Emergency care assistant
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Emergency Care Assistants (ECA), are a new role in the frontline staff on NHS emergency ambulances within the United Kingdom, introduced as part of modernisation of the NHS ambulance services to cut costs. Having only been created in 2006, the role is evolving rapidly, and has not been standardised over the country, but will usually consist of assisting qualified paramedics and emergency medical technicians with their duties, although this is not always the case in exceptional circumstances.
Emergency care assistants (ECAs) respond to emergency calls as part of an accident and emergency crew or at times as a first responder, using skills and procedures that they have been trained and directed to do. They need to help move patients safely and observe patient vital signs and provide and take relevant information from carers or others at the scene.
Based at a local ambulance station or at a large hospital as part of a team, they work shifts, going out in all weathers at all hours, sometimes working in difficult conditions such as in confined spaces or on a motorway.
ECAs also drive a range of ambulance service trust vehicles under normal and emergency (blue light) circumstances and carry out checks to vehicles at the start of and during each shift, to make sure they are clean, have fuel and are appropriately stocked. They need to know how to use all of the medical and life support equipment carried on vehicles that is appropriate to their skill level, and how to assist a qualified paramedic.
A key responsibility of the ECA is to make sure that equipment is carefully stored, transported and cared for so that it is always in good working order and to complete relevant documentation, be familiar with and use communication equipment (including radios and telephones) to inform colleagues about the work they are dealing with.
Development
ECAs at present have no clear career pathway of progression to technician or paramedic status is being widely discussed at present and has become a hot topic within many ambulance trusts. In the fourth quarter of 2008, West Midlands Ambulance Service NHS Trust announced progression for 80 ECAs to become emergency medical technicians in 2009. A large number of ECAs have since undertaken IHCD ambulance technician courses and many are now qualified technicians. West Midlands Ambulance Service is continuing to offer technician courses throughout 2010 to existing staff eligible to take them.
Some other ambulance Trusts that use the ECA role have begun to work on providing development for ECA's to become paramedics, using part time higher education routes, such as the Open University. This is in line with the NHS "Skills Escalator" approach to staff development. It provides a development route for ECAs that are able to study (to a minimum of Higher Education Diploma), whilst remaining in employment, rather than becoming a full-time university student.
Problems with Implementation
Initially the role of ECA was and to some extent continues to be unwelcome by a number of staff, who believe that working with an ECA would increase the responsibility that they are asked to undertake. Whilst this does indeed transfer the clinical responsibility entirely on the paramedic or technician, there is no reason why this would result on a reduced level of care for patients. The change merely ensures that the patient is treated 'by a paramedic' with the assistance of an ECA.
The Death of the Ambulance Technician?
Yes - The role of ambulance technician has been phased out of many trusts, and those who are currently employed within this role, will have to commit to the paramedical science degree to qualify them as paramedics, or accept a role as an emergency care assistant. Technicians who opt to apply for the degree will be given the opportunity, though it is not realistic to assume that all technicians will be successful or indeed capable of completing the course.
Concern was also raised about the amount of driving an ECA has to do during a 12 hour shift as driving time regulations do not apply to emergency services. Whilst any member of staff may drive when responding to an emergency case, initially only the ECA was able to drive when a patient is on board. Now, many trusts have set out guidelines which allow ECAs to attend to patients who are unlikely to require clinical intervention en-route to hospital.
The future of the ECA role
ECAs are now slowly becoming more accepted into the ambulance service, and appear to be a fundamental part of the future of NHS ambulance services. The ECA's Scope of Practice in the East Midland's Ambulance Service NHS Trust states that "As the responsible clinician it is an individual decision as to which patients are suitable to be transferred with an ECA attendant and it is accepted that this will occur more frequently with experienced paramedics especially when they are confident in the ability of the ECA they are working with."[1] Many trusts however operate a policy preventing any clinical responsibility being delegated to the ECA. It is anticipated however, that the ambulance service may some day choose to allow ECA's to work to their full potential, and recognise the benefits of having such a role within the organisation.
At the other extreme, because of current a lack of paramedic numbers, some ambulance Trusts are using ECA's increasingly as lone responders when under operational pressure. Justification for this is taken from the use of first responders, who have minimal training and are not usually ambulance trust employees. The rationale being that if a first responder can be sent to a 999 call with two days training, then an ECA, with 6 weeks training should be sent. Whilst this is possibly defensible in extremis, regular use of solo ECAs in a clinical role leads to a decline in clnical quality, plus unnacceptable levels of stress in ECAs themselves.
West Midlands Ambulance Service NHS Trust, one of the initial pioneers of the ECA role, announced in late 2009 that it would no longer be employing direct entry staff as emergency care assistants. A new role of 'student paramedic' has since been created which allows staff to become a state registered paramedic within two years, undertaking a training course at a partner university while being employed full time by the ambulance service.