Quality statement 1: Ambulance services

Quality statement

Ambulance services have specialist and advanced paramedic practitioners.

Rationale

Paramedics with an enhanced level of education that is consistent with Health Education England's multi-professional framework for advanced clinical practice in England can potentially reduce emergency department attendances and hospital admissions. Service delivery models for specialist and advanced paramedics need to take into account local geography, population demographics, and availability of and access to other health and social care services. There are different ways to deploy specialist and advanced paramedics so effective coordination using varied dispatch systems is needed to maximise the benefits these practitioners can provide.

Quality measures

Structure

a) Evidence of ambulance services supporting specialist and advanced paramedic training.

Data source: Local data collection, for example, personal development plans (PDPs), training plans and education and workforce strategies. The College of Paramedics and Health Education England's Digital career framework includes details on the levels of experience and education required to undertake specialist and advanced paramedic practitioner roles.

b) Evidence of ambulance services having specialist and advanced paramedic practitioners who can respond to 999 calls for suspected medical emergencies.

Data source: Local data collection, for example service protocols and staff rotas.

Outcome

Proportion of incidents resolved without conveyance to an emergency department.

Data source: Local data collection, for example, audit of electronic case records. The National Audit Office report on NHS ambulance services includes details on resolved incidents without conveyance to an emergency department.

What the quality statement means for different audiences

Service providers (ambulance services) have specialist and advanced paramedic practitioners to assess and treat adults with suspected medical emergencies. They should have local arrangements in place to provide education and training for paramedic staff with sufficient post‑qualification experience to enable these staff to undertake specialist or advanced paramedic practitioner roles. Models of service delivery for paramedic practitioners need to take into account local geography, population demographics, and availability of and access to other health and social care services. They should also have effective coordination and dispatch systems within ambulance services to maximise the benefits of specialist and advanced paramedic practitioners.

Healthcare professionals (specialist and advanced paramedic practitioners) assess selected adults with suspected medical emergencies who need urgent care in the community. They provide enhanced assessment and treatment to decide whether the person can be discharged or needs further treatment and, if so, where they should be taken for further treatment.

Commissioners (clinical commissioning groups) ensure that they commission ambulance services that have specialist and advanced paramedic practitioners to provide enhanced assessment and treatment. They also ensure that effective coordination and dispatch systems are used within ambulance services to maximise the benefits of specialist and advanced paramedic practitioners.

Source guidance

Emergency and acute medical care in over 16s: service delivery and organisation (2018) NICE guideline NG94, recommendation 1.1.1

Definitions of terms used in this quality statement

Specialist paramedic practitioner

A paramedic who has undertaken, or is working towards a postgraduate diploma (PGDip) in a subject relevant to their practice. They will have acquired and continue to demonstrate an enhanced knowledge base, complex decision-making skills, competence and judgement in their area of specialist practice.

[The College of Paramedics and Health Education England's Digital career framework 2017]

Advanced paramedic practitioner

An experienced paramedic who has undertaken, or is working towards a master's degree in a subject relevant to their practice. They will have acquired and continue to demonstrate an expert knowledge base, complex decision-making skills, competence and judgement in their area of advanced practice.

[The College of Paramedics and Health Education England's Digital career framework 2017]