There are two important parts of training, that of the initial training that you have to do and the other being the continual development, refreshment and assessment of our skills that should be constant through our career.
The LAS is a place where you never quite know the skill level of the person that you find yourself at the scene of an accident with. In part this is due to the varied training programmes that you have in order to be employed by the service.
For instance, I was trained in sixteen weeks. I was sat down in front of a Powerpoint presentation while a trainer read out what was on the screen. We also had to practice some physical skills – the use of a carry chair and CPR were just two of those skills.
There was very much a 'systems' approach to my EMT education. 'This is the heart, this is what goes wrong with it and this is what we do with these patients, this is the brain, this is what goes wrong with it, this is what we do to patients who have this problem.' There was little teaching of the underlying reasons, causes and biology behind the diseases.
As an example – I was taught that diabetics with high blood sugars will continue to eat because their 'cake gland' goes into overdrive and this is why they eat lots and get fat.
Other parts of the course seemed to have floated in from elsewhere – for en example we had to know what 'astroglia' were.
The course was full of 'Need to know' – i.e – a patient having a heart attack is given oxygen. Then there was the 'Nice to know' – i.e. the reason why we give oxygen to these patients.
In other words – you Need to know certain things to be an ambulance person, but if, just if, you have a bit of an interest in it, this is something that is Nice to know but not essential and as it isn't on your exams you shouldn't worry too much.
Of course, now you have the guidance that we shouldn't give people having heart attacks oxygen in most cases we don't have the theoretical background as to why this is a good idea – and so 'old hands' continue to give it because it's what they were taught.
The other day I delivered a baby in the back of my ambulance. My maternity training consisted of one afternoon of a bored looking midwife telling us that basically it would be best if we just take everyone to hospital and try not to touch anything. Oh, and if you have an umbilical cord poking out, stick a damp dressing on it and transport the mother on her head.
I seem to remember spending a whole day on mental health problems. The majority of that was issues with violence and the legal requirements to get someone Sectioned.
I can't remember if we learned about alcoholism, I suspect that it was a half-day thing – way too short given the number of our patients that are alcoholic. Certainly no time was given over to the care of the binge drinker.
But it's changing, I think.
I say that I think because reports from the new people we are getting coming out onto the road vary wildly.
The LAS is, rightly in my view, going down the route of having people study to degree level. This means that, hopefully, there is more to the course than powerpoint and playing with dummies. Hopefully they are learning some theory, some basics of reflective practice, some idea of how to critically read a research paper.
But then the LAS continue to do in service training. This isn't to a degree level, and yet the staff come out the same.
I have no idea what is going on, and if I work with a new member of staff I have no idea what they have learned.
My crewmate, one of the first Paramedic degree students knows very little about mental health problems. But she likes working with me because I teach her the knowledge that I've been taught as a nurse, or learnt on my own.
Before I worked on the ambulances I was a nurse, and if there is one very important thing that my nursing diploma taught me it was that you need to keep learning, and it gave me that enthusiasm to keep learning.
I don't see that at the moment, either in the old-fashioned staff (how I was trained), or in the new degree level students.
The problem with our initial training (and the majority of my colleagues went through the same training I did) is that it is very much rote learning, and rote learning by people who are often not teachers. The trainers are mostly people who have been through an internally run 'instructors course'.
Before joining the NHS I trained for four years to be a teacher of children.
Because of this rote teaching, there is little room to give students an enthusiasm to continue learning. There is no teaching of the skills of how to learn, how to read research, how to develop yourself – and as I will show you later, developing yourself is pretty much the only development that you can rely on having.
Because of this teaching – the bare basics, the lack of underlying theory and the rote – if 'A' then 'B' then 'C' and then take to hospital. There is created a staff body that sees itself as, not healthcare professionals, but as 'blokes with bandages'. There is no questioning of current practice, there is no provision of the skills needed for self directed learning and there is no desire or enthusiasm for further learning.
We are partly towards a solution at the moment in that a lot of people are joining the service after a three year Paramedic Science degree course. What we need to do is work towards getting every member of staff that has road duties that same degree course on a part-time basis. No-one should lose their job because of trouble in passing this, but it should be compulsory that everyone should work towards it.
If not a degree, then the absolute minimum we should be aiming for is a diploma level education.
It is only with better training that we can properly have staff that are competent and feel secure in leaving some patients at home rather than clogging up the A&E departments, which is the future service that we are going to have to provide – if only to differentiate ourselves from the private ambulance firms that are itching to get NHS contracts.
We need proper EMS educators. The sadly true joke was that road staff became instructors because they wanted to shag as many students as possible. Hopefully this is changing, I've heard too many first hand accounts of trainers trying to get students into bed – and not just from the LAS…
We need educators that are smart, well-trained, and enthusiastic. Road skills and experience is certainly useful, but being good on the road doesn't necessarily make you a good teacher.
A well educated work-force is a happy work-force. Raise the morale of the staff and performance will raise, and education is just one way to raise the morale of the workforce.
We cannot continue to turn out people who have learnt by rote and who are uninterested in further learning, we cannot continue to turn out people who see themselves as semi-skilled workers.
Not unless all you want from your workforce is bums on seats to hit that eight minute target.
UPDATE – I meant to put this link in about a Service being forced to halt it's training because it isn't up to standard…