The Ambulance Service: Spend your life riding to the rescue

Not everyone working for the ambulance service crew saves lives, but whether you're doing mouth-to-mouth or just driving, you're making a difference. Andy Sharman reports

The term "emergency" is perhaps misleading, since responding to 999 calls makes up only 10 per cent of the average ambulance service workload. Yet with one in 20 Britons requiring some sort of emergency health treatment every year, paramedics, technicians and care assistants are vital.

Ambulance care assistants are the most junior arm of the service. They make up the force that drives the non-emergency patient transport service (PTS), conveying patients between hospitals, nursing homes and residential properties. In this role, you can develop a closer relationship with your patients, since you will routinely care for the same people, day in, day out.

"I love our patients," says Vanessa Spencer, an ambulance transport assistant with the East Anglia Ambulance Service, "and the flexible working hours are good because I've got a young family."

While assistants need to be au fait with first aid, as well as being safe drivers, demands can often be rather more subtle. "You have to be sympathetic, understanding and nod in the right places," says Spencer. "You often need to know when not to speak. You need tact, but you must also be able to communicate with different sorts of people, on different levels."

There is one crucial litmus test as to whether or not this role, stripped of all the so-called "sexy medicine" we see on television, is appropriate for you: "If you don't care about people," asserts Spencer, "there's no point in getting into the job."

There are two sides to the ambulance service, and the emergency workload is met head-on by teams of ambulance technicians and paramedics. Though they're part of the same service, a gulf stands between emergency and non-emergency crew. "Being out on the road is what I've always wanted," says Lancashire trainee technician Lisa Hulley. "The main difference between ambulance care assistants and my job is that you're not dealing with routine cases. Every day is different - you're not picking up the same people. It's the variety, really."

Technicians often work side-by-side with paramedics, providing essential support in, for example, resuscitation, fracture management, analgesia (pain relief) and limited drug administration. "We don't have as many skills as paramedics," says Hulley, "but the skills we have can really make a difference."

A job in itself, work as an ambulance technician can also be the first step on the road to promotion. "The technician training gave me a thirst for knowledge," says Gareth EB Jones, "and inspired me to go on to do my paramedic training." Now a qualified paramedic in Caernarfon, Jones's progression is testament to the traditional career-ladder approach, rather than the fast-track graduate route. What's more, technician Hulley puts "life skills" on an equal footing with academia. "I'm at a stage in my life when I feel I have the experiences necessary to help me in the role I'm doing now," she says.

That said, paramedic qualifications are becoming ever more technical. "I've seen the ambulance service develop tremendously," says Roland Furber, an ex-serviceman and chief executive of the British Paramedic Association. "When I entered the profession, aged 19, all you needed was a driving licence and basic first aid. Now, future paramedic qualifications will be based on university degrees, and that's a good thing.

"You need to have a good brain and good manual dexterity; to take control and lead in very difficult situations; to lead people under a tremendous amount of stress; to be a listener, but also talk in plain English; to be a decision-maker and to remember that you're affecting peoples' lives." With more than 35 years' experience in the profession, Furber knows what's required of paramedics, and it's clear from what he says that a fusion of theory and practice is the best way forward for training.

Increasingly, universities are teaming up with ambulance services. The NHS lists Coventry University, Sheffield Hallam University and the University of Hertfordshire as institutions offering approved courses for paramedics. All three institutions operate in collaboration with regional services.

"People will be doing so much on the course," says Ian Canning, a lecturer in paramedical science at the University of Hertfordshire. "We give them the paramedic grounding, consolidated with academic knowledge and then practical knowledge."

Students on the paramedic science BSc foundation degree spend 80 per cent of their final two years on placements with their partnership trust, typically the London Ambulance Service, where they will earn a truncated salary.

Graduates leave the course already eligible for registration as a paramedic with the Health Professions Council, something that wouldn't be possible without such a hands-on approach.

"If you're never out there practising, there are inherent problems," adds Canning, an established paramedic himself. "You need the experience to test yourself in order to see if you can cope - to see if you're suited to a job in the ambulance service."

The lowdown

What qualifications do I need?

Non-emergency roles may require four GCSEs at grades A-C or suitable alternatives. Technicians are required to undergo in-house training and examinations. However, paramedics will soon require a university education.

Are there any accredited university courses?

Yes. Courses at Coventry, Sheffield Hallam and the University of Hertfordshire lead to qualifications in paramedical science. The University of Portsmouth will soon be joining them.

How much will I earn?

Salaries currently progress from ambulance care assistants (£14,400), through ambulance technicians (£19,800), to paramedics (£21,400). However, these may improve with the impending Agenda for Change, an NHS-wide initiative that will grant equal pay for work of equal value.

Further information

NHS careers: www.nhscareers.nhs.uk; the Ambulance Service Association: www.asa.uk.net; the British Paramedic Association: www.britishparamedic.org

The ambulance care assistant: 'You need good teamwork'

Keila Turner, 26, is now an ambulance care assistant with the West Country Ambulance Service, having spent five and a half years in the Royal Navy.

"I fancied a career change, and the Ambulance Service seemed like a very good challenge and a job with great career prospects. My job involves patient care, looking after people, taking people to and from nursing homes, and ensuring safe transit.

"You're always meeting new people, but you also manage to get quite friendly with the regulars. At this level, we deal mainly with elderly patients and sometimes people who can't communicate very well, so simple things like talking to people, being able to communicate with people on their level, really makes a difference.

"A lot of people when they see us think that we're paramedics, since we wear the same uniforms, only our epaulettes are different. They think we're trained to deal with anything, like paramedics. So you sometimes have to demote yourself. However, because we're all first aid trained, if you come across any kind of accident, at any time, you're obliged to help.

"You need good teamwork. You'll work each shift with a different crew member. But this means that when you come across a situation, even if you don't feel entirely comfortable with it, you've always got somebody. You have your crewmate who you can consult with. You also have your paramedic supervisor who's on the phone if needs be.

"I didn't realise how complicated the career progression was. I thought you went straight in at paramedic level. If you just sit back, no one will do anything for you. You have to be proactive."

Steve Hatton, 28, is an emergency care practitioner - a solo paramedic - with the South Yorkshire Ambulance Service. He graduated from the University of Hertfordshire in 2002.

"I would recommend university courses, because it's soon going to be the only way forward. I found it an easy conversion from being at university to being a professional. Being a paramedic is a very practical career, so you need a practical course. The course I did was roughly a 50-50 split between academic work and being out on the road.

"If all you've seen is ER or Casualty, try to speak to a paramedic. It's worth asking to get work experience if you're over 18. These TV programmes are obviously highly dramatised. They only do the traumas and the deaths. Thankfully, most of a paramedic's shift is quite routine. Sometimes it's primary care: people panic and don't know what to do, so they call 999 and your job is just to reassure them.

"Having said that, you never know what's next. I've delivered five babies in my short time. It's usually when the mothers have been caught unawares and the midwives don't have time to get there. Delivering a baby is so satisfying. It makes a change from seeing people at their worst."