The advanced paramedic internship: an important clinical learning opportunity

Ireland introduced paramedic services to its ambulance services in 2005 and an accredited training programme has begun to train candidates. The training programme is 11 months long and includes distance learning, taught and internship phases. The internship involves six weeks of supervised paramedic practice in the setting of a rapid response vehicle crewed by two candidates, principally in urban and suburban settings. Internationally, little information has been published on the educational opportunities or impact of paramedic training and particularly on the clinical practice components of that training.

A detailed audit was carried out of clinical care activity completed by the initial 30 candidates to undertake the internship. Data were collected on patient descriptors, types of clinical problem, basic and advanced interventions undertaken and the Clinical Practice Guideline-Advanced (CPG-A) under which the advanced intervention was undertaken. Data were compiled using SPSS V11.

Thirty candidates completed the 6-week internship, caring for a total of 1237 patients, of whom 46.3% had an advanced intervention. Intravenous cannulation was the most common advanced procedure undertaken, in one fifth of all patients seen. Twenty-two candidates inserted a total of 42 tracheal tubes or laryngeal mask airways and 55 cardiac arrests were managed. Smaller numbers of glycaemic, epilepsy and fluid resuscitation cases were dealt with.

Well supervised clinical training facilitates the transition from student to autonomous practitioner. Candidates in this programme accomplished a range of clinical assessments, decisions and interventions with the support of a senior supervisor, but in a situation where they carried responsibility for safe practice.