is all about doing what you can to make yourself stand out from the many other applicants.

Gary: One of the challenges I have observed over the years is the need for critical care teams (e.g. air ambulance) and road crews to form a high performing team on scene, rapidly. I sense these days that a lot of the old communication barriers have been broken down, but I suspect there is still work to do on this. Can you comment? Tony: Scenes which involve patients who are critically ill or injured are often stressful for all involved. I think it is this ‘stress’ that can sometimes cause communication to not be as effective as it could be. That said, training and awareness around CRM, human factors, hierarchy gradient and communication skills has greatly increased in recent years, and I do feel that the traditional perceived barriers between different pre-hospital teams have mostly been broken down. Everyone attending these challenging incidents wants the best outcome for the patient(s) and it is essential that all on scene work well together to deliver excellent prehospital care. Going forward, I feel it is vital to champion diversity within specialist teams as this will undoubtedly continue to improve teamwork, communication, and decision-making skills within our profession. Gary: Emergency and critical care has always been a multidisciplinary affair. In my early years as a paramedic, I recall being very well supported by the West Midlands Care Team at larger incidents, working alongside doctors and nurses at scene. What are your thoughts on interprofessional collaboration, its benefits, and challenges? Tony: Pre-hospital emergency and critical care should absolutely be a multidisciplinary environment. AHPs, nurses and doctors all bring unique qualities to patient care, just like the in-hospital setting. However, I think it is important that comprehensive training and education is delivered to prepare clinicians, regardless of profession, for the unique challenges of the pre-hospital environment.

It is fantastic to see rapidly expanding scope of practice, education opportunities, and governance from some employers of paramedics working in specialist or advanced roles. With regards to critical care, I am confident that, with time, we will see paramedics safely delivering procedures and interventions that are currently only provided by our doctor colleagues. Gary: Tell us about your vision for your role. What can the College do to support the growth and development of paramedic practice in emergency and critical care? Tony: I am truly delighted to have started in this new post this year and I’m looking forward to championing clinical development for paramedics who work in emergency and critical care settings.

Soon, I am to start a scoping exercise to investigate what pre-hospital paramedic-delivered critical care currently looks like across the UK. I am hoping this work, along with the feedback from the recent critical care workstream development survey will help the College go on to produce a nationally-agreed development framework for those working in critical care.

My long-term vision is clearly defined, nationally agreed roles (training and education requirement, scope of practice etc.) for specialist, advanced and consultant paramedics in critical care. Maybe even one day we will have our registration annotated to reflect this.

Gary: Thank you Tony. It’s great having you on the team.