Emergency medical personnel in the United Kingdom are people engaged in the provision of emergency medical services. This includes paramedics, emergency medical technicians and emergency care assistants. 'Paramedic' is a protected title, strictly regulated by the Health and Care Professions Council, although there is tendency for the public to use this term when referring to any member of ambulance staff.
Emergency medical personnel most often work in an ambulance alongside another member of staff. Typically, an ambulance will be crewed by either a paramedic with another crew member (technician or emergency care assistant), two technicians or a technician with an emergency support worker.
The majority of emergency medical personnel are employed by the public ambulance services of the National Health Service and respond to emergency calls generated by the 999 system. Many are also employed by a growing number of private ambulance companies and voluntary aid societies such as the British Red Cross and St. John Ambulance, who provide services such as event medical cover or support to some NHS ambulance services in times of need or under contract.
Many NHS trusts are in the process of phasing out the ambulance technician / emergency medical technician (Band 5 on the Agenda for Change) role from the services and replacing it with the emergency care support worker or emergency care assistant roles (Band 3 on the Agenda for Change), and most services are no longer training staff at technician level.
All ambulance services (in England), whether public, private or voluntary, are regulated by the Care Quality Commission, who dictate the expected standard of care.
History The 1966 Millar Report Prior to 1966, the training provided to ambulance attendants was variable. Each county ran their service differently; where some had dedicated ambulance services, some were under the aegis of the fire, police, or transport departments, and some were contracted out to parties such as St John Ambulance or the British Red Cross. In most places, the maximum training an attendant would have was a first aid certificate. In 1966, the Ministry of Health produced "A Report by the Working Party on Ambulance Training and Equipment", better known as 'The Millar Report'. Part 1 established the 'Ambulance Services Proficiency Certificate', which included training in first aid, anatomy and physiology, basic oxygen administration and suction of airways, resuscitation, splinting and handling, and operational matters. Also offered was the 'Ambulance Services Advanced Proficiency Certificate', which led the attendant to become an 'extended-care attendant' or 'Millar-Trained'. It included training on conditions of breathing and circulation, artificial airways, ventilators, control of circulation and blood pressure, surgical emergencies, and nervous system conditions. The attendant then had to complete a minimum of 20 hours practical experience in a hospital. Completion was signified by a badge worn on the sleeve of the attendant's clothing.
Those hoping to achieve Millar-Trained status joined the Association of Emergency Medical Technicians. This was an organisation run by members to promote and train Paramedics. The AEMT was supported by BASICS and large numbers of hospital doctors. Training took place at various locations with members attending off-duty and at their own expense. Trainees followed a wide academic curriculum which led to a written exam and if successful, they became Associates and entered the clinical phase of training. They then attended hospitals to receive their practical skills training. The final examination was designed to put as much pressure on the candidate as possible. The hospital consultant would sign to say that he was happy for a passing candidate to treat their family.
NHSTA 'Extended Ambulance Aid' In the early to mid 1980s, some ambulance service training departments started offering advanced skill training. In 1986, the NHS Training Authority introduced the certificate in Extended Ambulance Aid. Existing AEMT Paramedics were forced to sit a conversion examination. The curriculum for the new qualification was substantially smaller cutting out a lot of anatomy and physiology as well as pharmacology and obstetrics. In November 1986, the examinations took place with the first certificates issued alphabetically. The candidate with highest score received certificate 177 and was the only paramedic at Huntingdon. Training was introduced the following year but due to costs the time was kept to a minimum. The AEMT folded in the 1990s as the training offered was no longer recognised by the ambulance services. Equipment owned by the branches was given to hospitals.
Institute for Healthcare Development The NHS Training Authority became the NHS Training Directorate and then the NHS Training Division, which in turn became the Institute of Health and Care Development. The institute was acquired by the Edexcel examination board in 1998, and Edexcel was acquired by Pearson in 2004. Pearson continued to operate the IHCD 'brand' until 2016.
The IHCD Ambulance Aid Award (Technician) was established as an evolution of the Millar training. It included a course of 6 weeks training in various areas, covering a variety of medical and trauma based emergencies, including respiratory and circulatory conditions, cardiac monitoring, oxygen, airways, resuscitation, and maternity.
Also offered was the IHCD Paramedic Practice Award. This 'in-house' paramedic training was a modular programme, usually between ten and 12 weeks, followed by time spent in a hospital emergency department, coronary care centre and operating theatre, assisting the anaesthetist and performing airway management techniques such as endotracheal intubation. Completion of the course allowed the paramedic to register with the Council for Professions Supplementary to Medicine (CPSM), which was superseded by the Health and Care Professions Council (HCPC), a regulatory body.
Prior to regulation and closure of the title, the term "paramedic" was used by a variety of people with varying levels of ability. Paramedics could apply to register via a grandfather scheme which ended in 2002.
Eventually the IHCD began to accredit a few non-NHS training establishments, allowing them to teach their curriculum. In the mid-1990s, some universities started to offer para-medicine diplomas and degrees, in association with local Ambulance Trusts. By necessity these included all of the practical skills found in the IHCD curriculum and allowed applicants to apply for registration with the HPC.
Amongst the professionals regulated by the Health and Care Professions Council, paramedicine was the only one not to have an extant professional body, until the British Paramedic Association was formed in 2001. This later became the Royal College of Paramedics and now acts as a representative organisation for the paramedic profession. Unlike some other professions, membership of the college is not mandatory in order to be a registered paramedic.
Deprecation of the IHCD There has been expansion of allied health professions who are regulated, leading to the regulatory body being re-established as the Health and Care Professions Council (HCPC). In 2010, the IHCD route (which by now was jointly badged with BTEC) which as a route to becoming a registered paramedic was largely deprecated, although is still recognised by the HCPC, and anyone successfully completing the BTEC Level 4 qualification is entitled to register as a paramedic. This leaves the university route as the primary pathway for new paramedics, with a number of universities offering qualifications which can lead to registration, both as full-time courses for new students (although they must also be accepted for the practical element of the training by an ambulance service) and part-time courses for existing ambulance staff.
By 2016, the Ambulance Aid Award and Paramedic Practice Award had both been deprecated, and Pearson ran no more courses.
Standards of proficiency which every paramedic must meet in order to become registered were first issued in 2003, with the most recent revision issued by HCPC in September 2014.
Notable Individuals Doctor Peter Baskett was one of the world's leading figures in cardiopulmonary resuscitation and pre-hospital medical care. In the early 1970s, alongside Professor Douglas Chamberlain, Baskett developed advanced training for the ambulance personnel who then became the first paramedics in Europe.'Peter Baskett - 40 years as a resuscitation leader and mentor' Nolan J, Chamberlain D, Soar J, Parr M and Zorab J (2008) Resuscitation 77, 279 - 282 <https://www.resuscitationjournal.com/article/S0300-9572(08)00448-6/abstract> Professor Douglas Chamberlain, together with Baskett, pioneered the first recognisable paramedic training programme in the UK. Up until this point, only basic ambulance training had been in place nationally, having been rolled out only four years earlier. Professor Malcolm Woollard was a leading voice for the paramedic profession and the first UK paramedic holding a professorial role. His focus was development of the profession. He was described as "a ground-breaker for the paramedic profession." Woolard died in 2018, but has a legacy of research that lives on.
Skill grades of staff The specific skills performed by each group of emergency medical personnel is dictated by a combination of education, associated legal frameworks and the policies of their employer. The most homogeneous group are the Paramedics, as the framework of practice is largely guided by their status as healthcare professionals registered with the HCPC.
Other clinics grades such as emergency medical technicians, emergency care support workers and emergency care assistants are not registered professions nor is their job title or role protected or dictated by any national body. Therefore, their skill sets and permitted clinical interventions are governed primarily by their employer within the scope of relevant legislation. This has led to significant differences in training and skill sets between staff of these grades with different employers.
National clinical standards exist for all ambulance clinicians, written by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). This body is made up of representatives from a number of medical, nursing, allied health professional and ambulance organisations. JRCALC publishes guidance based on the principles of evidence-based medicine and best practice, but compliance with JRCALC is based on the employing organisations and the judgement of individual clinicians.
Emergency care assistants (ECA) or emergency care support workers (ECSW) Emergency care assistants or emergency care support workers are trained to a basic level of ambulance practice. As a result, they typically work as assistants to a paramedic, technician or AAP. Their role varies widely between services and as such, their clinical knowledge is typically from that of first aid up to the FutureQuals Level 3 Diploma in Ambulance Emergency and Urgent Care Support or, in the private sector, Qualsafe FREC4.
To reduce costs, many ambulance organisations have tried to reduce the number of ambulance technicians, increasing the number of emergency care support worker or emergency care assistants. Some U.K. ambulances services have taken this one step further by hiring "emergency drivers" with no medical training.
Ambulance Technicians