Georgette Eaton

EDUCATION, EDUCATION, EDUCATION – Saturday 20 May

I mentioned in my last blog about how we as specialist practitioners are impassioned to support our colleagues to develop their practice. It’s a part of being a clinical leader on station and each station of specialist practitioners have a role in this to contribute to their station team. However, we as individuals also all have our own interests in our field of practice, and mine is most definitely education and research. Education and research might sound to be really stuffy, but they really are not. Have you read Jess’ blog? She’s having lots of fun at the SCAS Education Centre transitioning from a New Zealand Paramedic to a Buckinghamshire SCAS Paramedic and learning all sorts of new things. So it really is a key part of the job.

As well as being a specialist practitioner, I am also a Lecturer in Paramedic Science at Oxford Brookes University. I mainly teach on the minor injury and minor illness modules (as these are mostly what I practice ‘on the road’ as a specialist practitioner), but I am also the research lead for the programme and so I teach research too. Pretty much everything that happens in healthcare is based upon research. We call it evidence based practice (practice being what you are doing, like being a paramedic). So, actions paramedics take are supported by clear reasoning (evidence), and then using their own professional judgement as well as taking into account the patient’s preferences. This relies on a good understanding of research: how to find it, how to understand it, and working out if it’s any good! It might not sound it, but it’s relatively simple and once you’ve grasped the basics, it’s easy to keep finding it, reviewing it, and making small positive changes.

However, research is quite an academic skill and it can be daunting to some paramedics. But, I am really passionate about it and the difference it can make to our practice, and one of my challenges is to demonstrate this to others working in the ambulance service! Fortunately, within SCAS there is a whole team dedicated to research, with ‘research paramedics’ who help to guide the clinical direction of the Trust. They do a lot of ‘behind the scenes’ work to promote best practice and ensure new ideas or equipment are incorporated into our practice.

With my dual role, I quite often have student paramedics observing with me during the shift. I love having the opportunity to observe how the students are incorporating what they have been taught into practice and test them on areas they might not understand so much yet. It’s not about testing their ability, but more about seeing them develop their knowledge and skills. It is a great reward when you encounter a student you have mentored as a qualified paramedic ‘on the road’ and can see their development, both personally and as a clinician. I have recently had student paramedic Matt out with me. He’s also one of my students at Oxford Brookes (students at Oxford Brookes have their ambulance practice placements in SCAS) and is sitting his final exams and assignments to qualify as a paramedic this summer. We had two shifts together and he asked me to test him on everything and anything, so we could work out where he wasn’t so strong and then revise those areas. Matt is a credit to the paramedic science programme, and with relatively few weak spots we decided we’d go back and revisit the anatomy and electrophysiology within the heart. A solid understanding of human anatomy is incredibly important when you’re in a job that looks after the human body! I always welcome a refresher and so during some ‘down time’ on the shift, Matt told me everything he knew about the heart and we went through it step-by-step. I think we both remembered a few things that had fallen into the recesses of our minds, and that’s what I love about teaching in education – being reminded some of the smaller aspects that are important pieces to create a complete picture.

However, I’m certainly not on my own in doing this. SCAS has paramedics who work as clinical mentors in each team, who are responsible for the development of staff and students in their team. These paramedics work within the wider SCAS Education Team, the group who oversee staff training and development within the organisation. These paramedics do a sterling job in mentoring students from their first year at university through to being qualified paramedics. Many specialist practitioners have also received training to be clinical mentors, and whilst it is rare for a paramedic to have both roles, mentorship fits nicely within the clinical leadership element that specialist practitioners strive for.

Education and research might sound boring, but they’re both important attributes in becoming a paramedic and then developing as a clinician. It’s also not all theory based either; there are a lot of practical skills behind being a paramedic and these are usually taught in simulation. The picture above shows some simulation training our student paramedics at Oxford Brookes take part in with Buckinghamshire Fire and Rescue Service at the Fire Training College in Gloucestershire. This is where students’ (and qualified members of staff) enter a scenario with realistic equipment and act as if it was a real patient, from the conversation to the clinical procedures performed. It’s a really good way to learn and it’s not just limited to the university or education centres; many stations have their own training equipment they can use in their ‘downtime’ to practice. And practice makes perfect, right?

OUT ON THE ROAD – Sunday 30 April

Did you check out my last blog about the First Aid Unit? Well, being a specialist practitioner in SCAS is incredibly varied, meaning I don’t always work at the FAU. Today, I am on what I consider to be our routine allocation, which is driving a response vehicle. You may have seen these around, estate-type cars with green and yellow ‘battenberg’ markings? Whilst the outside looks just the same as those used by other clinicians in SCAS, the inside is slightly different! Specialist Paramedics carry a lot more equipment than a frontline ambulance.

Firstly, we have a few more additional examination tools. These include special scopes for looking into eyes (ophthalmoscope) and ears (auriscope). We have tendon hammers to test reflexes (like your typical knee jerk) and tuning forks to test hearing. We also carry a device called a Toxco. Our colleagues who work in resilience carry this (and a lot more specialist kit), but it means we can easily detect if someone has too much carbon monoxide in their blood, usually following a fire. These tools allow us to complete a very thorough assessment of patients we see, and go a little more in depth than our paramedic colleagues.

We then have three more bags: a wound care bag; a drugs bag; and catheterisation kit.

Within our specialist wound care pack we have equipment to clean and then close and wounds. We also carry tools for primary wound closure (steri-strips, glue and sutures) and every type of special dressing you can imagine, from packing to chronic wounds; dressings specialist for burn care; and also impregnated gauzes that help blood to clot.

We also carry a range of medications, which we supply under a patient group directive (which allows us to supply and administer specified medicines to pre-defined groups of patients, without a prescription). We carry a range of pain killers; antibiotics (for everything from an acute ear infection to a urinary infection); anti-sickness drugs for dizziness or similar disorders; steroids for people suffering with respiratory infections as well as inhalers (many people forget to renew their inhaler prescription, and don’t realise until it’s too late!). We also have many of these in solution form, so we can supply them to children, people who have difficulty swallowing or via a special line into the stomach. It’s about being flexible in who we can treat, and providing care to a diverse population.

Lastly, many of the specialist practitioners can perform urinary catheterisation. This is when a flexible tube (catheter) is used to empty the bladder and collect urine in a drainage bag. It is usually used when people have difficulty urinating naturally.

All this plus the ‘normal’ paramedic equipment that allows us to deal with life-threatening emergencies. As I’m sure you can imagine, it’s a fair bit to carry. Thankfully, I was always good at Tetris as a child, so I do manage to fit it all in!

But how do you become a Specialist Practitioner? Specialist Practitioners can have their foundation either as a Paramedic or a Nurse (or some have both). Additional education is required to specialise in urgent care and this is currently a post-graduate certificate (which is two modules studied at Master’s level), however many go on to complete the full Masters’ programme.

Yet, our role isn’t limited to clinical care. We are also clinical leaders, which mean we are role models on our stations and within our teams. This means that we need to keep up to date with research relating to our role (both as a paramedic and an urgent care specialist) and cascade this to our other colleagues in operations, from emergency care assistants right through to team leaders. Each station of specialist practitioners runs their own initiatives relative to their area and what their personal interests are. Within Oxfordshire, we have regular meetings to review documentation completed by clinicians, and offer feedback for personal development. So many of our clinicians do a great job, it’s really rewarding to give positive feedback from this group. So, our role isn’t just about treating patients at home (or at first aid units) and preventing admission to hospital; as a group of staff we are also passionate to encourage our colleagues to develop their own practice too. Working together well means we can provide the best care to our patient, in the right time and right place. After all, that’s why I chose to become a Specialist Paramedic.

INTRODUCING GEORGETTE EATON, SPECIALIST PARAMEDIC, OXFORDSHIRE

I write my first blog post from Chipping Norton First Aid Unit. If you’ve not heard of either, Chipping Norton (affectionately known as ‘Chippy’ locally) is a market town in West Oxfordshire. And a First Aid Unit is exactly what it says in the title: it’s a small unit that can treat a wide variety of problems from cuts and sprains to minor infections. It was set up by a much loved and respected colleague, Gary Toohey, to provide out-of-hours first aid cover to the local area as well as relieve the stresses within the Emergency Departments (ED) at the nearby hospitals. Many people attend ED when they could be treated just as well (and probably quicker) at a first aid unit, or a minor injuries unit. There is, however, a key difference here: first aid units do not have X-ray support, whereas most minor injury units do.

This unit is relatively small, with a desk overlooking the car park (and viewing any potential visitors), cupboards and a dressing trolley lining one wall, with an examination couch at the back. However, we stock everything and anything required to treat minor ailments and injuries. Additionally, since we’re a rural community service, we have on the odd occasion provided the first steps in treatment for those experiencing heart attacks, severely broken bones and even delivered babies – although thankfully, there is a maternity suite upstairs!

Either way, we are a busy little unit manned by one Specialist Paramedic (and sometimes an accompanying student) at a time. On the first weekend in April, that was me. I’ve been a specialist paramedic for four years this year and really do enjoy my job. Working in unscheduled care, similar to the nature of any emergency or healthcare service, you’re never really sure who you might meet, what you might see and where you might go. If only these four walls of the unit could talk…!

I am currently two and a half hours into my weekend shift, and have so far seen three patients: a child with a minor ear infection; an elderly lady who required a dressing change for her sore leg ulcers; and a young male who had cut his thumb during some woodwork. What I love about this particular service we run within SCAS is not only the clinical variety I encounter each day, but that feeling of making a real difference. We can review the child later in the week if their ear infection gets worse, which helps alleviate mums’ anxiety and means we can catch any deterioration quickly. I have redressed the elderly lady’s leg ulcers several times before, and it really is satisfying to see that they are getting better and her mobility is improving – from something as simple as cleansing and redressing a wound! Treating the young man’s laceration also means his wound can be closed in a timely manner, preventing infection among other things, and also meant he didn’t have to wait too long to be seen. It’s not just the difference in the local community; it also makes a difference to the wider health services – alleviating pressure for my colleagues in emergency departments as well as within general practice. Oh! That’s the bell! Outside I can see a teenager in football kit hobbling towards the unit, with one ankle in a bandage. I ought to open the door to our fourth patient of the morning!

Eight hours later….

It has been busy today! Following my four patients this morning (the teenager had a rather bruised ankle from a heroic tackle that won his team the match), I have since seen:

  • 3 year old with a high temperature
  • 20 year with a subungual haematoma (bleeding under the nailbed)
  • 43 year old who had crushed his thumb in the car door- he will be seen by the plastics team at the John Radcliffe Hospital in Oxford tomorrow morning
  • 68 year old with vertigo
  • An 11 year old with a soft tissue injury to his knee (another football injury, this time requiring an X-ray at the local minor injuries unit)
  • 52 year old with an ear infection, who didn’t require antibiotics
  • 72 year old with mental ill-health, who required additional social support
  • 26 year old who had been bitten by a dog
  • 36 year old who required a dressing change (ongoing management for burns from three weeks ago)
  • 10 month old with a milk rash
  • 49 year old with urinary tract (water) infection. After testing her urine, I was able to give her some antibiotics to get rid of her infection.

There has definitely been some variety! That’s the beauty of this unit, as well as never knowing what or who you might see next, the breadth of conditions we can help out with is really quite vast. I think that’s largely because my background as a paramedic (being autonomous and having to rule out the worst-case-scenario) has really helped me develop how I think about conditions. Plus additional training to be able to identify and treat minor injuries and illnesses really means this unit can just about deal with anything! The other benefit is, if there’s something I’m not sure about, we have a good network of referral routes. So if we can’t treat within the unit, we can help find someone who can. For instance, the gentleman who had trapped his thumb; he had a laceration through his nail as well as a possible fracture. I referred him for an X-ray at a nearby minor injury unit and also organised a review for him within a team who specialise in repairs of wounds or injuries in complex or essential places. I would say a thumb is pretty essential for most things!

So, after a busy day it’s time to restock the dressing trolley, clean the surfaces and the rest of the room, and generally prepare the unit for the morning. I might even have time for some tea; I think I deserve a cuppa!