Ambulance Driver or Paramedic?

As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing? 

Do we fully engage in shared patient care with our attending partner, or do we switch off so that we can simply drive the ambulance and take it easy?

With so many countries and jurisdictions now regulated, or about to be, we are beginning to see considerable change in how paramedics operate within (as well as how we ourselves view) both attending and driving roles.

For some, this is likely to be welcomed, but for others, it may prove an unexpected stressor, as those “driver mode” days are well and truly over.

In the prehospital environment, there’s no doubt about it, someone has to drive when a patient needs to be transported to definitive care. If that someone happens to be a registered paramedic, however, as is often the case, it is expected that their involvement is not limited to sitting behind the wheel, driving from one location to another.

In Australia, for example, AHPRA’s Paramedicine Board describes paramedics as "practitioners" throughout documentation regarding registration. This comes with it several responsibilities and expectations relating to every interaction involving patient care. 

Whilst working as a paramedic, our code of conduct within the professional standards, to which we have agreed upon submitting our registration applications, includes several aspects which apply whether we are attending, or driving.

Clear and effective communication with patients, colleagues and other practitioners is expected at all times, as well as taking steps to alleviate any patient symptoms or distress. Consideration of benefit vs harm in relation to clinical management must be maintained, along with appropriate consultation and shared decision making, between colleagues, during treatment of patients. Clear co-ordination and delegation of shared care between practitioners, as well as the responsibility to collaborate in order to mitigate potential risk to patients.

With this in mind, our professional autonomy, integrity and reputation must remain at the fore throughout every call we attend, no matter which seat we occupy in the ambulance. Now, more than ever, teamwork is a must.

Through various aspects of prehospital training, whether it’s in-house or via tertiary education, the provision of high quality health care is based around effective communication and teamwork. It is widely known that collaboration between practitioners improves patient outcomes, reduces medical errors and enhances patient satisfaction. Any failure within a team dynamic not only compromises patient care, but can create tension, negatively affect the environment we’re working in and undoubtedly cause distress to each practitioner involved.

In addition, with societal knowledge (and therefore expectation) of our roles increasing, the likelihood of more complicated complaints begins to rise. Paramedic behaviours and perceived levels of care are becoming an area of focus in other jurisdictions, not just the success or failure of clinical decisions undertaken. Examples such as delays in communication with family members and failing to ease the emotional stress of patients feature heavily. The psychological pressure, therefore, involved in coming up with appropriate solutions to patient care in stressful, unpredictable and ever changing prehospital situations intensifies.

None of us want, or need, the extra stress this creates, nor do we want to risk patient safety, therefore how do we begin to balance out both roles without stepping on a partner’s toes?

Five key aspects of teamwork may help to keep us on track towards best patient care, safe practices, efficiency, professional management of the scene and overall satisfaction of everyone involved in each call.

1) Deliver (and accept when in a secondary role) a leadership style that co-ordinates and plans with a conversational, collaborative approach between both paramedics.

Not only can this provide clarity and establish what needs to be done, it may ensure that with minimal additional effort, patients, family members and others on scene feel well informed and continuously reassured.

2) Mutually monitor each other’s performance to detect and avoid task overload, as well as prevent lapses in care.

Without questioning or criticising, both primary and secondary roles can help to keep each other on track and maintain a working environment that is supportive. Sharing information and updates both on scene and during transport may ensure that no individual feels alone in a pressurised situation.

3) Backup positive behaviours and provide supportive actions within shared care.

Assisting by setting up for interventions, gaining history from and providing reassurance to family members, and using body language or expression to support explanations our partner is giving, highlights a strong, patient focussed team. Not only is this likely to bolster the primary paramedic’s confidence in stressful situations, it may be pivotal in demonstrating the professional, cohesive and efficient nature of a paramedic team to each person present.

4) Create a truly team based approach by sharing ideas, taking the perspectives of both paramedics into account.

As the primary paramedic, verbalising a plan of action and requesting feedback is integral to involving a crewmate. Whilst this may prove challenging, dependent upon individual personalities, it may be the only way to ensure that a secondary paramedic  agrees with what needs to be done. For best patient care and avoidance of risk, error or complaint, no matter how difficult it seems, it’s imperative that we find a way. In addition, if we are responsible for a trainee, or unregistered partner, ensuring that we know what’s going on at all times is the only way that we can keep our own registration intact.

5) Be adaptable, with both practitioners willing and able to ensure that changing conditions and situations are not only prepared for, but dealt with effectively.

Working together continuously and maintaining vigilance, whilst attending, driving or anything in between, may ensure that any change in situation is recognised.

The next time we feel frustrated at being called “ambulance drivers” perhaps we ask ourselves an important question. When it’s our turn to drive, are we giving our absolute best as the secondary paramedic within a professional, patient centred team, on every single call?

Thanks for reading.

Tammie

References

Austin, Z., van der Gaag, A., Gallagher, A., Jago, R., Banks, S., Lucas, G. & Zasada, M. (2018). Understanding complaints to regulators about paramedics in the UK and social workers in England: findings from a multi-method study. Journal of Medical Regulation, 104 (3) 19-28.

Bhatt, J. & Swick, M. (2017). Focusing on teamwork and communication to improve patient safety. American Hospital Association. https://www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-patient-safety

Freytag, J., Stroben, F., Hautz, W. W., Eisenmann, D. & Kämmer, J. E. (2017). Improving patient safety through better teamwork: how effective are different methods of simulation debriefing? Protocol for a pragmatic, prospective and randomised study. BMJ Journals, 7 (6). https://bmjopen.bmj.com/content/7/6/e015977

Paramedicine Board AHPRA (2018). Code of conduct (interim). https://www.paramedicineboard.gov.au/Professional-standards/Codes-guidelines-and-policies/Code-of-conduct.aspx

Patterson, P. D., Weaver, M. D. & Hostler, D. (2017). Human factors and ergonomics of prehospital emergency care. Teams and teamwork in emergency medical services. CRC Press, Boca Raton.

Weller, J., Boyd, M. & Cumin, D. (2012). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate Medical Journal, 90 (1061). https://pmj.bmj.com/content/90/1061/149

(This article was originally published in the Australian Emergency Services Magazine in December 2019. Subscribe for free by visiting AESM online and read each bi-monthly issue as soon as it arrives in your inbox.)

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As a current, practising paramedic in Australia, Tammie Bullard is passionate about prehospital care. With a background in metropolitan and country ambulance, academic study, clinical training, precepting and lecturing, she aims to put it to good use. Through the shared experiences of countless students, colleagues and mentors, her first book is designed to encourage effortless and ongoing self-reflection in every paramedic that strives to excel in their rewarding choice of career. Find out more about the author and the book through any of the links included below.

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