I am a 22-year-old Paramedic Science student at the University of Surrey in the UK. The 3-year degree programme is split equally between university and working shifts with the South East Coast Ambulance Service. In summer 2019 I had a 3-week placement with the British Columbia Emergency Health Service.
UK Paramedic Student’s Experiences in Vancouver
Between our second and final year of study we have the chance to organise an Elective Placement to explore practice areas of interest or investigate career prospects. Whilst the University provides some organisational support and insurance, our electives are student-led and require us to find a placement provider and fund costs.
I grasped the opportunity to organise my placement in Canada and was luckily put in touch with Paramedic Practice Leader Leon Baranowski of BCEHS in Vancouver by my ex-lecturer Lucas Hawkes-Frost. I aimed to compare Canadian practice and systems to the UK’s, gain an understanding of different ways of working as a paramedic internationally and identify the training required to work within specialist roles.
Ready to stick out in my greens amongst the sea of navy blue, I felt nervously excited when I arrived at the BCEHS headquarters. I was immediately put at ease and my excitement increased as we ran through my schedule. It was fascinating to hear about the organisation’s recent progression and was surprised to learn that unlike the standardisation of UK’s National Health Service, the Canadian health services operate provincially. However, after hearing more about British Colombia’s demographics, unique geography and climate I could understand why- providing health care was a logistical nightmare!
Gaining an insight into the running of an ambulance service furthered my appreciation of all aspects that must integrate to form a functioning organisation. I particularly admired the Paramedic Practice Leaders using their clinical experience to help improve the service. Whilst acknowledging that this progression would scale over a number of years, I left with the sense that it was an exciting time to be part of BCEHS.
I spent the rest of my first day being introduced to many people in dispatch and meetings. Everyone was friendly, open and enthusiastic to talk about their role and despite leaving with a brain overflowing with new information, my first impressions were very positive.
The (UK!) Surrey area where I work is a world away from Vancouver. Many of my shifts include long transfers through winding country roads and I wasn’t quite prepared for the hectic city pace! But working my first shifts on SRVs with paramedic specialists was the perfect introduction. As the token tourist I appreciated that paramedics Jodi, Christiana and Rico took the time to point out the sights!
I was in awe of beautiful areas like Jericho Beach and North Vancouver but it was the Downtown Eastside that I found most eye-opening. Although I had heard a little about the mental health and drug crisis, to be fronted by people shooting up heroin at 8:30am was still a surprise. I was interested to hear about future implementations that might help relieve the situation.
Observing assessment of high acuity patients and management of crews by paramedic specialists was invaluable experience. One memorable job was a a traumatic brain injury patient who warranted efficient management and transfer to hospital. Management and co-ordination of various resources were second to none and resulted in transfer from the roadside to resus and into CT in less than 15 minutes. Something I noticed from this scene and throughout the rest of my placement, was how good crews were at vocalising primary and secondary surveys, helping to keep management systematic.
Chatting to various paramedics and hospital staff helped to further my understanding of BC’s health system and gauge the differences from home. Not being directly comparable to the UK’s, ascertaining the different credentials and scopes of practice was challenging as well as explaining my own training and elective placement. Although coming with financial burden of fees and living costs, I realised how fortunate we are to have degree programmes. Following my study, I will hold a paramedic registration equivalent to an advanced care paramedic with slight contrasts in skills and drugs carried. It surprised me to learn that your primary care paramedics must move from bigger cities to work by pager or stand-by. Which gave me a great appreciation of their commitment to gaining full time employment in the profession.
A similar registration route is also available in the UK and most paramedics with long service years followed this traditional path. I love the ambulance service’s diversity and the ability to absorb the ‘best bits’ from an array of practice styles. This is something I feel should be celebrated where each paramedic can integrate into a team focusing on patient care which is why we chose to be part of this profession. Even after just two shifts, I sensed a good morale within BCEHS and admired paramedics’ energy and upbeat nature.
During my second week I was able to explore BCEHS’s specialist programmes starting with the Critical Care Team. Newly acquired familiarisation with BC’s geography meant I was not surprised that the Air Ambulance was such an integral part of the service, and I was in awe of some of the stories shared by Ward and Graeme, who kindly welcomed me for the day. Their management of some patients sounded near on impossible and even more so when they explained long and complicated transfers they’ve previously undertaken with critically unwell patients. Viewing the aircraft’s compact work space only increased my respect for this high-pressured role. Being every student paramedic’s dream to ride out with HEMS, I couldn’t believe my luck when a call came in and we flew over breath-taking views of the remote Gulf Islands.
It was incredible to observe the team’s patient management. Attending a combative patient who had ingested bleach and was metabolising sedative drugs faster than they could be drawn up provided invaluable learning and I witnessed interventions that I had rarely seen performed. I was impressed by the integration and teamwork of the resources on scene.
I then took a ferry ride and drive to the stunning harbour town of Madeira Park to work with the Community Paramedic. From the moment I met Cheryl it was obvious how much she enjoyed her job and cared about her community. It was a privilege going on home visits with Cheryl and in being able to devote up to an hour for each, I witnessed some of the best patient centred care I have seen delivered in practice. Watching how this level of care was so well received by Cheryl’s clients was a side of the job that cannot often be observed and showed how important the service was to the community.
I went from there to a Saturday night shift working out of Downtown Eastside! It was great to see that the service’s night shift camaraderie was no different to home and I really enjoyed the shift. Despite forewarnings of typical weekend incidents, we did not attend a single street call or intoxicated patients! Nevertheless, I still saw extreme living conditions which felt bizarre to think of as the paramedic’s usual working environment.
My third week was spent with various ACP and PCP ambulance crews. I used this time to absorb as much from the experience as I could and recognise what transition between services would involve. Variation in drugs carried, administration indications and alternative equipment (loved the nifty stretchers and oversized radios!) were all differences that stood out. It was interesting to watch ACPs practice skills, like rapid sequence intubation, that aren’t part of the UK paramedic’s current base scope. I also recognised how well resources were dispatched with ACPs attending patients that warranted their skill set unlike in the UK where a more general and less targeted model occurs. So, although I was at first taken aback at the seeming lack of ACPs working in comparison to the UK, it seemed that the allocation of resources helped to combat this.
Fewer alternative referral pathways were another difference and hospital transfer of lower acuity patients seemed more frequent. With population demand causing strains that mirror the UK services, I am intrigued to follow the transformation of practice as care pathways are restructured within BCEHS.
One particularly memorable patient during my final week, was a young cardiac arrest patient who, thanks to early CPR initiation by an off-shift nurse and the arriving crew’s swift intervention, went from lying, essentially dead, on the sidewalk to attempting to sit up with a GCS of 15. It was an extraordinary call to be part of and made me extremely proud of the profession as I observed the crew’s amazing work.
I left Canada with a very positive impression and hope to return one day to work for your service! I am extremely grateful to Leon and Lucas for making my placement possible and to everyone at BCEHS for being so welcoming; it really was invaluable to learn about and experience working with another country’s service. I was touched to receive a framed photo and challenge coin from paramedic specialist Jodie on my last day and along with my memories will be something that I treasure.