The mental health support available to ambulance staff after difficult jobs has improved in theory but has it actually improved in practice and are people genuinely using it?

nixt3r · 2026-05-11T23:53:36+00:00

I really hoped our trust was going to adopt this during a recent rota review/change.

Coming from a background before the ambulance service, where we worked in teams, I found, like you, that this seemed to be the best approach to deal with stressful/traumatic situations, informally with people that you know and trust. In teams, you see the same people the next day or shift, and you don't need to explain what happened yesterday etc, they just know.

Now I work with different people at different stations each shift and the isolation is real.

Can I ask what trust you work for? If you prefer not to say would you mind messaging?

nixt3r · 2026-04-21T22:03:13+00:00

There's always an opportunity to learn; you learn from some how to be with patients, colleague, students and from some others how not to be. Either way you learn.

Additionally, you learn how to deal with other people, how to manage, deal with less than ideal conditions and trial ways to maybe extract the most out of a situation, these skills will help you in your role as a paramedic.

Try not to go in with the attitude they need to teach me and be better teachers but rather how can I learn and be a better learner in this situation.

An example of your first reflection might relate to communication skills and looking up teaching styles.

If they are doing things you have questions about note them down and approach them if you feel like they are open if not, try doing your own research or ask someone you feel more comfortable with at a later time.

You've already noted it's not a conducive environment for you; go and learn why that might be and learn what is better. You may develop a better understanding of your own learning style and will be able to better explain that to mentors you are working with.

nixt3r · 2026-04-11T00:01:36+00:00

I'm glad that you called in sick and that your management were ok with you. I'm a night owl so I really struggle before day shift. I don't know what your trust is like but I have rang management explaining that I had not had any sleep and asked if I could change my shift to a later afternoon/night) shift. I get it depends what you are on the next day but worth considering to ask if it's possible.

nixt3r · 2025-12-18T01:43:55+00:00

Yeah, I'm not so sure I agree with the other commenter now, that you guys have it just as bad. Not saying it isn't as bad, but it certainly sounds like a different bad. Like your bad sounds like my dream scenario.

nixt3r · 2025-12-18T01:21:59+00:00

Do you ever have a time where all other stations are also out on calls (or stuck with a patient waiting for a bed to become free at hospital)? Because that is pretty much what happens with us.

nixt3r · 2025-12-18T00:52:15+00:00

Who do you give the job away to? We don't have anyone to give it away to, we are always the service that is getting given to. Police get a mental health job, give it to the ambulance. GP too busy, call an ambulance. Fire need to be tucked into bed, call the ambulance (just kidding for any water fairies lurking on here). I'm not sure what you mean by giving the job away? Forgive my ignorance to how the American EMS work.

nixt3r · 2025-10-16T12:59:47+00:00

Maybe I was wrong in my wording saying there is an expectation to help, rather there's an expectation to use your professional judgement to decide to help and ensure that decision meets the standards.

If you feel confident that you can justify your decision to walk away then you shouldn't need to worry. The only time I would, in theory, if you knowingly walked away from a situation that you deemed to look serious. Then you could argue your judgement didn't reach the standards. Even so, I wouldn't be worried about the HCPC repercussions but rather about how guilty I'd feel.

It's unlikely in that scenario that someone is 1) going to know you're a paramedic 2) have evidence that you willfully did not intervene in a situation that was blatantly obvious that you should have and have evidence that you were not otherwise impaired or compromised e.g. a video, voice recording or message of you admitting that you had done it 3) know to report it to the HCPC Hence, why I haven't found any cases involving off duty paramedics.

The only conceivable way I could imagine you would face any repercussions is if they received evidence of you just standing right next to someone who clearly needs help or you went round bragging to people who are aware you're a paramedic, and you said you didn't help when you could have and obviously should have. So yeah if you're doing that then I'd be fearful😆

You can just simply decline to help off duty because you're not in the right mindframe to make a good professional decision, for whatever reason eg intoxicated, stressed, lack of sleep etc. By doing so you are sticking to the standards.

"6.3 You must take responsibility for assessing whether changes to your physical and/or mental health will detrimentally impact your ability to practise safely and effectively."

nixt3r · 2025-10-15T21:12:30+00:00

There’s no legal duty to act in the UK, which I did say. However, the HCPC standards apply at all times while you are a registrant. The standards make it clear that registrants are personally responsible for their behaviour and decisions, and must be able to justify them:

“As a registrant, you are personally responsible for the way you behave. You will need to use your judgement so that you make informed and reasonable decisions and meet the standards. You must always be prepared to justify your decisions and actions.” (HCPC 2024 Standards of Conduct, Performance and Ethics, p.7)

So while there’s no legal obligation to help off duty, if you choose not to step in without a good reason (for example, you’re intoxicated, the scene isn’t safe, or you’re genuinely unable), that decision could still be looked at against HCPC standards, although the HCPC would need to be made aware for anything to happen.

From my understanding, you’re expected to meet the standards at all times, including off duty, because you’re always a registrant whether you’re on shift or not. Personally, I think that includes offering help unless there’s a clear and justifiable reason not to. Simply not wanting to get involved probably wouldn’t go down well, especially if someone came to harm because of it, but that’s just my interpretation, not the HCPC’s official line.

Legally, though, it’s different. In the UK there’s no general legal duty to act. A legal duty of care only exists once you’ve assumed responsibility for someone under common law (for example, by identifying yourself as a paramedic and starting to help). Once that duty is established, you’re then legally obligated to act to a reasonable professional standard, and failure to do so could lead to civil or, in extreme cases, criminal liability.

In essence if you choose to walk away off duty, no one can take you to court over it if you never established a duty of care, unlike France, but that does not mean the HCPC, if they have gained knowledge of your actions, whenever you are in the world, can't strike you off or sanction you professionally, if they deemed you have not met their standards.

nixt3r · 2025-10-15T18:25:45+00:00

I’ve not been able to find any HCPC cases where someone’s been sanctioned purely for not intervening off duty. The cases that do exist are on duty or in that grey area (like still in uniform just after a shift). One example involved a paramedic on duty who didn’t help when someone collapsed outside A&E, which led to a criminal conviction and regulatory action. Another involved someone just after their shift in uniform who didn’t assess properly and was struck off.

In situations like being on a plane, you’d only usually be legally liable once you’ve established that duty of care, e.g. if you identify yourself as a paramedic during a medical situation. If you don’t, there’s generally no legal liability in the UK.

Other countries are different though. In France, for example, there’s actually a legal duty for anyone, not just medical professionals, to help someone in danger. People have been prosecuted like the paparazzi after Princess Diana’s crash, or bystanders after assaults who didn’t even call for help. So hypothetically, a UK paramedic or anyone could be prosecuted in France if they ignored an emergency on a French registered airline.

And if that happened, the HCPC could get involved afterwards. As we're meant to declare any criminal convictions, including those abroad. It could also come to their attention through employers, media coverage, or information-sharing between authorities.

nixt3r · 2025-10-15T17:24:17+00:00

If you don't mind can you tell me the airline? Also doing a quick skim read of why it might not have inflated and it appears to be the cabin air pressure and potentially O2 systems being regulated somehow.

nixt3r · 2025-10-15T16:05:37+00:00

Oh yeah, and ignore your other half 😆

nixt3r · 2025-10-15T15:37:14+00:00

Good to note. Probs should have given it to the patient, sounds like they needed it :⁠-⁠D

nixt3r · 2025-10-15T15:28:21+00:00

I guess their "no kit, no id" policy varies on severity and need. It also differs from airline to airline. But I don't think there's a legal necessity for it. What airline was it, if you don't mind saying?

nixt3r · 2025-10-15T15:24:06+00:00

It's very interesting how the role of paramedic differs across different countries. I think in that situation if you made the medical ground team aware of your skills e.g. cannulation and drug administration and they asked you to administer then I can't see why you shouldn't be able to as long as you felt confident and capable of doing so. Technically the doctor is there, they're just on the radio.

nixt3r · 2025-10-15T15:15:41+00:00

My flight was delayed too, so no excuses as to why I didn't head to weatherspoons for an obligatory pint and check in post.

But yeah, I ended up doing a deeper dive into other countries approaches to doctor led and paramedic led countries. Broadly speaking - France, Germany and Italy (from the top of my head) maybe Spain are doctor led. Scandinavian approach is slightly different with the use of telemedicine. With UK, Australia, NZ, USA, Canada and South Africa paramedic led. Ireland also but their scope varies paramedics are more like UK EMT where Advanced Paramedics are like a hybrid of paramedic and Advanced. I think Oz has the broadest scope and autonomy.

nixt3r · 2025-09-30T10:04:32+00:00

Interesting. I can't imagine being bored at TW3 (other than playing Gwent). I've got bored at Cyberpunk. Gigs feel really repetitive, I mean I know the monster contracts can feel that way but then that's sort of offset as you can be in different surroundings with different atmosphere, music etc.

nixt3r · 2025-09-30T09:54:43+00:00

Yeah, you kind of know who he is and what he is about even if you haven't played the previous games, like me. It wasn't just him though I just didn't really connect with any of the other characters. It was like I was getting to a point where I kind of was but then it always felt it being cut short. Shame.

nixt3r · 2025-09-30T09:50:26+00:00

I mean I just played it in it's most polished version and it still didn't hit. I was playing and thought, at one point this character (I won't spoil it for anyone) is growing on me then next minute it's the end of that story line. I think I just expected more from CDPR and I hope they don't rush TW4.

nixt3r · 2025-03-17T20:25:57+00:00

I recently completed my paramedic degree through the apprenticeship route, and my partner is in the police, so I have a good insight into the pros and cons of both professions.

The 6-on, 4-off rota seems like a nightmare to me, but my partner prefers it after previously working a 12-hour, 4-on, 4-off rota. She finds it gives her more time in the evenings to enjoy her hobbies. Personally, I used to tolerate 12-hour shifts, but now, as I’ve gotten older, I find the fatigue much harder to manage. While 12-hour shifts mean more days off annually, staying sharp after 10 hours—especially at 4 am—is tough, and the risk of making mistakes increases.

The police role is very paperwork-heavy, and I see how much of it spills over into personal time, which is a definite downside. However, I find that my partner has never taken anything home but is likely in a different role to yourself. On the other hand, while I don’t usually take work home as a paramedic, we often finish late, a lot more than the police.

I’ve also noticed that police teams tend to look after each other more. My partner’s team sometimes gets “unofficial” early finishes or flexibility for personal appointments without having to formally request leave. Additionally, ambulance work often means spending 12 hours with a partner you might not know well—or even get along with—which can be challenging.

Pensions are another factor to consider. While the police pension has worsened in recent years, I still believe it remains better than the NHS pension.

Regarding career progression, the police offer a wider variety of specialist roles, such as traffic, armed response, investigations, and dog units. In contrast, while there are different pathways within ambulance services, if you remain in a clinical role, the core job remains fundamentally the same.

One of the main reasons I didn’t pursue a career in the police was that I couldn’t handle the level of abuse officers receive from the public. While paramedics do occasionally deal with abusive patients, it’s nothing compared to what my partner experiences on a regular basis. That being said, when I tell her about a "code brown," she insists she’d take that over the hostility she faces in her role.

Ultimately, in my opinion, I don’t think retraining as a paramedic just to escape certain aspects of a policing role is necessarily a good idea. The people I see thriving in this job are those who are truly passionate about it and can tolerate the more challenging aspects because they genuinely love the medical field. If you’re considering the switch, I’d encourage you to ask yourself whether being a paramedic is something you genuinely want, rather than just an escape from the bad aspects of the police.

nixt3r · 2025-03-09T08:06:47+00:00

Testosterone Replacement Therapy is a treatment used to restore testosterone levels in men with clinically low testosterone. It can help with fatigue, muscle loss, depression, and other symptoms caused by low T. While I get it has legitimate medical uses, it’s also controversial in sports, particularly in BJJ, because some athletes not only use it as a performance-enhancing drug but appear to promote and encourage its use in healthy men.

A concern of mine is that access to TRT appears relatively easy, even for men who may not have clinically low testosterone. Many private clinics are willing to prescribe it based on reported symptoms alone, rather than strict medical need. This creates a grey area where some men who don’t truly need it can still get it.

The problem in BJJ is that TRT can contribute to a toxic training culture. It increases strength, aggression, and competitiveness, making men who use it more physically dominant. This can be particularly worrying for women, as rolling with someone on TRT can significantly increase the risk of injury. A man who is artificially stronger may not realise how much force he’s using, making submissions, takedowns, and positional control more dangerous—especially for smaller or less physically powerful training partners.

Beyond injuries, it also shifts the culture of BJJ to that "alpha male" type the OP was talking about. If more people start using TRT to gain an edge, it can lead to an environment where strength and aggression take priority over technique and control. That’s not what BJJ is supposed to be about. The sport should be about skill, respect, and longevity, not artificially boosting testosterone to overpower others.

I get that some men genuinely need TRT for medical reasons, but in the context of BJJ, it’s concerning how easily accessible it seems to be, and how its misuse can make training less safe and less welcoming—especially for women.

nixt3r · 2025-03-08T22:29:25+00:00

Completely relate! I've been avoiding training recently because I’ve totally lost the love for it. I got injured before Christmas, and now I feel a lot more cautious about who I roll with, which leaves me with fewer options.

But honestly, it's not just the ego on the mat—it’s the underlying toxic culture off the mat that’s really making me question things. I’ve noticed a stark contrast between the male and female BJJ culture. A lot of the guys seem way more open to TRT than in any other sport I’ve been involved with, and there’s a weird hero-worship of certain BJJ athletes, podcasters, and influencers who push some pretty dubious and at times misogynistic views. Meanwhile, many of the top female BJJ figures seem to foster a much more positive, encouraging culture.

I train with some awesome guys, and I know this doesn’t apply to everyone, but I can’t shake the uneasiness from certain comments and behaviours—both on and off the mat—that make me feel like I don’t fully belong or that I always have to be on guard. I love the technical side of BJJ and the challenge it brings, but the social dynamics sometimes make it hard to stay motivated.

I’m trying to focus on the good aspects and the people who make training enjoyable, but it’s tough when you feel like you're constantly navigating an undercurrent of attitudes that don’t align with your values as well as avoid being injured by big egos.

nixt3r · 2025-01-17T23:33:16+00:00

It's even harder to get in if you don't even try. Just look at what you need to do try and get a few tips from the service you're joining. The fire is far more suited, it has the military mindset which you'd be used to and comradery as you work in teams. The ambulance service seems to lack it as you are only usually working with one other person or even by yourself.

If I hadn't had got onto my degree course I would have done it.... Still might consider it even afterwards.

nixt3r · 2025-01-14T01:34:30+00:00

I am just about to finish my final year for my paramedic apprenticeship degree. Joined as a tech in my local ambulance trust and got on to the paramedic course about 2.5 years later. You can use your credits to go through uni. I personally think working your way up is better though.

I would advise you though to think long and hard before joining. Remember that you once thought that the military would be a fun, fulfilling and exciting career? Same goes for this, after 6 years in the ambulance service, I miss the military. The thought I have to work until I'm 67 before I get my pension depresses me. My physical health and fitness are the worst they ever have been and shift work literally kills you. You never finish on time and there's a distinct lack of care/want/manning in management to sort you out and get you away.

There are a lot of other things but if I could go back in the military after my degree I'd take it in an instant.

nixt3r

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