European Paramedic Curriculum (EPaCur) –A Nordic Unification in Paramedic Education?

Author: Christoffer Ericsson, PhD Student, MSc, MHc, Degree Programme Director – Emergency Care, christoffer.ericsson@arcada.fi

Flashing blue lights, traumatic accidents, life-saving acute procedures and time-critical action are elements that identify the innately rough and gritty out-of hospital environment or prehospital emergency care still today, even if mostly through vivid imagery of dramatically staged television scenes. Although these elements still do constitute a significant part of the ambulance work, paramedics today are also a remarkably more holistic and wide-reaching service, being able to identify and intervene in social distress and mental health issues and initiating vital critical care that seamlessly continues through the doors of the emergency department and intensive care, even if not always with that aforementioned pace of drama. The Emergency Medical Services (EMS) have therefore become the first vital link in societal healthcare services and for some, the only link.

Being a rather young profession, the paramedic field is wide, visible and active with systemic interprofessional collaboration between prehospital, anesthesia and emergency medicine being an established tradition. Sharing not only clinical knowledge, development ideas, systematic changes and debates on relevant educational questions, the discourse has been facilitated through, among others, free open access medical education (FOAMed), focusing on low-threshold social media, podcast and blogging as a medium and also through traditional international conferences [1]. The field of research, in old times even seen as a less-appealing garlic for these night-prowling red-eyed paramedics, is now the road many have chosen to pursue with deeper academic insights in mind. Doctoral students with paramedic backgrounds have continuously increased both globally and also in Finland [2], showing that an interest in developing the prehospital profession beyond the confines of the ‘yellow rig’ has been ignited. The ongoing global Covid-19 pandemic has also naturally forced all and any forms of healthcare to collaborate jointly in a global unified front against the spreading virus. A need for a common professional ground and basis for international paramedic education and competencies is therefore relevant, especially since other healthcare professions, such as registered nurse and midwifes, have directive-regulated professions stipulated on EU level (Directive 2013/55/EU).

As a result of widened responsibilities in caring, a strong professional profile and interprofessional collaboration, paramedics (those artists formerly known as “ambulance drivers”) have in the last decades seen the need for a higher education to stand on. Initiating from mainly certificate-based courses, that still do exist, many countries in Europe and beyond increasingly offer some form of university-level degrees [3], either as paramedical specializations for nurses or specific Paramedic/Emergency Care degrees, both on bachelor- and masters-level. The first dual-degree education in the UK is now offered by Edge Hill University in Manchester [4] and even countries such as South Africa, where paramedics have always been considered a strong established profession, a field not touched upon even by in-hospital emergency doctors or anesthesia for fear of incompetence in the out-of-hospital context, is slowly moving from a certificate-based training level towards a higher university-degree, not without systemic challenges thou. [5] All these signs show that a higher-level paramedic education strongly seems supported by the increased need for very specific sets of skills, knowledge and attitudes required from autonomous prehospital professionals. [6]

As the need for a university-based education for paramedics has been established and proven, differences between educational levels, competencies and systems are still apparent, as established in both a previous 2004 review by Langhelle et al [7] and an updated 2018 Nordic EMS benchmarking report [8], both showing challenges and needs for national level paramedic competencies. Narrowing the perspective down to the Nordic countries, Finland, Sweden, Norway, Denmark and Iceland, which traditionally have worked together on many fronts in prehospital care, the level of paramedic education differs even on this geographical scale; from Norwegian BSc Paramedic-degrees (180 ECTS) to Swedish sub-specializations for nurses, the Finnish dual-degree in Emergency Care/Nursing (240 ECTS) to vocational courses in Denmark and Iceland, the Nordic field clearly needs some form of unity and coherence. This is especially relevant since international mobility between students and professionals has a long tradition and collaborative research and development opportunities do exist and would perhaps even be better enabled through a higher common education.

Initiated out of such a need basis, the Erasmus-funded project, European Paramedic Curriculum (EPaCur) [9], is a first step in attempting to find such a unity on paramedic education in, initially, the Nordic countries with long-term goals of applying potential generalizable finding even on a European level. Partners in the projects are; University of Akureyri (ICE) as the coordinator, Arcada University of Applied Sciences (Arcada) (FIN), OsloMet (NOR) and Region Hovedstaden (DK) as partners. The aim of the project is to collect data potentially improve paramedic education at the tertiary level, strengthening coordination between the Nordic countries with Paramedic education and enabling greater opportunities for cross-border work, students and faculty exchange through creating an “exemplary curricula” for the education of Paramedics at university level (180 ECTS or more) by using the varying knowledge and experience of all involved parties. Of all parties, Arcada clearly has the longest experience of university-level paramedic education, with 20-plus years of the dual-degree Emergency Care BHc-degree, originally initiated in 1998. Such a coordinated curriculum potentially also strengthens the already existing international collaboration between the universities, opens for possibilities to teach joint courses online (relevant concept in the pandemic age of distance learning) and enables students to widen their exchange options for vocational and simulation training. [9] As an incentive bonus, this form of project could concretely enable the partner countries lacking university-degree education to effectively initiate a process for funding and starting it, by using the project summary products as basis for argument. As the project, kicked off in 2020, soon nears a closure in September 2021 with journal publications and findings presented along the way, the hope is that the final results would be like a fork in disentangling the proverbial noodle-soup that is Nordic paramedic education and joint competencies.

The selection of Arcada as a partner in this Nordic project is not a coincidence. Arcada has for many years had a long-standing tradition of Nordic paramedic collaboration, where students and alumni of our Emergency Care programme have a reputation of being competent, eager, clinically and theoretically knowledgeable and ethically reflective, setting a high standard for what it means to be a paramedic nursing professional. As one of the founding partners in the NordPlus-funded NordParamedics collaboration network [10], Arcada, together with Högskolan i Borås (SWE), OsloMet and University of Akureyri, have actively participated in hosting and exchanging students and faculty from all above partner countries, to great success and interest. Arcada also has strong ties to workforce; Falck Stockholm, the main EMS service provider in Stockholm, is a place where many Arcada Emergency Care alumni do their final clinical exchange rotations and even stay for work after graduation. Even in these pandemic times, where travel is restricted and all ideas of exchange across border are often merely dreams, the Nordic collaboration lives on through projects like this. Perhaps even due to such restrictions, we are finding new ways to strengthen collaboration through RDI projects and distance-based seminars. Ideas that hopefully will be realized and lead to deeper bonds. All this also includes a unified vision and a long-term commonality goal to pursue, where Arcada will clearly be standing at the wheel.

References:

[1] EMS International Conference. Accessed: 18.7.2020 [www]: https://emseurope.org/

[2] Paramedic PhD Statistics. Accessed: 18.7.2020 [www]: https://www.paramedicphd.com/statistics

[3] WHO. 2008. Emergency Medical Services in The European Union – Report of an assessment project co-ordinated by the World Health Organization. https://www.euro.who.int/__data/assets/pdf_file/0003/114564/E92039.pdf

[4] MSci Nurse Paramedic Programme – Edge Hill University https://www.edgehill.ac.uk/courses/nurse-paramedic-adult/

[5] Sobuwa, S., & Christopher, L. D. (2019). Emergency care education in South Africa: past, present and future. Australasian Journal of Paramedicine, 2019;16.

[6] Bos, N; Krol, M; Veenvliet, C; Plass, A M. 2015. Ambulance care in Europe – Organization and practices of ambulance services in 14 European countries https://www.nivel.nl/sites/default/files/bestanden/Rapport_ambulance_care_europe.pdf

[7] Langhelle, A., Lossius, H. M., Silfvast, T., Björnsson, H. M., Lippert, F. K., Ersson, A., & Søreide, E. (2004). International EMS systems: the Nordic countries. Resuscitation, 61(1), 9-21.

[8] The Nordic Emergency Medical Services – Project on Data Collection and Benchmarking 2014-2018. Helsedirektoratet – Norwegian Directorate of Health. Accessed: 18.7.2020 [www]: https://www.landlaeknir.is/servlet/file/store93/item36845/Nordic%20EMS%20benchmarking%20report%202014-2018.pdf

[9] European Curriculum for Paramedic BS – Erasmus Project. Accessed: 18.7.2020 [www]: https://ec.europa.eu/programmes/erasmus-plus/projects/eplus-project-details/#project/2019-1-IS01-KA203-051166

[10] NordParamedics Network. Accessed: 18.7.2020 [www]: https://blogg.hioa.no/nordparamedics/