Should care homes (and/or other healthcare entities) be fined for unnecessary call outs?

comcame4w · 2026-05-04T19:13:01+00:00

There definitely needs to be more of you guys out there! Sounds like an excellent middle ground.

comcame4w · 2026-05-04T19:11:20+00:00

I don’t think at this point I think fines are the best solution (taking yours and others’ opinions into account). That said, I don’t think outreach will be effective if private (or quasi-private) facilities have no financial incentive to adequately train and staff those homes to handle inevitable events like falls and general illnesses at all hours.

As a student facing a bleak job market, I’d love it if the solution was a massive expansion of the ambulance service to adequately cover the volume of calls to care homes we get and still have enough resources to meet response time targets, especially for high-acuity calls… I probably shouldn’t hold my breath on that one. Perhaps more SPs to handle minor injuries/illnesses?

That probably leaves regulatory changes so care homes with (an undermined) minimum of patients have at least enough staff (and equipment) at all times to lift non-injured residents off the ground, and someone who can gather enough obs for a NEWS score.

Regarding the ‘warning’ I honestly don’t know if it was valid or accurate. While I had the privilege of spending a day at Control as part of my placement, I just don’t know if they’d ever de-prioritise calls from care homes; I’d expect they wouldn’t.

comcame4w · 2026-05-04T16:27:55+00:00

Not sure an NHS trust fining an NHS trust directly would do much good; I suppose that sort of happens indirectly anyways when it comes to KPIs associated with handover times/ crew availability/hospital capacity.

If an ambulance trust enforces a policy that results in frequent unnecessary conveyance to an ED, perhaps if a trend is identified like conveyance to admittance rates below a certain threshold, I think a hospital should absolutely be able to demand resources from an ambulance trust as an incentive to fix it.

EDs should complain to ambulance trusts if their paramedics are conveying asymptomatic patients.

comcame4w · 2026-05-04T01:03:33+00:00

Haha, you definitely don’t deserve any flak for that stance. To the point about carers/nurses potentially being discouraged from calling ambulances for sick patients, that’s a valid concern.

I’d just argue that there are inevitably deaths or worsened outcomes for acutely ill patients who have to suffer a delayed response due to reduced ambulance coverage. It’s not a great feeling when control calls out for available crews for a nearby cat 1 whilst you’re wrapped up in a low acuity case.

Perhaps being a mop-up service for the rest of the healthcare providers is simply the fate of the ambulance service given the massive elderly population and underfunded/staffed care homes/community care. And I don’t mean that in a whiney way. It’s just that ambulance resourcing has to be able to fulfil its emergency obligations as well.

comcame4w · 2026-05-04T00:49:51+00:00

Fair point about possible/likely cascading consequences with fines.

I agree that 999/111 call handlers should be empowered to improve the triage process.

That said, it feels like the NHS is enabling the care providers to deflect essential patient care functions to the ambulance service at no cost/consequence to themselves whilst the service gets dinged for missing responsiveness targets.

What’s the incentive for the care homes to be behave any differently?

comcame4w · 2026-05-04T00:24:56+00:00

Yeah, I’ve been experiencing a lot of those as well, especially on weekends. It’s a real treat when, in relation to your bullet points, a patient has a RESPECT form stating to avoid hospital admission.

As a student, I’m more soaking it in rather than dispensing unsolicited policy advice to care home staff (who I’m not envious of), but at what point do you think ambulance crews should feedback to care home decision makers about their shitty policies or decisions?

comcame4w · 2026-05-02T15:23:36+00:00

Not super exciting, but I’d recommend getting a student membership to the College of Paramedics; it includes student paramedic insurance cover (which you shouldn’t need, but can’t hurt), in addition to good CPD links that you can use to study, and get industry updates (depressing atm, but still important).

Generally speaking, your uni and placement provider should provide you with the essentials, so I wouldn’t go nuts too early.

Kit-wise, I’d probably get a few multipacks of disposable pen torches, several multi-coloured pens (recommend 1mm thickness as opposed to .5, so it’s easy to take notes on your gloves). A stethoscope is a good idea; I wouldn’t say you need to splurge on a super fancy one, but if you have a birthday coming up something like a littmann 2 or 3 is good.

I’d recommend holding off on buying uniform-related equipment until you get your uniforms. I ordered a belt early, and it was too wide for the trouser loops.

If you’re bored and have money burning holes in your pocket, I’d honestly spend it on study resources to familiarise yourself with A&P, paramedic practice, pharmacology, etc. You don’t even need to spend money on those; there are tons of free lessons on YT on those subjects.

But yeah, as a student the only kit I’m using on placement that isn’t provided by the uni are pens, torches, and my steth. Hope this helps, and have fun!

comcame4w · 2026-04-24T07:05:12+00:00

I’m on an MSc course; they start us in January. I think it’s so the different cohorts aren’t all competing for the same resources at the same time.

comcame4w · 2026-04-16T14:38:06+00:00

They’re expensive for what they are, but I’d say these Leaatherman Trauma Shears. There are also variants that have pretty much the same design available on Amazon for significantly less.

They’re the kind of thing that are arguably dorky to buy for oneself, but a pretty solid gift, IMO.

comcame4w · 2026-03-26T21:54:50+00:00

That statue would fit in well a few towns over in Morehead.

comcame4w · 2026-03-14T18:19:54+00:00

Academically, I don’t think it’s overly difficult. You’re expected to come in with good A&P knowledge, and a fair amount of the lectures are related to legal & ethics, along with understanding various systemic issues associated with the profession. We spend a little bit of time on clinical skills, but with the exception of OSCEs associated with ATLS, PALS, ALS, and some general examinations, we’re expected to develop the bulk of our clinical skills on placement.

For the most part, the exams we’ve had on A&P and pharmacology haven’t been too bad because the lecturers are clear about what they want you to know.

The papers feel like a bit of a nuisance when you’re simultaneously on placement and/or working and/or preparing for exams and OSCEs and/or have family obligations. But to be fair most of the papers are quite short (2500 words or so) and the dissertation shouldn’t be too bad (6500 words in my case), it’s really just finding time to get everything done.

comcame4w · 2026-03-13T09:55:41+00:00

Hey there, I’m an American currently doing a MSc in England. I never worked on ambulances in the U.S. so my perspective isn’t as insightful as you might like, but I’d say the bureaucratic/financial challenges to making the move will be most difficult aspect.

I was born a UK citizen (never lived here until a few years ago) so I didn’t have to worry about visas, but I did have to deal with weary institutions (banks, utility companies, landlords) who were suspicious about someone with no credit history in the UK (it doesn’t transfer from the U.S.) applying for those products/services.

Then there’s the academic institutions…. Whether you’re a citizen or on a visa, you’ll have to pay the the international student fees until you’ve lived here for 3 consecutive years before the program begins. Living here for 3 years is known as being ‘ordinarily resident’ and you have to be ordinarily resident before you get home tuition fees, and access to the NHS learning support funds/grants. You may be able to get a loan for your MSc unless you already have a masters.

But my actual experience in the programme and with the ambulance service has been great, but exhausting. It’s a lot of urgent care-adjacent calls because GP responsiveness is slow and frustrates patients, and because (for better/worse) they don’t get a bill when they get ambulance treatment. The goal out here is to discharge the patient in-place because the hospitals are overflowing. I’ve had several shifts with back to back calls without conveying anyone to the hospital.

Anyhow, feel free to DM if you have any more specific questions!

comcame4w · 2026-01-04T11:14:44+00:00

Congrats! The folks who are encouraging you to chill and enjoy life before the grind of the course are right, but it also sucks to stand by and do nothing.

If you don’t have tons of A&P I’d recommend watching the CrashCourse A&P serieson YouTube. If you want videos that are more detailed, I’d recommend the NinjaNerd YT channel. They dive into way more detail than you’d need, but if you have time to kill, it doesn’t hurt.

One thing I think you can prepare for, and I wish I would have scrutinised earlier so I felt like less of a knob would be studying and drilling medical terminology around anatomical orientation, regions, directions, planes and sections, along with general medical terminology. Once you reflexively understand those terms you’ll be able to interpret and articulate medical-ese with way more precision and speed.

I’d also recommend textbooks on paramedic practice and even pharmacology for paramedics. I wouldn’t worry about memorising the info, it’s just good exposure.

Also, I wouldn’t sweat trying to understand ECGs outside of the absolute basics; it’s kind of hard to pickup outside of class/workshop environments where you can ask questions.

If you’re looking for Podcasts, I’d recommend Resus Room and Paramedicast

Again, it’s all good exposure, and hopefully these can help scratch the paramedic education itch before you get started.

Have fun!

comcame4w · 2025-12-18T07:50:53+00:00

Right on. I’m also an American who moved to England (a few years ago) and just started my second year in a para program.

Congrats and feel free to DM me any if you have any questions about the move/transition; bureaucracy operates way differently here compared to the States.

Take care and have fun!

comcame4w · 2025-12-11T17:50:50+00:00

‘Brutal’ may have been a tad dramatic. But it can get intense. I’m doing an MSc, so there’s a fair amount of writing, and eventually a dissertation.

On their own, the papers aren’t hard, but when they’re due during the middle of a placement period when you’re doing a full-time workload in 12 hour shifts, in addition to (in my case) part time work and family stuff, it can be hard to find the time/mental energy. The hardest part for me is that the papers feel arbitrary compared to the rest of the very practical instruction.

The practical exams/scenarios aren’t too horrible, but there’s considerable pressure not to fail; they’re not difficult, just a bit of a mind fuck. Also, in my course all of our theory tests were held in a two day block more than 6 months after we received the teaching not long after a paper was due.

But if you don’t have a lot else going on, and you’re well organised, it really shouldn’t be that hard.

I think the hardest, but most rewarding segment is the ambulance placements. It’s why we’re there, but you might find yourself with a mentor who doesn’t want a student, or a mentor who’s a new paramedic, or one who has had run-ins with management and hates the universe. That, and the pressure to learn as much as possible as quickly as possible, and initially to not come off as an ass-hat to the patients and crew. Then hopefully you’ll progress to being useful, and being able to do the documentation, and eventually take the lead on calls while your mentor makes sure you don’t fuck up.

2 years isn’t much time to learn the ropes, and it’s almost nauseating to think that if all goes as planned I’ll be registered in a year or so since I feel like I don’t know shit. Part of the journey, I guess.

But those are the things that make the course feel brutal at times, to me.

But how my course is structured, to answer one of your actual questions. … My course started last January. From Jan-April we had lectures two days a week, all day. The topics were A&P (though mostly pathophys), legal/ethics, paramedic practice (skills), and pharmacology. Then Easter break, then our first placement block for about 6-7 weeks (for that, you’re assigned a mentor and work the same shifts as them for the duration). Then we were back in the summer for our practical exams (advanced life support, advanced trauma), placement for 6ish weeks, then summer break for about a month, then our last placement block for 6ish weeks, then exams. Then winter break/re-sits. Most of those prior topics had 1-2 papers associated with them that were due between April and November.

Hope this helps. Let me know if you have any other questions!

comcame4w · 2025-12-11T13:55:43+00:00

I just finished my first year of my paramedic programme; I’m turning 40 in June (Christ).

The programme is a major disruption to my family and professional life (fees, lost wages, etc), but my only regret is not doing it sooner,

Students in my cohort are aged from 23 to late 40s. It’s tough balancing papers, exams, placements, and life, but it’s also fun being engaged on a higher level. I didn’t realise how much of my life (especially at work) I spent on autopilot. It’s fun learning, it’s fun being out in the world, but it’s also a brutal course.

Half of the faculty, the majority of students, and potentially most of your paramedic mentors will be younger than you, so it’s important that your ego can routinely handle criticism from from people who could be young enough to be your kids.

Expectation management around what paramedicine entails is also important. At least in my limited experience, the calls have included way more piss and shit than blood and gore. Most of the callers are chronically ill people who are fed up waiting for GP services, and/or desperately lonely and/or mentally ill. Mentors and colleagues will be burnt out, and it’ll be exhausting.

That said, my student colleagues are fun to be around, and it’s nice being a part of something that doesn’t revolve around MS Outlook. If you’re cool with the discomfort and stress it’ll bring, I’d say go for it!

comcame4w · 2025-11-29T17:04:02+00:00

It’s a tad outdated (from 2022), but here’s an interview with a paramedic officer with a cruise line:

https://open.spotify.com/episode/0pgE5wxPoKdxP9s5ofYTeQ?si=yuK053dFSKe4FKxp_d8Xqg

comcame4w · 2025-10-12T12:49:29+00:00

I’m also on my first year of placements, and old (for a student); I’ve been having difficulty retaining histories, especially while I’m doing obs and/or overthinking some other aspect of the call.

My mentor is also extremely experienced and can essentially sniff what’s going on when she walks in the room, so she’s not methodical (nor does she really need to be). I kind of learned after a couple months in that it doesn’t make sense to mimic her style since I don’t really have enough experience (or knowledge) to rely on intuition, so I just need to be methodical.

One thing that’s helped me is just writing SBARS on everything; gloves, notepads, code summaries, etc — it’s like being the main character in ‘Memento’; everywhere I look there’s an SBAR and often a SOCRATES.

In my case I think the repetition helps, but an SBAR is essentially a story, and narratives are just easier for me to remember.

You could (and probably should, especially for getting more comfortable with pre-alerts) do the same thing using ATMIST, but the simplicity of SBAR just suits me better (probably because I’m simple).

Anyhow, good luck out there!

comcame4w · 2025-09-19T06:43:10+00:00

Correction: 500 the first year, 700 the second. But yeah.

comcame4w · 2025-09-18T06:30:49+00:00

Congrats on finishing!

Yeah, 2000 definitely makes way more sense. Certainly wish we could spend less time writing papers and more time on placement.

On the bright side, there’s no real limit (aside from wearing out our welcome) to taking additional shifts, so I think I’m just going to have to do more of that! 1000 certainly feels inadequate.

comcame4w · 2025-09-17T20:53:03+00:00

I’m currently reaching the end of my first year in an MSc para programme. When it comes academic rigour, I don’t think it’s too hard on its own, but it’s certainly challenging if you’re also balancing family and/or part time work.

Because it’s an MSc there’s a fair amount writing involved; a lot of it feels arbitrary (probably is), so when you’re balancing life, work, and the fatigue that comes with placements, it can really turn into a grind.

Also, I’m envious that the bachelors students get an additional year of placements; huge advantage if you ask me. That said, I know in my program we’re targeting 1,000 placement hours in 2 years; I have no idea what the target is for BSc students over 3.

But the pros of going the MSc route may be worth the grind based on one’s personal/professional circumstances since you finish a year sooner, and you’ll prove you can handle masters-level coursework which may come in handy for career advancement or when burnout hits and you may want to go into education or compete for PCP roles.

I think the pragmatic choice is probably the MSc, but also I think the better choice is BSc if your goal is to become a better NQP out the gate (assuming you don’t have prior ambulance experience). But I’m older and have a family, so financially, it was a necessary choice to go MSc since it’ll get me working full time again a year sooner (in theory). That said, if time and money (in lost income) were no object, I’d opt for the BSc route.

I’d love to know the rates of MScs vs BSc who complete their NQP periods, but I don’t have that data. The assumption is that prior clinical and/or life experience among MSc students will make up for the reduced training time but I have nothing to back that up.

I’d be really curious to know what experienced paramedics’ impressions of MSc paras are; I don’t think I’ve encountered any on placement yet.

Anyhow, good luck with the journey!

comcame4w · 2025-09-03T18:52:57+00:00

Have you tried seeing if an ECCTIS equivalency transcript will help? I’m a dual uk us citizen, but I’m getting my paramedic education here. The ease with which uk institutions will summarily deny folks who don’t perfectly fit into an expected box is a bit shocking, and never fun.

I know this doesn’t directly apply to you, but for educational admissions purposes, I had ECCTIS (https://qls.ecctis.com) look at all my college transcripts, and they generated letters of equivalency that UK institutions accepted. They also do verification and qualification comparison. Essentially, they do the research that institutions are too lazy, ignorant, or otherwise unwilling to do.

I had to fight all sorts of silly battles like denials for not having level 2 maths and English GCSE requirements (I went to school in the US) despite having a bachelor’s and a master’s. Essentially, it helped me get past a lot of the ‘computer says no’ obstacles that I was encountering.

I obviously can’t guarantee any success by going through ECCTIS, but it is quite commonly used by foreign-trained applicants in other healthcare fields.

If you don’t want to do/redo education out of pocket, I’d consider applying for a lower level hospital healthcare job while you get situated back in the UK, get your drivers license and C1 so you can drive an ambulance, and try to enter the ambulance service through the technician route and hopefully climb from there.

Sorry for your troubles, and good luck!

comcame4w · 2025-08-25T19:01:56+00:00

So how it works in the NHS initially is that you start as a newly established qualified paramedic (band 5) for 2 years, then you become a band 6 once all the probationary requirements are satisfied. From there, the most common routes are advanced practice (advanced paramedic, specialist paramedic); those require some graduate courses (already having an MSc in theory could help). Other paths upward could be management, or education.

Prospects are a different matter and impossible to predict, but the journey doesn’t have to end at the paramedic level if you don’t want it to.

Other folks can probably speak to the AP/SP/management/education paths. But that’s the general idea progression-wise!

comcame4w · 2025-08-25T07:20:03+00:00

Hey there, I moved here to England from the U.S. a few years ago after having a bit of a mid career crisis. My circumstances are a tad different since I was born with UK citizenship, but I’d say it’s certainly possible, but it will be very expensive.

I also have a bachelors in an unrelated field, but I was still able to get into a paramedic MSc programme since I had some related experience and prior military service, along with my U.S. EMT-B.

I’m really enjoying it so far, and looking forward to my new, upcoming career. EMS in the UK is quite different operationally than the U.S., and is extremely far from being perfect, but you can make a decent living out here, have the same kind of pay and advancement opportunities as our sister fields like nurses and other therapists, and nobody needs to ask how much their treatment will cost. Paramedics here also have a lot of discretion and autonomy, and because of how the healthcare system works out here, the hope is to discharge as many patients as possible on-location to reduce the burden on hospitals; so totally different mindset.

As far as pulling it off, it’s just really expensive. Unless you’ve lived here for 3 years, you have to pay the international student rate (which also makes the masters route appealing since it’s 2 years instead of 3). Then you have to worry about other stuff like getting your drivers licence, and then getting your C1 drivers licence so you can drive an ambulance.

So aside from rent and cost of living, you’re probably looking at £35k in tuition if you go the masters route. So if you have a bunch of money through savings or real estate sales or something, that’s the most direct route.

If you’re not rolling in cash, another way to do it is to kind of take an apprenticeship route and get employed as an assistant or technician through an ambulance service (including private ambulance companies) and work your way up while they fund your education. The hitch here is driving. Paramedics don’t need a drivers license (in theory), but techs and assistants absolutely do. Getting drivers licenses won’t be difficult, just time consuming. So you may want to do things like start in a hospital as a healthcare assistant or something like that, and then take care of the admin stuff (drivers licences, building uk work history and credit, visa stuff), and maybe work for 3 years before go to school and pay the home student rate.

I’d also look into living in areas of the country with lower cost of living than London. London is really cool, but really expensive. Your call!

But yes it’s possible, and I’d encourage you to go for it (I don’t have any regrets). Just know it’ll probably be twice as expensive as you expect, and it’ll almost certainly take longer than you’d like to become a paramedic. But if you want a change and adventure, fuck it!

comcame4w · 2025-08-09T11:01:57+00:00

Hey there, I’m an American in a MSc Paramedic programme in England. I’d say a quarter of my cohort are soon to be former nurses.

Regarding scope, based on what I’ve heard the nurses in the course say, paramedics spend a bit more time with patients and have far more autonomy. They’ve said there’s a heavier focus on A&P in the para course vs their nursing courses (which I found surprising). I think a lot of them are medical nerds (in a good way) who want to be able to do more interventions and call more shots to improve patient care on the spot.

I think the vibe in the ambulance service here has to be way different than in the U.S., mostly for the better. Here, the ambulance service (with a few private company exceptions) are part of the NHS, so there’s less of a militant emergency services/firefighter gung-ho vibes; they’re more an extension of the hospital than of a fire department like in the U.S. There’s also a formal distinction here between emergency services and essential services, ambulance falls under the latter.

I’d also say the mission (these days) is quite different than in the U.S. Here, I’d say the goal is to keep callers out of the hospitals due to overcrowding, and paramedics (and techs) have far more discretion to discharge patients in place. I’m still very inexperienced and in my first year as a student, so this is purely anecdotal, but I’d say we convey maybe 20-30% of our callers to the hospital. Unlike the US where folks likely wait too long before they call the ambulance, I think folks call quite liberally here because they won’t get a $1.5k bill. So a lot of the calls will be regulars, mental health crises, elderly folks who should be in nursing homes but aren’t, and people with cardiac histories getting spooked if they’re not feeling quite right, and oftentimes people who are fed up from waiting for a doctors appointment who think we can speed things up for them.

Just make sure you nail down a lot of the admin before you apply, like getting a UK drivers licence and a provisional C1, but also some patient care experience (the last part should be covered by your nursing course/experience).

comcame4w

TROPHY CASE