If there is one thing in this world that is constant, it is change. The subject matter is almost irrelevant. Whether you talk about large political topics such as the climate, economy or job creation or much smaller issues such as that new rattle coming from under the hood of your car, it is inevitable. Things will change and they will change every day. When you talk about health care, it is no different.
From the time I started in this crazy profession over twenty-five years ago, many, many, many things have changed. Most of those changes came about because of the natural evolution of paramedicine. It is well established that certain events or time lines helped accelerate this evolution with perhaps nothing having a larger overall effect than war. War was where organized field medicine became prominent and although they did not know it at the time, the field medics that served from the time periods of the First World War through the Vietnam War inclusive set the real first parameters of what civilian paramedicine was going to look like. As any history buff reading this knows, there were many battles and wars in the 1800s and there have also been many battles and wars since Vietnam. However, it was only in the late 1960s and early 70s that civilian paramedicine really began to take shape and it was the wars and battles leading up to that time that dictated what it would look like.
Since then the evolution of paramedicine has been something incredibly exciting to watch and be a part of. To witness the changes in protocols, equipment and scopes of practice over the last two and half decades has made me quite glad that I was involved during this time. One question I’ve posed to historians is, “Who do you think actually had it harder? Those who went from simply putting someone in the back of a vehicle and driving them to the hospital with no patient care given to having to do first aid, cpr and defibrillation? Or those who three decades later went from working at a basic life support level to an advanced life support level of patient care?” It’s an interesting debate to have over a coffee with your peers sometime.
Whenever a new procedure or piece of equipment was introduced into the scope of practice, there was always one sentiment grumbled amongst the paramedics. “How am I going to remember how and when to do this?” As it turns out, this one simple question became the impetus for the creation of what we now know as continuing education. The need to have ongoing training and education became apparent as time went on and more and more responsibilities were given to paramedics. Whenever something is new and being developed, the decisions to be made include what format will it take, what subjects need to be covered, how in depth will it be and what, if any, would be the repercussions of not successfully completing the training.
In the earliest stages of my career, it was truly left to the paramedics to take care of their own ongoing education. Once a calendar year you would be required to go in for a day, be tested on the subjects and procedures that you were supposed to know, and then go back out into the field and carry on for another year. Although I had my start in the mid-90s, if you take a look back through the 1980s in Canada you can see that it was this way for most every paramedic in the business for almost fifteen years. There were different variations of course as well as some exceptions in different areas, but over all this was the standard.
It was only a few years into my career that intravenous cannulation and medication administration were introduced into the scopes of practice and this changed everything. Now we were performing invasive procedures on our patients that previously only doctors or nurses could do in hospital. Now it was determined that direct medical oversight was needed and ongoing continuing education was required as much as if not more than annual recertification.
Keeping in mind that back then the internet wasn’t what it is today and cell phones with data storage and the ability to receive emails did not exist yet, the only way to hand out education materials was through what we now call the old- fashioned way, books.
Here you can see a copy of a continuing education module put out in 1999 by the Alberta Prehospital Professions Association who are now the Alberta College of Paramedics. I have five years-worth of these modules still in my cabinet to this day. I’m sure some of you are asking the obvious question of why I would keep material that is over twenty years old? The answer, it’s still relevant.
The human body hasn’t changed. Anatomy and physiology has not changed. What has changed is how we deal with the diseases and injuries that affect the human body. New procedures and especially new medications have entered our scopes and given us options for treatment that we never had before. But these new procedures and new medications brought with them new responsibilities that were simply too much to be left to having one annual review. Ongoing education had become a necessity for paramedics to maintain competence in what they did.
Below you can also see a book about auscultation skills involving breath and heart sounds. This copy is a third edition that was published in 2006. However, I had the first edition of this twenty-six years ago when I was a student. I only obtained this copy when my first copy was lost, or eaten by my dog, or used as a fire starter. I really don’t know what happened to it. But I knew I liked it and it was something that I would be able to reference my entire career since it also came with audio CDs that you could listen to and remind yourself of what you were hearing. Why do I still have this old book? Just like the other book, it is still relevant.
I, like most of you have thrown out way more education materials than I have kept over the years. Now, with nearly everything digitized you either have it saved to your computer or phone, or you delete it. Or at least you have it saved until a nasty virus comes along and wipes out everything on your computer including those once-in-a-lifetime pictures from your trip to Africa!
But I digress. Having all of your medical and operational protocols in an App has proven to be very effective as a quick reference tool as it is very quick and easy to use either on scene or on route to a scene to let paramedics remind themselves of certain protocols. With so many procedures and protocols to remember now, including everything related to Covid-19, getting things right while in the moment is much more important than having outstanding memorization skills. Although you should feel blessed if you do possess this skill. But with everything now in digital format including communication between management, medical oversight and paramedics, there is no reason why updates, alerts and important announcements could not be instantaneous throughout your service. Digitization and the internet have certainly provided the greatest opportunity for the powers that be to provide rapid and updated ongoing education to their paramedics.
Life long learning is fun. Or at least it should be. Although the responsibilities and stress levels are greater for paramedics today than they were twenty-five years ago, it is still a wonderful profession to be in. To be able to go to work every day knowing you have a chance to make a positive difference in someone else’s life is a blessing and is not something that should be taken for granted. However, in order to keep up with the demands of todays job, we all need to pitch in. By “all” I mean management, medical oversight, our paramedic associations and paramedics themselves. No one group should be left with the sole responsibility of handling continuing education. Everyone should be doing their part to ensure to the best of their ability that their service is the highest quality they can make it. Together, we can make a difference.
The COVID-19 pandemic hit all of us like a baseball bat over the head. In the field we were suddenly faced with new protocols and procedures coming at us every single day. Reaction time was immediate and we had to learn on the fly about what was going on and what was being done about it. At the time of this writing we are clearly into the second wave of this and it may end up being worse than the initial one. I want to tell all of my colleagues in Canada and around the world to stay strong, follow your protocols to help protect you and your family, and above all else, keep the faith. This too shall pass.