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The importance of ECPs

ECPs are highly skilled paramedics who have chosen to complete an additional two years of specialist training at post-graduate level. This additional training means their focus is on assessment and treatment of patients in the community – often avoiding an unnecessary trip to the hospital emergency department. 

ECPs continually support patients in the community with things like antibiotics for a chest infection, or a urinary tract infection, and removing or putting in stitches. This community medical treatment works alongside our acute emergency work to provide emergency healthcare to our communities.  

Currently, Wellington Free has 22 ECPs across the paramedic workforce, with another eight in training.

A ‘self-confessed geek’

Josie is a self-confessed geek – she’s continually professionally developing; she studies constantly, is a seeker of information, and strives for excellence in everything she does. Josie reflects that this is partly due to her need to highlight the hugely important role paramedics and ECPs have in the healthcare system but mostly because she’s deeply committed to ensuring people get the healthcare they need and deserve. 

“Sometimes it’s almost selfish – when I can walk away knowing the patient has what they need, I feel really good about that. Especially when you’ve helped a disadvantaged population in some way, building trust and increased engagement with the healthcare system. 

For so many people there are barriers to care – financial, transport, understanding what is available, childcare, mistrust of the healthcare system or bad experiences. So I feel like removing barriers to accessing care is a huge part of my role.”

ECPs in action

Josie’s additional training and skills are so helpful to patients, like this story she has about helping a patient struggling to manage epistaxis (more commonly known as a nosebleed).

“Nosebleeds are fairly common but for some people they can become serious, sometimes life-threatening.  People who have had recent nasal surgery, people who are taking anticoagulants (blood thinning medication) or have hypertension (when a person has high blood pressure, a condition where the force of your blood against your artery walls is consistently too high).  The ECP skillset has a number of steps we can use to manage nosebleeds in the community, meaning that people with serious bleeding don’t have to go to the hospital emergency department. Meaning they get treatment quicker and can start feeling better sooner.”   

While the patients who need ECPs’ expert healthcare may not be in an immediately life-threatening situation, they’re often people with high-complexity conditions who need urgent care. They’re sick and often have competing health issues meaning treatment also has to be considered alongside their personal goals of managing their health overall. Josie explains:

“I went to a man who was very unwell with cancer, and he was having a nosebleed. He was so relieved that I could help him in his home, and he didn’t have to go to the emergency department. I was able to plug his nose and use entop spray (local anaesthetic) to constrict his vascular system. We use the same treatment as they do in the hospital. I was able to help him remain at home which helped him avoid exposure to hospital germs while his immunity was low.” 

Working together for patients’ best interests

Josie explains that there’s a real partnership element to the healthcare an ECP provides, a partnership between the patient and paramedic. ECPs have the skills and training to discuss options, treatments at home, and goals of care. This is empowering for the person who’s sick but also for their family and whānau who are often involved.

“I like being involved in healthcare planning, spending more time with patients and discussing health goals. We’ve got the time and the training to get to know what they want for themselves. We’re able to put things in place that ensures they get the healthcare they need, when they don’t want to go to hospital for example.”  

Another hugely valuable role that ECPs have is supporting their paramedic colleagues, using their additional set of skills to input into patient care.   

"Yesterday I supported a paramedic who had a patient with serious back pain, there were no indicators that this was anything life-threatening, he didn’t want to go to hospital, the crew didn’t think he needed to go to hospital, but he couldn’t see his GP for a couple of days. He also couldn’t cope with the pain. As an ECP we have access to a broader range of analgesics (pain medications), so I assessed him, gave him some medication, treated him at home for his pain, made sure he had a plan to get to his GP appointment, got him an appointment to see an osteopath and a prescription for additional pain relief.”

Josie’s story highlights how ECPs can help patients avoid waiting hours at the emergency department to be seen for a prescription. It also shows how patients can get immediate treatment for their healthcare needs and how follow ups can be put in place for them. This allows emergency ambulance crews to safely leave patients at home and attend to another incident.  

Supporting the future of extended care paramedics

As well as working on the frontline, Josie also has a hugely important role teaching the ECPs of the future – lecturing those who are studying for the additional ECP qualification at Whitireia Polytechnic. She explains:

“I love the role of lecturing because I feel like it upskills me as well. I need to be completely informed of all the current standards and information. I have to be constantly learning myself.” 

For Josie:

“My main driver is getting the best outcome from the people we see – all my effort to highlight excellence leads back to ensuring patients get the care they need from Wellington Free Ambulance. 

The more energy I put into the health of my community the more I get out. To walk away knowing that you’ve honoured a patient’s wishes – that’s what makes a good day.”

Thanks, Josie, for sharing your story! If you’d like to support ECPs like Josie, please donate today – www.supportwfa.org.nz