Training (Part One)

Am I a taxi driver with bandages whose job is to get to a location in eight minutes, or am I a well trained, well equipped professional with the ability and knowledge to provide effective medical care in emergency situations?

At the moment I feel like a taxi driver.

Today I am going to tell to you about in service training, and where I see the LAS as failing – tomorrow I'll give my ideas for how we can improve this situation.

Across the NHS workers receive in-service training where they learn new skills, refresh old skills, get updated on new equipment and policies and even get assessed on how well they currently perform those skills.

In the LAS that just doesn't happen.

I went looking for my 'continuing professional development' folder so that I could tell you the last time I had some training. I can't find it, I suspect that it is buried somewhere up in my loft, which gives you an idea of when I last used it.

I have a clinical guidelines book – it's dated 2006.

I honestly can't remember the last bit of training I had – I think that it was some years ago and was about how to escape from an attacker.

Actually that isn't true – the last training session I had was on how to use the new radios, I had this training a few weeks after the radios had been 'rolled out', lasted an hour and we were constantly interrupted by Control asking when our ambulance would be available to go back on the road. This was the third time I'd tried to get trained, the first time I tried to get trained it was cancelled ten minutes into the session, the second time it was cancelled before I arrived at station.

My last CPR training was when the number of compressions per breath was changed to 30:2 (whenever that was)- this was given to me in a ten minute presentation from a team leader.

The last time we were given a new drug to play with I had a single sheet of A4 paper which I was to sign and return to say that I had understood the information on it.

Policies change and unless I see the one bulletin on station directing me to the incredibly poorly-designed internal website (that I seldom have a chance to check because we are so busy) I'll never hear about it.

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The problem is that a well trained staff doesn't help the service hit it's governmental ORCON target. Remember that the ORCON target means that reaching someone who is dead beyond any hope of resuscitation in under eight minutes is a success, while reaching a patient in eight minutes and one second yet saving their life is a failure.

When our REAP level goes too high, due to a high volume of calls, or the service not meeting our ORCON target, training is one of the first things to be cancelled. Sadly 'too high' is the normal REAP level these days.

Training is not given the priority that I think it needs – the service wants ambulance crews to leave patients at home (it saves us money and time – meaning that we can get back on the road to continue hitting that ORCON target). But how can crews be confident about leaving patients at home when our post-qualification training is so woefully inadequate?

Since leaving nursing can you guess how many times I have been taught to wash my hands? Handwashing is incredibly important in infection control and you need to be taught how to do this properly, even assessed using a gel that glows under ultraviolet light. There is a specific, effective way to wash your hands that is taught in hospitals in order to make sure it is effective.

I have, since joining the ambulance service, never been taught how to wash my hands.

We have new vehicles being rolled out across the service, there are some big changes as to how the equipment on them is to be used. The training session for these new vehicles takes two hours. I've attempted to get trained on these vehicles on four occasions – on all four occasions the training has been cancelled.

The reason for this training to be cancelled? Someone in Control has decreed that you can't be trained during the rest-break window of your shift.

If we don't get a rest break then we get paid £10. If we are being trained for two hours of that window then the chances of us having a rest break are reduced and the service will have to pay us £10

So, we don't get trained because of the expense of £10.

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When I started in the ambulance service we were hit over the head with sixteen weeks of intensive classroom training that turned plumbers, housewives, carpenters and office workers into ambulance people. It wasn't much fun but it seemed effective – we were taught by ambulance people who'd become training officers.

I'd like to tell you how the training has changed, I think it's now more central and people are trained over the period of (I think) three years to be paramedics. Carpenter to paramedic in three years is… quite fast. You could do it in the 'old days' but by then you'd have had around three years 'on the road' learning the basics of your craft, not around a year.

My knowledge of the current training is informed only by the students who are coming out of the training school – and it's not good. Courses are rewritten as they are being taught, days back in the classroom to consolidate knowledge gained on the road are cancelled (most likely due to trying to reach the ORCON target), students are coming out of training to do practical placements with some rather strange ideas of how we work on the road.

We sometimes get students being put on a placement with us – my crewmate is a paramedic and she is supposed to educate the student in how to practically do our work. She is supposed to have a PPED course under her belt, a course that teaches her how to teach student paramedics. She doesn't. She's asked to be put on this course for a number of years (longer than I've been working with her) and she keeps getting no answer.

How is this being fair, or maintaining the quality of training, for the student paramedic?

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I've personally noticed that my skills have decreased since joining the ambulance service. My knowledge of drugs has started dripping out my ears, my understanding of medical conditions is decreasing and the physical skills of medical care are atrophying.

The reason is that, for 80% of our jobs there is no need for an ambulance, nor for hospital treatment. We arrive, I chat with the patient and then tell them to take a seat in the ambulance. By rote I check their blood pressure and pulse and then we take them to hospital. With such an influx of uncomplicated cases (drunks, colds, runny noses, babies with a high temperature) it is obvious that there is going to be a loss of skills.

Unfortunately, with no training or regular assessment, this skill decay goes unchallenged.

I try to keep my skills up, but with no support from work it's incredibly difficult – so I find myself turning to American EMS sites and podcasts to try and maintain some sort of education.

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One of the ways that you build a motivated work force is through training – something that isn't happening. We get up, turn up to work and do our best to work 'safe'. In this case 'safe' means working so that we don't get any complaints or lose our jobs.

There is no enthusiasm to learn more about our job, about medical conditions or how to do things more effectively.

Hardly anyone reads research on pre-hospital care. After a twelve hour shift I'm seldom in the mood to hit the books myself. The service doesn't provide any encouragement for us to learn on our own, we don't have any libraries, the internal website doesn't have any links with e-learning or educational sites (not that I think any UK based ones exist for ambulance workers) and we don't have any protected time where we can feedback with our peers.

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So, in summary – I think that in the pursuit of pointless targets we do not get the training that we deserve. We do not get the training that the public would expect us to have. Training courses are incredibly rare and are cancelled more often than they are run. What post-qualification training we do get is on an ad hoc basis and doesn't take account of modern training techniques.

Current training of trainees also seems inadequate and it seems that all that is wanted is 'bums on seat' (although this is only my impression that I've had from the students I've spoken to).

There is no counter for skills decay, nor any assessment of the skills that we do occasionally use in order to make sure that we are providing best practice.

In essence I feel like a taxi driver with bandages – not someone educated to provide pre-hospital care beyond the very basics.

14 thoughts on “Training (Part One)”

  1. Whilst not involved in the emergency service myself, I have, all my working life, come up against a major attitude problem with training. The British way seems to be “Just get on with the job” and that training is a waste of time. This is enforced since any training initiatives that used to occasionally occur always concentrated on simple and pointless skills (Presentation skills etc.) rather than the more useful, technical stuff which, of course, required more skilled people to teach.

  2. Do the paramedics have a requirement to do CPD to maintain their HPC registration? I (a clinical scientist) certainly do. So what happens if/when it is decided that you EMTs require registration too? The trusts will surely have to support it?S.

  3. This may well sound like a bit of shameless advertising (which I guess it sort of is :P) but in Berkshire at any rate the paramedics in SJA do get the opportunity to attach themselves to local divisions and take part in their training; obviously it's difficult to fit around shifts, but it gives the opportunity to practice your skills.If you don't want to turn your work into your hobby I can totally understand that ^.^ But just thought I'd mention it, if work doesn't provide support then it might be worth looking to other organisations…

  4. Here is the thing – I see people who are desperate for training – they realise the benefits of training and seek it out.Of course these are people who use the internet regularly and perhaps that means something… I don't know.

  5. I beg to differ. My understanding is that you must present a portfolio with all your Continuing Professional Development in it and then hope it meets the required standards. Remember, it is up to us now to show why we should still be a state registered Paramedic. CPD encompasses alot of things; not just what the Service books for you in the way of courses. It is no justification anymore to say “the training is non-existent, etc”. I may be wrong, but it's only a matter of time untill someone loses their registration because of this.

  6. I forgot to add. The HPC do not want certifiactes issued to Paramedics(and Techs), unless you send documented evidence of how you put into practice what you learned on the course. Gone are the days of turning up and taking your certificate. Times are a changing.

  7. I know that paramedics CPD folders can be called up by the HPC, I don't believe Techs folders are generally called up by anyone after the initial training period.As for student paramedics only having 3 years training most university courses are two years, during these two years students only ever third man, they are then expect to graduate and go out on the road as qualified paramedics taking clinical lead of situations. I have to say that I am on a 3 year course where 2nd and 3rd year I work part time yet I wish I had more time to work on the road before I graduate, I have no idea how scared some of these 2 years students must be.

    In regards to training after qualification I think it's pretty poor across the country. Our local service are currently running CPD training but very few of the sessions are practical skills and I don't believe it is compulsary for staff to take part. Whenever something new comes out its just pinned on the wall and people are expected to sign a peice of paper to say they've read it. It shouldn't be up to you to fight for training, it should be available so that you have the confidence to use the skills you are trained for.

  8. I'm really surprised that you don't have to do any kind of re-assessment. In St John Ambulance, everyone has to be “revalidated” once a year, including ambulance crews, and the assessors will stop you from going out on duty if your skills aren't up to scratch. Similarly in IT, if you pass a Cisco exam then it's only valid for 3 years, then you either have to retake it or take a higher exam in order to keep that qualification. (I've sometimes thought that it would be a good idea to do that for GCSEs too – I've forgotten a lot of the French I learnt at school.)

  9. Now I know why I am glad I don't work in a city like London. Yes we get out fair share of innapropriate jobs etc but nothing like your 80%. Take today for instance out of 11 999 calls inc symtomatic bradycardia requiring atropine from me, acute asthma, cva etc only one call we weren't required_ECP dealing. We had one stand down as well. All genuine stuff. For me most shifts are like that. I think the education thing is the same all over but as a Paramedic I am responsible for my own education according to the HPC. I must say I have learned far more through my own self directed study than I ever did at training school. What makes me laugh is going to training school for a training officer to go over the quicktrach surgical airway device (who has never used one in anger) yet I have and so had 2 of the other guys! Same as needle decompression. Same as paeds cannulation and drugs administration, I have had quite a bit of experience. If you get the exposure then up goes your confidence. But if you don't get the exposure and/or decent/regular updates/refreshers then how is your confidence going to grow? I must be one of the lucky ones.

  10. I don't think training is a common thing wherever you work – the assumption is that you will learn by doing the skills you need. I'm a marketer in financial services and the push to maintain CPD comes from my professional organisations – not my company.Marketing has changed a lot since the internet came along – and it's important that FS marketers understand what they are marketing so they are sold correctly – but my FS qualifications are never requested on job descriptions and my marketing qualifications are nice to haves. As the saying goes, experience means you've been doing something a long time – it doesn't mean you've been doing it properly.I think there are a lot of areas where more of a focus on life long learning would be a good thing – but people are worried about what to do with the people who aren't up to snuff (hence all the grandfathering when regs are brought in). I'd vote for five yearly driving tests, for example.But it does strike me as particularly worrying that there seems to be such a culture of actively preventing you from training in LAS. What have you done to raise it higher up in the organisation? You're a public figure with the ability to guage peer opinion – you might find you have more clout than you think…

  11. Amen brother medic!While we don't have those exact same problems here in the US, training is quite lax. Sadly enough a majority of the training we do get is half-assed or it is well done and no one bothers to pay attention.

    I could go on all night about my trouble here, but I have a strong gut feeling you and I are in the same boat. At least when it comes to getting things changed

    Good luck with your battle, I'll hold my own over here.

  12. I have to agree that training is sparse in a lot of sectors. I am the Head Veterinary Nurse of a practice. I'm involved in the training of new nurses. Since the qualification changed to an NVQ (oh the horror!) I have seen the student nurses brush up on their essay writing skills in order to get those all important ticks in the boxes. There's now even a degree route into the profession but the studetns are only required to work placement for something like 12 weeks.Whatever happened to practical training, being able to cannulate a 6 week old dehydrated, soon to be dead parvo puppy? How to deflate a rapidly swelling GDV? How to dematt a cat without ripping its skin? How to intubate a cat in laryngeal paralysis? All these things take time, energy and practice to perfect. How can my students do that if I only see them for twelve weeks during their three year course? Oh, and keep the practice running effectively when I don't have the protected time mentioned earlier?

    Post qualification CPD is difficult to get hold of. Occasionally a drug or food rep will pop in to give a talk (provided you spend a fortune on their product) but these are few and far between. Official training course counting towards CPD are hugely expensive. Upwards of 300. I'm a Veterinary Nurse, do they honestly think I have 300 down the back of the sofa? I have no time allowance so all CPD time needs to be taken as holiday. Hmmm, expensive AND I have to give up holiday? Whatcha reckon the chances of me doing any CPD (apart from reading journals) is?

  13. “Your a public figure with the ability to guage peer opinion – you might find you have more clout than you think…”If only that were true.

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