Training and legal changes will now permit the teams who first meet the sick and injured to provide a wider range of medical care, writes Elaine Edwards
The State's first 50 paramedics trained in advanced emergency medical skills will be formally registered and practising by early in the new year.
And some who have just finished the rigorous academic and practical training have no doubt those skills have already helped to save lives in medical emergencies.
Sixteen paramedics working with ambulance services throughout Ireland have just completed the final phase of a higher diploma run by the medical school at UCD in conjunction with the National Ambulance Training School (Nats). The training concludes with a seven-week internship facilitated by Dublin Fire Brigade ambulance service, one of the busiest in the country.
Armed with their new skills - and with legal changes in place to allow them do so - the advanced paramedics may now administer around 20 medications, including crucial drugs for cardiac arrest patients and, for example, antibiotics to treat meningococcal septicaemia.
Paramedics qualified to ordinary emergency medical technician (EMT) standard may administer only four drugs to treat pain, chest pain and low blood sugar.
The Misuse of Drugs Regulations 1988 and the Medicinal Products Regulations 2003 were amended in August to allow advanced paramedics administer drugs such as amiodarone, lidocaine and atropine (used to treat cardiac arrest), diazepam (seizures), epinephrine or adrenaline (anaphylaxis), glucose gel and glucagon (diabetics), morphine (severe pain) and salbutamol nebulisers (asthma attacks).
Declan Lonergan, who has worked with the South Eastern Region ambulance service based in Waterford since 1987, was one of the first group to finish the UCD diploma course last month.
He is both a trained ambulance aid instructor and an advanced cardiac life-support instructor and has a master's degree in change management.
Lonergan says a crucial element of the programme at UCD is its focus on critical decision-making skills as well as on medical knowledge and advanced intervention techniques. Candidates are trained not to merely implement advanced techniques as a first option, but to weigh up each set of circumstances on its own merits.
"You focus on the basics before you implement the advanced interventions and that's crucial," he says.
Lonergan's advanced training, he believes, was beneficial to a number of patients during his internship with Dublin Fire Brigade ambulance service recently.
He has been able to administer drugs to alleviate severe pain in the case of a patient with a dislocated hip, to insert an intravenous drip to help a woman suffering from shock, and also to put a patient with asthma on a salbutomol nebuliser to help them breathe.
"It has already made a difference to patients," he says.
Lonergan also praises the back-up the trainee advanced paramedics received from doctors and other medical staff during their internships. All the interns are supervised during their shift by a doctor or another professional trained in emergency medicine.
Ultimately, when the paramedics are on the road, they will have to work to strict protocols in relation to the treatments they can administer.
"We have been getting very positive feedback from the A&E departments," Lonergan says.
Martin O'Reilly, who has worked with Dublin Fire Brigade ambulance service for 16 years, teaches on the emergency medical technician programme and was also one of the first graduates from the UCD programme.
He says there's been huge interest in the programme among his colleagues.
"People are really excited about it and, during the field internship, our colleagues have seen how it works and have assisted us in enabling it to work on the ambulances."
He highlights the rigorous training on the programme, which starts with a distance learning module covering professional development, anatomy, physiology, health and safety and major emergency training.
This is followed by a national exam governed by the Pre-Hospital Emergency Care Council (PHECC).
Candidates who pass move on to module two, which is composed of six weeks in college and six weeks in clinical placement.
The candidates have placements in a number of hospitals throughout Dublin, including both adult and paediatric A&E, operating theatres, maternity and coronary care. They also had a general practice placement and experience of a drug-treatment clinic.
O'Reilly also believes his advanced skills were of benefit in a number of emergencies during his internship, particularly in the case of cardiac arrests, and where advanced airways techniques needed to be employed.
"It was excellent experience and this is what really develops you as a professional. This training programme wouldn't have succeeded as well as it has but for the professionalism and dedication and skill levels of the ambulance service and paramedics who are already there. It's an enhancement but, without the EMT paramedics, we wouldn't have been able to achieve what we set out to. They do an absolutely fantastic job and often in difficult situations."
Prof Gerard Bury, head of UCD's department of general practice, which runs the programme, says the recent changes to allow advanced paramedics administer certain drugs under controlled conditions have been "long-sought" and that they go back to a 1993 report on the ambulance services.
He emphasises the support structures for those undergoing their internship. "Right now, we're on week three and the candidates are still accompanied all the time by a doctor or instructor. Next week, we will cautiously move to less direct supervision but there'll always be a doctor or an intern supervisor on one of the vehicles, and all of the cases are dealt with on the phone as they arise," Prof Bury says.
He points out that each ambulance in Dublin deals with one or two cardiac arrests a day, where treatment is time-critical.
"Clearly what we are not trying to do is to confuse training with demonstrating the long-term efficacy of such a service. This is not logistically organised with multiple vehicles with short response times as a logistical service would be.
"But, nonetheless, we are seeing a huge demand for the service with lots of advanced interventions being carried out," he says.
The law has also been amended to give statutory status to a register of pre-hospital emergency care practitioners, including paramedics and advanced paramedics. This is due to come into operation in December.
Although many of the new advanced paramedics have already trained in advanced techniques in Britain and the US, they must undertake the UCD diploma to join the register.
The roll-out of the advanced paramedic programme was described by the Minister of State at the Department of Health Brian Lenihan as "the most significant development in the ambulance sector for many years".
Prof Bury agrees the scheme will "absolutely" save lives. He too welcomes the roll-out of the programme, some 12 years after it was first called for.
"It's been a very long road," he says.
Ultimately, when the paramedics are on the road, they will have to work to strict protocols