The allied health professions faced new and different challenges, and opportunities,  during the COVID-19 pandemic. As emergency responders, paramedics were pivotal in the triage, management and treatment of patients in the community. However, juggling the often competing needs of the community, over-burdened hospitals, aged care facilities and sometimes challenging public policy – while trying to practice self-care and protect their own families  – created another set of challenges for paramedics.

We talked with Bianca Jackson, a paramedic with Ambulance Victoria and mother of three children, about her career as a paramedic, and how she navigated her work-life balance during and after the pandemic.

Paramedic career pathway

Tell us a bit about your professional journey as a paramedic and what inspired you to embark on a career in paramedicine.

“I was always really interested in emergency medicine—the hectic guts and gore of an emergency department.”

When Bianca finished school, paramedicine was a diploma, so she completed a biomedical science degree instead.

“It was fabulous, it opened doors to different options. It gave me a really good base in anatomy, physiology, the body, research. Since becoming a paramedic, I’ve done a lot of research, and that particular degree helped with how to write a thesis, how to do research, that sort of thing.”

Bianca travelled to Israel to volunteer in their ambulance service while studying her  degree.

“I think it was probably there, working on that ambulance that I went, ‘This is what I have to do’. I had found my calling. It was really enjoyable, and I think every shift since then has been just as enjoyable as the first one I did over in Israel.”

When Bianca returned from Israel, a degree in paramedicine had started. “I applied and went through that pathway. And 16 years later, here we are,” she says.

Bianca started working as an on-road paramedic at 25 years of age. When asked if that was a daunting career to step into at that young age she joked, “That’s old these days! We’re getting people finishing school going straight into a three-year degree, so they can come into the ambulance service when they’re 21.”

 How are paramedics prepared for life on the frontline at such a young age?

“No training prepares you for some of the things we see, it prepares you for how to manage the things we see. From an emotional perspective, I think life experience sort of prepares you for it. Then it’s a matter of being very engaged with how you’re feeling about certain things, knowing when to pull back because you’ve had enough or you need a break, and accessing the right resources to get through those challenges.”

Being a paramedic during COVID-19 in Melbourne, Victoria

Melbourne was hit hard by COVID-19 in terms of lockdowns and hospitalisations. How did your training and experience prepare you for the realities of such a working environment?

“You prepare, and you prepare, and you prepare, and then the thing happens and it’s chaotic. And the things that you had prepared for, sort of do a 360.”

Ambulance Victoria had policies and procedures in place to navigate the pandemic, however staff were faced with unfamiliar techniques and were having to learn ‘on the go’.

“Early on, we were wearing all the PPE and doing all the things we knew to do in a pandemic, when the information was minimal. It was quite stressful because you didn’t know what risk there was to you, but also there was the risk of you bringing something home to your family and kids. I think a lot of people struggled with that.

“It was quite fatiguing. You took one patient into hospital and then you had to clean everything; you had to clean every nook and cranny of the ambulance, had to change everything, had to change your PPE. There are all these procedures and policies around how to take your PPE off, and if you did it the wrong way, we had to take you out of service and isolate you for a period of time until we knew you hadn’t contracted COVID from a breach.

“There were a lot of things that weren’t day-to-day business for us. It was very challenging. But looking back, I think Victoria, the ambulance service, the emergency services did a really, really good job at looking after the community and looking after ourselves. Not many people contracted COVID at work. We had paramedics with COVID but they tended to catch it in the community. We were able to mitigate that risk really well with PPE and procedures.”

Professional support and self-care

Paramedics were charged with navigating the unpredictability of the pandemic and fluctuating advice. Bianca recalls attitudes of positivity and gratitude amongst it all.

“There’s just been this constant, daily routine of keeping updated, reading new things, learning new things. You can’t just come to work and relax knowing that you know what you’re doing, because you’re good at your job. You have to stay on top of all the information and a lot of the information was quite confusing, and it constantly changed. So you might have read the documentation that prepped you for the start your shift, and then halfway through your shift the government regulations changed, or they’d find something else like someone’s now arrived from overseas with COVID, so that’s a new risk factor and now you have to start being super vigilant.

“All of those things were changing minute by minute, and from a communication perspective, it was really hard to stay on top of everything. But yeah, that’s probably COVID in a nutshell, from a paramedic’s perspective.

“On the brighter side, people were throwing free coffees at us, delivering food and being really wonderful. Paramedics would turn around and say it’s hard work, but we still had jobs. We were very thankful during that time.”

How did your colleagues support each other during that time?

“That was a bit of a struggle. Normally, if you go to a really horrific scene, you might actually embrace your partner and, just have a moment, but you couldn’t do that. But, COVID or no COVID, we go through stressful things and we’ve got a really good peer support network set up. Paramedics not only can access it, but we’re really encouraged to seek out psychologists and just keep talking. Actually, coming to work became social for people because everyone else was trapped at home.

“Through the lockdowns, at least, it was a nice release and people really supported one another and the crews were all really helpful. You’d all be listening out on the radio, helping out your colleagues.

“Everyone just looked after each other, so there was a nice camaraderie through it. There often is here anyway. But specifically through that time everyone was really looking after one another and doing what they could.”

 You’ve mentioned dealing with fatigue—what support systems been set up for paramedic staff as a result of the pandemic?

”There were some really great initiatives, government and ambulance combined: free food at hospitals, so you didn’t have to carry your lunch in an ambulance that may have had COVID exposure; 10-hour rest breaks between shifts to make sure people were having that time; COVID leave, so on top of sick leave or any other leave arrangements, we’re given extra leave if we got COVID or if a family member had COVID.

“So we were very well supported from that perspective, not that that helps with fatigue, but it was a nice thank you, appreciating what we do.”

Work-life balance as a paramedic

As a mother of three children, how do you negotiate work/life balance, especially working in emergency or trauma environments?

“When the kids were younger I was working on a flexible work arrangement, so I was on-road part-time. It was really nice coming to work as a mum, as being a mum is so hectic, and sometimes from an intellectual perspective, it’s less stimulating. Also, you can just sit at a table and have lunch, not doing 300 things at the same time, and go to the toilet by yourself!

“COVID really kicked off opportunities for me within ambulance because I had the background in emergency management. So I started building back a few more hours, working in a management space. Around this time, my youngest was in kindergarten five days a week—you’ve still got to drop them off, pick them up, they’ve got activities, and you want to spend time with them as well, whilst trying to do a good job at work. It’s a definitely a juggle.”

How do you manage the psychological or emotional burden of life as a paramedic when coming home to a young family?

“What the public would think that we find stressful, we don’t find stressful. Those gory jobs that would create stress for people in the community, that’s what we enjoy, we enjoy going to those things, we enjoy fixing the bones, helping people with their pain. The thing that triggers paramedics can be things to do with children, or something that reminds you of a family member, or if you’re going through something at home, and then something at work reminds you of that. It can just be years and years of thinking that something hasn’t bothered you, but then lots of little things pop up in the background; you don’t often know it’s coming.

“I actually find having a busy family life really good. Because when I’m at work, I’m at work and I’m just on. When I get home, I can really switch off from anything that’s going on at work and almost compartmentalise it. If I’ve gone to anything that’s really thrown me, I know that we’ve got our peer support—you’ll get a couple of phone calls, you can chat it through with people. If it’s a particular job that stresses me out, I find chatting to the people who were there with me really helpful. Sometimes following up with medical staff that looked after a patient as well, where I’ve just followed up to find out what actually happened, because the unknown is what stresses you. ‘Did I do enough?’ Sometimes that closure helps.”

How paramedicine makes a difference

Do you have any stand-out moments of making a difference to patient or community outcomes?

“Attending community members when they’re in crisis, just being there, you can see the relief in people’s faces the second the door opens and we walk in. I think that’s probably the biggest impact we have for the community.”

In addition to the daily impact on the ground, Bianca also considers research, health promotion and innovation in paramedicine as having significant influence on community and individual patient outcomes.”

“We have a lot of research going on, and we collect a lot of data around our performance. We use that to drive improvements, to have better outcomes for patients. One of the biggest things for us right now is cardiac arrest. Worldwide there’s research that shows that every minute matters. We can come and do our thing, but if the patient has had a really long downtime with no CPR and no intervention from a defibrillator, it really reduces their survival rate. So we have a whole department that works on this. There’s two aspects: one is GoodSAM, which promotes people to become good Samaritans by signing up to the app. If a cardiac arrest comes in, we can notify people via the GoodSAM app. It might be their next door neighbour, or someone working in the next building, and while it’s going to take us ten minutes to get an ambulance there, they can go and start CPR and we guide them through the process.

“The other thing we’re promoting is public access defibrillation. We try to get out into the community, into relevant spaces, whether it’s libraries, swimming pools, or gyms, and get automatic defibrillators into those community areas. Essentially, a lay person can stick the defibrillation pads on a person in cardiac arrest, and it has a picture to show you where to place it, the machine will instruct you on the rest. It’s a really easy tool, a huge life saving measure. This is just one example of what we do as an organisation to improve our clinical outcomes and patient outcomes. There’s a lot of focus on community.”

Translating paramedic research into practice

How has your research in training paramedics to respond to mass casualty incidents influenced the team at Ambulance Victoria

“Mass casualty events and emergency management is my passion area. After my time in Israel, and then working with Ambulance Victoria, there were areas where I thought we didn’t have exposure and experience. There were certain things that were really well coordinated over in Israel, so I studied a Master’s in Emergency Management and did a comparison between the two; how we train in that area, what our policies and procedures are, what works well, what doesn’t work well.

“I really got to use my Master’s and the experiences I’d had overseas, to implement them in a positive way during COVID and see it flow into our policies and procedures, and in staff management.”

When asked about her motivation to undertake a Master’s degree, Bianca puts it down to passion and a lifelong interest in studying. But she acknowledges that research culture and support within the workplace is growing.

“Now we have a research unit within Ambulance Victoria. Traditionally, there’s hasn’t been a lot of research done within the organisation, we haven’t had a lot of paramedics doing research, but it’s on the increase. Now, we’re doing a lot of clinical trials, so it’s a really interesting space for research. We’ve got a trial on at the moment where they’re doing ECMO (extracorporeal membrane oxygenation) in the field, which is this unbelievable procedure they usually do in hospital, and it basically gives the heart time to rest and this machine becomes the heart. There’s a trial running now within Ambulance Victoria, where someone’s in cardiac arrest and a team will come out with their machines and put them on ECMO pre hospital—it’s pretty phenomenal.”

Is there anything you would like to see done differently in the paramedicine space?

“The workforce has changed enormously in the time since I started. It’s much younger, and we’re gender equivalent now, and that’s being represented across the whole organisation. It would be really nice to see the whole system working a little bit better. There’s lots of things in the pipeline, lots of projects and planning in the background which are working towards getting ambulances out to the patients in a timely manner.

“The thing I really like impacting is the clinical stuff, seeing that part of our clinical trajectory change based on data and evidence. We’re definitely impacting a lot in that space, increasing the amount of research in the organisation, which is fabulous.”

 

 

For more insights on the exceptional experience of paramedics across the globe, check out our A-Z feature on the paramedicine profession. | Connect with Bianca on LinkedIn.

If you wish to share your experiences or thoughts on AHP stress management post-COVID, please leave a comment below.

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