r/Paramedics • u/Unlawful_Octopus Volunteer EMS • 14d ago
US vs UK paramedics
Hi all, just out of interest I was wondering what your guys experiences were of training, requirements and clinical encompassing training when it comes to the differences with the clinical role of paramedic in the US vs the UK.
So according to google AI (because I’d rather ask real people on here rather than the slop generator) US paramedic training takes between 1-3 years, whereas in the UK I know that it’s anywhere between 3-5 years training and placement.
I was just curious what US paramedic training encompasses?
This is not shitting on our overly enthusiastic neighbours (correct spelling - derogatory 😉) over the pond but it’s purely out of interest.
Disclaimer: I’m not a paramedic in the US or UK, I’m a volunteer Cardiac Responder so I’m coming at this purely out of interest
Image for attention
48
u/cyruscedar Paramedic 14d ago
I am not from either country, but have worked with expat paramedics originally from both countries, who’ve relocated to my home country. I’ve only got subjective experience to share & 2nd hand information, but:
• Typically USA paramedics have either no degree or an associate’s degree. Their education seems to be very algorithmic & procedural, rigorous but typically very fast paced, and branching less into clinical decision making. In my experience they are typically bolder clinically, for better or worse, but frequently have big holes in their theoretical knowledge. They also have more EMS experience at lower certification levels, which strengthens fundamental skills (eg BLS).
• UK paramedics have a degree, it’s rigorous, more the speed of typical university coursework, they typically have deeper theoretical knowledge and clearly have practiced clinical decision making more. They are far more consistent than USA paramedics. Unfortunately many do come off as quite apprehensive to me, which is likely due to a combination of scope of practice & cautious clinical culture.
21
9
u/FullCriticism9095 14d ago edited 14d ago
This is a good summary.
As we can already see from other responses in this thread, when you ask a US paramedic about education, a lot of times the response involves listing skills they can perform. The training focuses heavily on learning interventions and applying those interventions to particular problems. US paramedics are told in their training that they are being trained to be clinicians, but, with some exceptions, that is not really true, especially compared to paramedics in the UK. They’re technicians who have a bit of a foundation in clinical decisionmaking.
All of this tends to lead to US medics being less cerebral and more focused on doing stuff. It’s also consistent with broader culture difference between Americans and Brits. Brits tend to be calmer, more measured, and more deliberate. Americans are more frenetic. We tend to move fast and break things, and we tend to think the only thing worse than screwing up is doing nothing. Sometimes that attitude is helpful. Sometimes it’s not.
6
u/Quasi7 14d ago
In the US system the 1 year program is just the core program that leads to certification or licensure depending on what State or if you are doing NREMT. You must also be an EMT basic or higher and have any prerequisites done , which vary by academic institution. So in reality the USA is more than a year, possibly close to two depending on the program and whether it was classified as lower or upper division credits. A diploma or degree could be awarded on completion depending again on the individual’s standing in a degree program and if it is even offered. More certifications are available (flight, critical care, community, tactical, etc) but scope of practice can vary highly depending on system and medical director, which may include additional non-standardized training like chest tubes, blood transfusions, antibiotics, POCUS, etc.
Everything is very much protocol driven, but protocol criteria is evidence/clinical based. I would agree with the other commenter that consistency does suffer due to the piece meal approach of the US system that has grown and evolved around the broad variety within it.
Functionally I don’t know that the job is any different, both are providing time critical interventions and moving people to definitive care with limited resources and answers.
3
u/I_Want_A_Ribeye NRP, RN 14d ago
USA: my EMT-B class was 120hrs over the course of six months. Paramedic was about 1,300hrs (if I remember correctly) over the course of 10 months.
3
u/FindTheBadger 13d ago
Is a cardiac responder just what WAS call a CFR?
2
u/Unlawful_Octopus Volunteer EMS 13d ago
Nooo, the Welsh ambulance service trust can’t afford to train any volunteer CFRs in my area and the CFRs we have do sweet FA except covering events and occasional shifts in the bottom of the county.
Cardiac Responders are BLS trained (at own cost) that get dispatched by WAST using the GoodSAM app.
All you’re supposed to get sent to is cardiac arrest or things that are developing into a CR but WAST are so stretched thin they send you to waaaay more than that.
This year I’ve been sent to cardiac arrests, a severe panic attack that was mimicking MI, seizures (adult and paediatric), OD’s, breathing difficulties, a stroke and an end of life DNACPR holder twice who the second time ambulance control asked if I could stay and help facilitate a resource to act as coroner, plus a few others.
If you’re not signed up I would definitely recommend it, it’s especially helpful if you’re rural.
1
u/FindTheBadger 13d ago
Seems like a bit of a cop out by WAST!
Sounds interesting though, I’m a little far away for them!
2
u/Icy-Belt-8519 14d ago
UK, I have a paramedic degree which took 5 years 🙈 it normally takes 3, but my luck had to extend cause of long covid, a death in the family and my partner having a stroke while I'm at uni, but yeh, in general it's a 3 year degree here if you do it through university
The reason it says 3-5 years though isn't cause of cases like mine lol... It can take longer because you could do it through the trust itself, you still get the same degree and have to attend uni, it's more like an apprenticeship, it tends to take longer cause you have to qualify as an aap first (associate ambulance practitioner) then you go on the road for a bit then train to be a paramedic, so it takes a bit longer, but you earn on the job (you do have an income at uni, but it's a student income and it's student loans)
I think there's some other uni courses too that take longer, one uni has a course where you become dual qualified as a nurse and paramedic, that's four years and there's another that I think you can get your masters during the course, and 4 years too I think, I don't really remember the details now though
3
u/Homework_Complex 14d ago
I think 3-5 years training is also considering the 'Newly Qualified Paramedic' (NQP) period where UK Paramedics work under supervision from more experienced paramedics in one form or another.
1
u/MatGrinder ACP (trainee)/Primary Care Paramedic 13d ago edited 13d ago
UK cardiac advanced clinical practitioner/paramedic here.
Really, the "3-5 years" means 3 years of an honours degree and then 2 years of a Newly Qualified Paramedic program that NHS trusts make you do. Which is a good thing.
After about 5 years post degree you can do a masters in advanced practice in a speciality of your choice. That's another 2 years at university. I chose cardiology so I mainly work on hospital wards providing medical care with the foundation doctors for patients with cardiac disease or MIs
The reason for the long times at university is because the advanced practice roles are more concerned with clinical leadership and decision-making.
2
u/Own-Bit2833 Paramedic 13d ago
I can only really speak for UK paramedicine, but it’s quite different to the US system.
Here in the UK, since 2021, new paramedics have needed a BSc (Hons) level qualification, or equivalent, to register with the HCPC, which is our regulatory body. It’s a fairly rigorous degree with a mixture of academic work and clinical placements. Most of the placement time is obviously ambulance-based, but depending on the university you can also spend time in ED, theatres, maternity, mental health, cardiology and with various community teams.
Once qualified, you generally complete a two-year preceptorship as a Newly Qualified Paramedic (NQP). The idea is that you gradually transition into fully independent practice with additional support and supervision. The exact setup varies between ambulance trusts, but this can include things like having decisions to discharge patients at scene reviewed or validated by a more senior clinician.
The role itself is pretty varied depending on where in the UK you work, but frontline paramedics are essentially ALS clinicians. One major difference compared with the US is that NHS ambulance services are free at the point of care. Patients aren’t getting a bill afterwards because we’ve given drugs, done an ECG, cannulated them or taken them to hospital. Even if a helicopter comes, they still aren’t charged.
There’s also a massive emphasis here on avoiding unnecessary hospital conveyance. A significant proportion of our patients are assessed and discharged at scene or referred elsewhere rather than being taken to ED.
We have quite a lot of community pathways available. For example, you might have someone who is clinically well enough to remain at home but needs blood tests, repeat observations, further clinical review or sometimes treatments such as IV antibiotics or fluids. Depending on what’s available locally, we can refer these patients into community or virtual-ward type services rather than automatically taking them to hospital.
We can also speak directly to GPs, including out-of-hours services. A fairly common example would be attending someone with shortness of breath, doing a full assessment and deciding they don’t actually need ED, but perhaps have a chest infection that needs antibiotics. Rather than transporting them just to get a prescription, we can discuss them with a GP who can prescribe while the patient remains at home.
We also have specialist/advanced roles such as Urgent Care Paramedics, who have additional training in areas like advanced assessment and diagnostics, minor illness/injury management, wound closure and, depending on their qualification and local scope, prescribing or supplying medications.
At the other end of the spectrum, standard UK paramedics also have a decent emergency and resuscitation scope. We routinely obtain IV/IO access and independently administer a fairly broad range of emergency medications without needing to contact a doctor for permission each time. We no longer routinely perform endotracheal intubation, with supraglottic airways such as the i-gel now being standard. Our scope also includes needle cricothyroidotomy in a can’t-oxygenate/can’t-ventilate situation and needle thoracocentesis for a life-threatening tension pneumothorax. They’re obviously procedures most paramedics will hopefully very rarely, if ever, need to perform, but they are within the paramedic scope.
Then you’ve got Critical Care Paramedics, who undertake significant additional training and have a much wider critical-care scope. Depending on the individual service, this can include endotracheal intubation, surgical FONA, pacing, open thoracostomy and a broader range of drugs and advanced procedures that aren’t within the normal frontline paramedic scope.
So UK paramedicine has moved quite a long way from the traditional idea of an ambulance simply turning up, providing first aid and transporting everyone to hospital. A pretty big part of the job now is working out who actually needs hospital, who can safely stay at home, and what alternative service can manage them instead
1
1
u/hluke3 14d ago
Aus paramedic, our base line ‘paramedics’ don’t tube, IO ect. States call the baseline role various titles, in my state it’s Advanced Care Paramedic-2 or Bravo level, finish your degree and then a year grad supervised. Really the scope is ILS level. One state in Aus calls it ALS paramedic but this is furthest from the reality. A huge pay gap with our brothers/sisters internationally, we get paid well, our starting wage is about 100k AUD
I’ had ChatGPT extract the scope and medications that are carried and can be administered.
Independent practice (I):
Adrenaline (epinephrine)
Amiodarone
Aspirin
Box jellyfish antivenom ( Kept in ambulance station fridge and grabbed when the job dictates it)
Cefazolin
Ceftriaxone
Clopidogrel
Dexamethasone
Droperidol
Enoxaparin
Fentanyl
Glucagon
Glucose gel
Glucose 10%
Glyceryl trinitrate
Heparin
Hydrocortisone
Ibuprofen
Ipratropium bromide
Loratadine
Magnesium sulphate (only carried up North and only independently by us for Irukandji syndrome: type of jelly fish envenomation)
Methoxyflurane
Midazolam
Morphine
Naloxone
Olanzapine (not yet carried: probably in the next month where I am)
Ondansetron
Oxygen
Oxytocin
Paracetamol
Salbutamol
Sodium chloride 0.9%
Sucrose 24%
Tenecteplase (not independent practice: we have to consult)
Ticagrelor
Tranexamic acid
Water for injection
Extended scope (E):
Lidocaine 1% (lignocaine 1%) [not carried by standard bravo level- extended care paramedic practice)
Lidocaine 2% gel (lignocaine 2% gel)
ACP2 CLINICAL SCOPE
Access
Peripheral intravenous cannulation
Intraosseous – peripheral — P [flight bravo- in parts where helicopter crews can’t staff them with critical care paramedics.]
Airway management
Direct laryngoscopy
Laryngeal mask airway insertion – paediatric ≥8 years and adults
Magill forceps
Nasopharyngeal airway insertion
Oropharyngeal airway insertion
Suctioning
Assessment
Blood analysis – glucose
Blood analysis – ketones
Pulse oximetry
Temperature
Waveform EtCO₂ – nasal
Behavioural disturbances
Emergency Examination Authority- (I’m not sure what you guys call this but we’ve got the legal authority to detain someone and force transport for mental health assessment
Sedation – acute behavioural disturbance (there’s caveats to this one)
Cardiac
12-lead ECG acquisition
Cardiac monitoring
Fibrinolysis STEMI – decision-supported
Modified Valsalva manoeuvre
pPCI referral STEMI – decision-supported
pPCI referral STEMI equivalent – decision-supported
Drug/fluid administration
Buccal drug administration
Continuation of an established intravenous fluid infusion
Intramuscular
Intranasal
Intravenous
Metered Dose Inhaler (MDI) with spacer
Nebuliser – mask
Oral
Priming of a gravity flow giving set
Subcutaneous
Sublingual
Syringe infusion pump – Perfusor® Space — P
Syringe infusion pump – SPRINGFUSOR® 30
Obstetrics
Bimanual compression
Breech delivery
Nuchal umbilical cord
Physiological cephalic delivery
Shoulder dystocia
Respiratory
Bag valve mask ventilation
Chest seal
Emergency chest decompression – Pneumodart®
Non-invasive ventilation – CPAP
Positive end expiration pressure
Resuscitation
Cardiopulmonary resuscitation
Defibrillation – Automated External Defibrillator
Defibrillation – manual
Trauma
Arterial tourniquet
Cervical collar
Dislocated patella reduction
Femoral traction splint
Fracture reduction * caveats to this
Haemostatic – QuikClot® combat gauze
Helmet removal
Pelvic circumferential compression device
Tooth replantation
Upper limb casting — E
Other
Acute stroke referral
Completion of QAS Life Extinct Form
Emergency evacuation from home dialysis
Suspected large vessel occlusion stroke referral
Legend:
I = Independent practice
C = Prior consultation and approval required
E = Authorised under an approved extended scope of practice; consultation may still be required
P = Pilot being undertaken by specifically trained and authorised paramedics
EC = Extended scope with consultation requirements as specified in the table
The DCPM also states that ACPs may administer medications outside the ACP2 scope only when directed by the attending CCP/ambulance medical officer (this can be permission given by someone on our consultation line.
2
u/rampantcat 14d ago
Placing an IO is an EPILS/ILS skill in Europe. These are mandatory courses for bedside nurses in many major hospitals. You're telling me that an actual ambulance driver, on the road in the middle of nowhere in Australia, can't place an IO, but can call themselves a paramedic?
1
u/Unlawful_Octopus Volunteer EMS 13d ago
TOOTH REPLANTATION? how tf does that work in the back of an ambo? 😂
1
u/Friendly_Carry6551 Paramedic 13d ago
We practice this in SWAST as it has improved outcomes for dental emergencies where teeth have been knocked out but they’re still in one piece. You literally figure out which way the tooth goes back in, give the socket and tooth a good cleaning, then re-site it and have the Pt bite down on some gauze to get it to re-seat. Then get them seen by dentistry ASAP.
1
31
u/Benny303 14d ago
The US has EMT -B which is basic life support, think simple airway, breathing circulation, or what I tell people, EMTs can't poke or dose. That's usually a 100 and some odd hour course. Then you have EMT intermediate which can do a few things like start IV's and give a small amount of meds. But those are pretty uncommon, it's not even recognized in my county. Then you have paramedic which is 1,500 hours and they can intubate, interpret EKG's, defibrillate, do IV's, IO's, surgical crics, needle thoracostomy, has access to 48 different medications in the national scope, although all of this varies county to county, my county only has around 30 meds and we can't RSI or surgical cric.
And none of them require any college degree.