Reflections with Julia: “The early mornings are so much easier now that I’m getting paid!”

Julia: Huge congratulations on qualifying as a paramedic! What have you been up to so far?

Beth: “My first day was 5th August, when I picked up my uniform, got my iPad, and other bits. Along with the other newly qualified paramedics, I then completed a week’s clinical conversion course at the clinical education centre. On this course we covered some of things that the uni course doesn’t touch upon, things like using some of the online platforms where we can access our rota and systems where referrals are made. We also had an opportunity to refresh some of our skills like advanced life support by doing simulations with mannequins as well as refamiliarising ourselves with the kit bags.

“They also have a large cupboard which they’ve converted into the back of a Fiat ambulance, it's very realistic. We had two small teams and were racing to find pieces of kit. It was great fun.

“Then we started our four weeks of blue light training. This is an intensive course on how to drive the Trust vehicles, both routine driving and response driving. At times it was literally like learning to drive again. We were constantly observed and had loads of exams. It was heavy going, but so much fun - we drove all over Sussex. To get the Emergency Response qualification, we had to have at least 25 hours of driving and pass the two written exams and the four driving tests.

“After that, I was then back in college for the final week for the ‘transition to practice’ course. The course is tailored to new paramedics. We had a maternity day, some more simulation, and we were given a lot of Trust-specific information relevant to paramedics. We also went through the drugs we carry.

“I finished that course on the Friday and the following Wednesday was my first shift.

“My first 300 hours of work has to be with a Band 6 paramedic, i.e. an experienced clinician, someone that has worked for more than two years. I’m currently doing 3 or 4 shifts a week - two of my first shifts were with my old mentor.”

How have you found the transition from student to newly qualified paramedic? What has struck you the most about that experience?

“My first shift was a 6am-6pm, and I didn’t sleep at all the night before. I felt genuinely terrified. I hadn’t been on the road for a few months. I felt so much pressure to know absolutely everything, forgetting that I was going to be supported. I’m not sure if I was more nervous about driving or attending!

“The way it tends to work is that one person drives, one person attends. The attendee is in the passenger seat on the way and takes lead, completing the paperwork. The driver will grab the kit and follow the one attending. If going to hospital, the attendee will then go in the back with the patient. This is not a hard and fast rule, you adapt to the requirements of the job, but we tend to follow this pattern.

“We tend to rotate each job, which helps to break the day up a bit, but it is case specific depending on how poorly the patient is. If they are very poorly, the most qualified goes in the back.

“Even if I was attending when I was a student, I always had someone in the back of the ambulance with me, to observe and support. Now I’m qualified, it's just me and the patient - that first time it was very odd and felt like there was so much space in the ambulance!

“Also, I’ve found that when you qualify, you put more pressure on yourself. People now look to me to make decisions. I've found I overthink more and make decisions aloud - this is just inexperience as I still feel like I don't know much, even though I do!

“People are no longer watching everything I do to make sure I’m ok, so that has changed the dynamic. There’s a lot of stuff we didn’t do as students that we now do. There is also more responsibility: I carry my own controlled drugs, people ask me questions and occasionally to review paperwork.

“I’m currently the only NQP at Hastings. I do message some of my other newly qualified friends when I have questions or do something new, like I texted them when I administered morphine for the first time. But we are all busy on different shift patterns, so it's not easy.”

What really stuck in my mind from our last conversation was the lack of actual trauma cases you were seeing. Much more seemed to be related to mental health and loneliness. Is this still the case? And would you say the effects of lockdown relating to this are still playing out?

“It’s actually far worse now than it was a year ago. Mental health is a huge part of the demand, plus the GPs are so overwhelmed, so it’s been very busy.

“People call 999 for something that has been going on for weeks, often they have been unable to get a GP appointment. They don't know where else to go, especially in the middle of the night. For some people, it’s ok and we can take them to hospital or give advice. But if they have a chronic illness and they just need their medication reviewed, we can’t do much for them. For some, they just need pain relief or a change of medication and they are desperate. It's very frustrating when we can't help.

“Some calls are for end-of-life care, when the carers or the family need to speak to a GP or a hospice and can’t, they are told to call 999. I was on scene for 4.5 hours recently, desperately trying to get a call with a doctor. This particular patient was not appropriate for hospital and had documents saying they weren’t to go to hospital. I needed to refer them back to someone more appropriate. They were in their last days and I was on the phone for nearly two hours before I spoke to someone who could help.

“A lot of what we do is not necessarily emergency care, so we are up against it as well. We often feel a bit useless. I can give advice and tell patients what the options are, but making that happen is very difficult. This is especially the case with the elderly and mental health patients. Thankfully we don't see as many children - parents are very good at taking them to hospital. We tend to see people who don’t have the means to get to hospital, or have poor physical mobility.”

Now you’re qualified and working full time, how do you find the time to keep learning and carrying out CPD?

“In our first two years, we have to complete a portfolio which covers a range of topics - there’s reflective practice and CPD within it. I have to do that in order to get my uplift to become a Band 6 paramedic. There is a lot covered within this, including consent, advocating for patients, communicating, leadership and providing examples of when you have worked on certain cases.

“Each piece of work is marked and then added to the portfolio. You can submit your writing, voice notes, and professional discussions. There is a mark scheme for each type of entry. You have to complete your portfolio in your own time. We are all responsible for our own CPD.

“SECAMB put you on a key skills course at one of the local stations, which is mandatory training. There are also workbooks online that have to be completed every year, such as on infection control and health and safety. SECAMB also run courses - not that often, due to staffing, but it could be an online webinar on airway management, for example, and then you get a CPD certificate.

Do your peers and colleagues find keeping up with CPD a challenge?

“Yes, there are only just enough hours in the week.”

Are podcasts still your CPD resource of choice then? What are you listening to at the moment?

“I find them interesting and tend to put them on in the car on my way to work. The Resus Room is a good one, and you can now get a CPD certificate once you have listened to it via the website.

“Sometimes there are courses that run online where you can watch a presentation or videos and then you get a certificate. I like to do these if they are free and if they interest me.

“People frequently set up events on Facebook for Teams or Zoom lectures on a particular topic.”

What advice would you give to student paramedics out there, who are perhaps in their final year and daunted by the idea of qualifying and being out on the road full-time?

“I would tell them it’s normal to feel terrified - 99% of people are terrified.

“If you are not confident on something, use your last year at uni to get that confidence you need and familiarise yourself with it. I hate ECGs and can’t grasp them, so I used to actively avoid them. But now I have to be able to interpret them, so I had to take it upon myself to build my confidence in understanding them. I'm no expert, but I know enough!

“Also, make sure you enjoy your time off. Have a summer holiday! Don’t stress about the dissertation until you have to. It’s going to fly by!

“The early mornings are so much easier now that I’m getting paid! It doesn’t feel like I’m getting up to go to work. But there are so many people that are burnt out - the staff that worked through COVID have done amazingly and really deserve a break.

“For me, being a paramedic doesn’t feel like work. Sometimes I still can’t believe that I am finally qualified and that I made it!”

A huge thank you to Beth for joining us once again to discuss her experiences. If you enjoyed this article and found it a valuable insight into the life of a paramedic, please share it on Twitter.