Emergency Care Practitioner

An Emergency Care Practitioner (ECP) generally come from a background in paramedicine and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard paramedic, qualified nurse or other ambulance crew such as EMT's and Ambulance Technicians. It has been recommended by the College of Paramedics and Department of Emergency medical care in universities that ECPs be trained to PgDip or MSc level, although not all are.[1] Evidence of the best way to target Emergency Care Practitioners is limited with utilisation of traditional Ambulance dispatch codes not always being shown to be most effective[2] and referrals from GPs also potentially failing to deliver management of demand that would be appropriate for this different level of practitioner.[3] Evidence however clearly demonstrates that in discreet groups of patients the use of these extended role staff responding to emergency calls can reduce admissions and thus improve patient outcomes as well as delivering a clear cost saving to the NHS.[4]

Employment

ECPs may be employed in a range of areas of care such as emergency medical services, primary care centres, hospitals, prisons, walk-in centres, or out-of-hours medical centres.[5][6] The majority of ECPs work autonomously. Many are employed by Primary Care Trusts or Ambulance Services. The work of the ECP appears to be recognised as a valuable asset in many care arenas with the current trend of employment within primary care practices becoming more prevalent.

Education and training

United Kingdom

ECPs in the United Kingdom are educated to different levels. In some areas a BSc or Post Graduate Certificate (PgC) makes one an ECP while in other areas an MSc may be needed. ECP's are educated to provide less comprehensive services than a physician, physician associate or nurse practitioner, however are ideal for acute non urgent situations.

A number of British universities are developing qualifications which can allow a paramedic or nurse to gain employment as an ECP.

University of Hertfordshire:

PgC Patient Assessment and Management (Primary Care or Critical Care Pathways available)
MSc Paramedic Science - by research
MPhil Paramedic Science - by research
PhD Paramedic Science - by research
DHRes Doctorate in Health research

South Africa

ECPs in South Africa are educated from the level of BHSc EMC (Bachelor of Health Science in Emergency Medical Care; B.EMC (Bachelor of Emergency Medical Care) or the older BTech EMC (Bachelor of Technology in Emergency Medical Care) - each of which requires 4 years full-time study or an additional 1-2 year part-time study for those already in possession of a National Diploma in Emergency Medical Care - (N.Dip EMC) up to the level of PhD EMC by thesis. The only four institutions offering the qualification are:

  • Nelson Mandela University, Port Elizabeth
  • Durban University of Technology, Durban
  • Cape Peninsula University of Technology, Cape Town
  • University of Johannesburg, Johannesburg

Skills

United Kingdom

Additional skills which UK ECPs may perform include:[7]

  • Administration of medications under patient group directions (PGDs) or supply via Valid Prescriptions. Some ECP's can independently prescribe allowing for greater autonomy.
  • Suturing, Steri-Strips (adhesive skin closure strips), and tissue adhesive wound closure (gluing of wounds)[8][9]
  • Minor surgical procedures in the field (such as removal of skin flaps)
  • Urinary catheterization (placing a Foley catheter.)
  • System-based assessment
  • Otoscopy, ophthalmoscopy, urinalysis
  • Neurological assessment (such as tendon reflexes, cranial nerve assessment (CNI-CNXII), MMSE)
  • Ordering X-rays and requesting further investigations
  • Interpreting X-ray and blood results.
  • Full UK advanced adult and paediatric life support skills
  • Full diagnostics assessment
  • Thrombolysis
  • On-scene discharge

South Africa

ECP skills in South Africa include:

  • Full South African, adult and paediatric, advanced life support skills
  • Full diagnostics assessment (Otoscopy, ophthalmoscopy, urinalysis, system based assessments)
  • Thrombolysis, fibrinolysis
  • Rapid Sequence Intubation (RSI)
  • On-scene discharge
  • Administration of emergency medications
  • Ordering X-rays and requesting further investigations
  • Specialised intensive care unit transport of adults and paediatrics

South African ECPs are also required to complete several medical rescue training modules during their studies such as high angle rescue, light motor vehicle rescue and aquatic rescue.

Emerging roles and opportunities

Since around 2008, the role of the ECP has become more popular around the world as the demonstrable benefits of the role become apparent.

As a result, the role has now expanded to parts of New Zealand and Australia. All of these are largely based on the UK model.

See also

References
  1. "What does a 'super-paramedic' do?". BBC News. 30 June 2005.
  2. Gray, J. T.; Walker, A. (1 September 2008). "AMPDS categories: are they an appropriate method to select cases for extended role ambulance practitioners?". Emergency Medicine Journal. 25 (9): 601–603. doi:10.1136/emj.2007.056184. ISSN 1472-0213. PMID 18723716.
  3. Gray, J. T.; Walker, A. (1 August 2009). "Is referral to emergency care practitioners by general practitioners in-hours effective?". Emergency Medicine Journal. 26 (8): 611–612. doi:10.1136/emj.2008.059956. ISSN 1472-0213. PMID 19625564.
  4. Gray, J. T.; Walker, A. (1 March 2008). "Avoiding admissions from the ambulance service: a review of elderly patients with falls and patients with breathing difficulties seen by emergency care practitioners in South Yorkshire". Emergency Medicine Journal. 25 (3): 168–171. doi:10.1136/emj.2007.050732. ISSN 1472-0213. PMID 18299372.
  5. Skills for Health - Measuring the Benefits of the Emergency Care Practitioner
  6. The Competence and Curriculum Framework for the Emergency Care Practitioner
  7. Bedfordshire and Hertfordshire Ambulance and Paramedic Service - Emergency Care Practitioners Information Pack Archived 2007-02-02 at the Wayback Machine
  8. "DERMABOND® PRINEO® Skin Closure System | J&J Medical Devices". www.jnjmedicaldevices.com.
  9. "How do I care for a wound treated with skin glue?". nhs.uk. 26 June 2018.
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