Kirikiriroa/Hamilton, Aotearoa New Zealand

'We’re definitely better paramedics because of it.'

When Annalise Wilson and Jack Phillips graduated from Charles Sturt University in 2019, their first stop as newly minted paramedics was thousands of miles away in England.

The couple, who both share a love of travel and an interest in seeing the world, had applied initially for jobs in Australia during their final year of study, but on realising that their qualifications were recognised in the UK, and with support from CSU educators who originally hailed from the area, they landed jobs with the East Midlands Ambulance Service (EMAS) in Leicester, serving a population of 4.9 million people.

Eschewing the hustle and bustle of London, Annalise said the lure of a less-urbanised environment, the professional growth opportunities the service provided, and the ability to travel widely throughout the UK and Europe on their days off were the main drawcards of the EMAS.

“I think London was going to be too much for me because I'm a bit of a country kid, so that was probably going to be quite overwhelming, and I'd never travelled before, I'd never been on a plane before,” she said. “The draw of being able to travel was quite big for me, but I just didn't want to be too overwhelmed.”

The pair started their jobs at the beginning of 2020 in the lead-up to COVID-19 and decided to stay on as the pandemic swept the country, presenting them with both challenges and opportunities for personal and professional growth.

“It was interesting; it was very sink or swim, but thankfully it was all swim.”

The pair ended up staying with the EMAS for three-and-a-half years. The initial application and induction process proved to be seamless; they applied for registration in the same manner they would for Ahpra, provided proof they had completed their university degrees, and were then employed for the first two years as newly qualified paramedics.

“You're still doing pretty much all of the same scope of practice as a fully qualified paramedic, you just get paid a little bit less and have a bit more support” Jack said. Another bonus was EMAS work sponsorship, which, unlike many other services in the UK, didn’t require dual citizenship - as Jack said, it was “a no-brainer”.

Because paramedics have long been working in primary healthcare across the health sector in the UK, the role encompassed a diversity of practice settings and hands-on experience in out-of-hospital and community paramedicine.

“They've been registered for years, they've had paramedics in GP practices for years, they have paramedics working in EDs for years - they've realised how useful it is because of the scope of practice and the skills and knowledge that we have,” Jack said.

Unlike many of their peers in Australia, the pair found themselves handling a significant volume of low-acuity cases, refining their assessment and diagnostic skills. They experienced innovative pathways for patient care, from liaising directly with GPs to accessing specialist support services for mental health crises and geriatric care.

Their tenure with EMAS wasn't just about honing their clinical skills; it was about embracing a holistic approach to patient care. They witnessed first-hand the importance of community engagement and preventative measures in alleviating the strain on hospital staff and resources. Through initiatives such as direct referrals to mental health hubs and collaboration with social services, they were able to ensure patients were safe and supported in their own homes.

“We got really good at discharging people and utilising all their different pathways, because they were well established,” Annalise said. “I can easily identify a patient who can potentially stay at home now, and I'm a lot more confident in leaving patients at home now because we did so much of it in the UK.”

“That was a weak point for both of us when we first came over. They were all so used to discharging patients and using all those pathways, but it was like a whole new realm of learning and getting comfortable with leaving patients at home, because for us it was alien.”

The extensive network of social services provided a robust safety net for both patients and clinicians, and enabled direct access to crisis care, fall referrals, and community nurses and palliative care teams.

“The goal they kept trying to promote was to avoid unnecessary ED admissions,” Jack said.

However, despite the safety nets, paramedics’ professional autonomy and the many referral pathways available, the internationally renowned National Health Service is buckling under pressure from arising multiple systemic issues - challenges that were exacerbated during the pandemic. As in Australia, ramping and ambulance response times have increased. In winter, the pair would often be queueing at hospitals for hours.

“That got a little bit tiresome, where you'd go to work knowing you'd have your first patient and you'd be waiting three, four hours, sometimes up to 12 hours, with the one patient,” Jack said.

“And that patient has probably been waiting for an ambulance for up to 12 hours,” Annalise added.

After three-and-a-half years with EMAS, the pair decided the time was right to move closer to family and friends, and in September began working with Hato Hone St John in Aotearoa New Zealand. Working for the service ticked all their boxes; it afforded them new professional opportunities and enabled them to travel and explore new areas.

“The experience we gained from the UK allowed us to feel better prepared and to integrate into a new service. Hato Hone St John has been extremely welcoming, supportive, and has already had a positive impact on our practice.”

Annalise said both moves have been life-changing.

“We’re definitely better paramedics because of it. Learning from so many different people, different clinicians, different situations, different practices, culture, everything. All of that was really fantastic learning. And we're still learning.”