The Reality of Ramping for Student Paramedics
Ramping is real, and the sooner we set our students up for success in navigating this new way of working, the better. Prepare them for what lies ahead in order to avoid unexpected disappointment and boredom. Educate them to expect long hours in limbo. Train them to titrate treatment over extended periods. Give clear guidelines to help them meet the standards we’d like to see.
Priorities are changing in prehospital care, with many paramedics now questioning career commitment for the future. In years gone by, joining the world of emergency medical services meant a high turnover of patients, among a daily mix of unpredictable emergencies. Part of the allure was in expecting the unexpected.
The medically minded individuals seeking ongoing patient contact found a vocation in medicine, mental health, nursing, midwifery and allied health professions. Those drawn towards more mobile, emergent, autonomous roles found their place in paramedicine.
Over time, training and education have improved skillsets and knowledge. The job has become more challenging and enthralling in its demand for increased intervention. New recruits are enticed by opportunities to provide ever higher standards of emergency care. They dedicate years and deepening debt to the academic qualifications required.
Student applications to universities and employers continue to arrive in droves. National industry insight reporting from the Australian Industry and Skills Committee suggests that, in 2019 alone, Australia wide, there were over 4,500 enrolments in ambulance and paramedic qualifications1. AHPRA's 2019/20 annual report outlines a 14.5% increase in the number of registered paramedics, over the preceding year, to almost 20,0002.
It's a fantastic career that can be extremely rewarding, so these figures make sense. But with so many new clinicians joining our ranks, how realistic are their expectations and how well suited will they be to the current way of working? The "hurry up and wait" approach that we're not preparing them for.
Recruitment campaigns by employers and educational institutions promote the frontline focus. Lifesaving skills; prehospital paramedicine; clinical challenges; emergency response; community-based roles and making a difference every day. Corporate social media feeds are full of inspirational stories, lives saved, and good deeds done. Television screens cover cardiac arrests, motor vehicle collisions, babies being born and all the feel-good factors that drive us to dedicate every effort, in an attempt to join this job.
We train them to drive using lights and sirens, so they can respond rapidly to patient emergencies and meet key performance indicators on arrival. We educate them in anatomy, physiology, pathophysiology, pharmacology, mental health emergencies, social studies, determinants of health, epidemics, pandemics, ethics, documentation legalities, interprofessional collaboration and more. We equip them with a growing collection of skills to include everything from basic life support, right through to advanced care. We teach them to use this education in recognising disease states for urgent intervention on scene, and timely transport aimed at improving patient outcomes. But what are we teaching them about the realities of care during several hours of ramping, stacking, waiting or wall time?
No matter how much we want to treat this issue as a temporary problem, the very existence of these well-known colloquialisms for the holding pattern that gridlocks our ambulances indicates otherwise. Even the term "corridor care" frequently features in journal articles, and evidence-based research repeatedly demonstrates that ramping has been a painful reality, in Australia, since the early 2000's3-6.
Adopting everything that we have learned over this past 20 years of waiting in line provides an ideal opportunity to educate and inform. The more we begin to focus recruitment and training on the "new" realities of paramedicine, the more our patients and our profession stand to gain.
Graduates will be more aware of risks associated with ramping, and the proactive measures they can take to address patient comfort, care and safety.
Their knowledge will naturally spread throughout a workforce highly trained for emergencies, but minimally in hospital-based procedural care.
Guidelines and protocols for corridor care can be structured purposefully, just like chest pain, childbirth, and choking have been in the past.
These clear procedures can inform every paramedic, intern, nurse, doctor and patient care provider of set standards and designated responsibilities.
New recruits form realistic expectations, rather than hit the ground running with high hopes of non-stop action, destined to disappoint.
Retention rates may increase, and those satisfied students may stay long enough to develop fresh ideas for fighting ramping in the future.
Formally adopting the issue into academia encourages evidence-based research and access to untapped resources that specific studies may reveal.
Nobody expects ambulance services or educators to take ownership of ramping; it's a multi-faceted problem that calls for a multi-faceted solution. But we can, as an industry, take ownership of our recruits. The onus of responsibility is on all of us in preparing them to provide their best in patient care, be it on scene, en route or on the ramp.
As paramedics we take pride in our ability to manage patients no matter where we find them.
Why not add corridor care scenarios, guidelines and assessments to the curriculum?
Thanks for reading,
Tammie.
References
Australian Industry and Skills Committee. (2020). National Industry Insights: Ambulance and Paramedic. Retrieved from https://nationalindustryinsights.aisc.net.au/industries/health/ambulance-and-paramedic#:~:text=In%202019%2C%20there%20were%20approximately,and%20then%20increasing%20in%202019.
Paramedicine Board AHPRA. (2020). 2019/20 Annual Summary. Retrieved from https://nationalindustryinsights.aisc.net.au/industries/health/ambulance-and-paramedic#:~:text=In%202019%2C%20there%20were%20approximately,and%20then%20increasing%20in%202019.
Ting, J. (2008). The potential adverse patient effects of ambulance ramping, a relatively new problem at the interface between prehospital and ED care. Journal of Emergencies, Trauma and Shock, 1 (2) 129-129. DOI: 10.4103/0974-2700.43201
Kennedy, M. (2005). Equitable Emergency Access: Rhetoric or reality? Emergency Medicine Australasia, 17 (4) 392-396. DOI: 10.1111/j.1742-6723.2005.00763.x
Kingswell, C., Shaban, R. Z. & Crilly, J. (2015). The lived experiences of patients and ambulance ramping in a regional Australian emergency department: An interpretive phenomenology study. Australasian Emergency Nursing Journal, 18 (4) 182-189. DOI: 10.1016/j.aenj.2015.08.003
Fatovich, D. M., Hughes, G. & McCarthy, S. M. (2009). Access block: it's all about available beds. The Medical Journal of Australia, 190 (7) 362-363. Retrieved from https://www.mja.com.au/system/files/issues/190_07_060409/fat11433_fm.pdf
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Content
Research prepared for Chapter 20 “Warming Up For The Wait” from Book #2 in the GBU Paramedic series.
Article first published in Australian Emergency Services Magazine Vol 21.
