Paramedics see poverty and loneliness
Hannele Palukka (left), Tiina Tiilikka and Petra Auvinen noticed that paramedics often treat the same people, such as those suffering from alcoholism and mental health problems. Seeing Finnish poverty moved us, the researchers say.
”I realised just how unequal people really are. The lives of the lonely elderly, alcoholics or people with mental health problems are so different from ours. Seeing the poverty in Finland moved me.”
This is how Hannele Palukka, Tiina Tiilikka and Petra Auvinen, researchers at the University of Tampere, describe their experiences in a project where they studied the work of paramedics in Pirkanmaa. The researchers travelled with the ambulances to emergency calls.
It was surprising that a lot of the paramedics’ work is service work. Regular clients keep the paramedics busy.
The researchers paid attention to how patiently and politely the paramedics treated even their most difficult clients.
- In their work, the paramedics have to balance the need for patients to get the correct treatment with the fact that they are also customers as well, says Petra Auvinen.
Previously, many paramedics had not actively thought that what they were doing was in fact customer service work.
- The patients tend to complain to Valvira (the National Supervisory Authority for Welfare and Health) so the paramedics have to keep their guard up, Hannele Palukka says.
“Service system in transition: work practices in emergency medical care and ambulance services” is a research project at the School of Social Sciences and Humanities of the University of Tampere which was conducted together with the University Alliance Finland, the Pirkanmaa Hospital District, Tampere Regional Emergency Service and Med Group Ltd. The final research report will be published in January 2013.
Unofficial division of labour causes tension
One of the main findings was that the division of labour between the paramedics was informal. There are two paramedics in the ambulance; one who treats the patient and has the overall responsibility for care. The other is the driving paramedic who drives the ambulance but also gives treatment to the patient.
There is a lot of flexibility in these roles, which can cause friction between the work partners in actual situations. The paramedics do not want to raise questions about the division of labour, in case they spoil the good rapport with their work partner.
One might have more work experience than the other and can interfere in situations where they have no business interfering in their role. This is of course a sensitive subject; people may not want to meddle with entrenched practices, Palukka says.
For example, when it is the driving paramedic who takes the patient’s vitals and the senior paramedic who writes them down, not all of the senior paramedics repeated the vitals aloud.
- This increases the margin of error. It also wastes time as the other paramedic has to make sure that the information has been noted down accurately, Auvinen says.
Auvinen and Palukka had previously analysed the interaction between a pilot and copilot in an aircraft cockpit and in an air control tower. The crew cooperation in the ambulance was not as well established as it is in aviation. The ambulances did not have similar crew cooperation procedures that have been developed for cockpits for safety reasons.
A male field
A typical paramedic is a 30—40 year-old male. According to the researchers, their work culture is quite male.
Paramedics do not have a formal system of coaching supervision. The work partners can go through difficult situations on their own if they want.
The textbooks say a lot about coaching supervision, but in practice the attitude is that it is not necessary, that we can manage, Tiina Tiilikka says.
You have to control your feelings in care situations but the paramedics think that it is not good either if you do not have feelings.
- A good paramedic is not someone who does not have feelings. Dealing with emotions and letting them go is an invisible skill in the work culture, Tiilikka says.
Into people’s homes
The work of paramedics is time-critical. You do not do the work in a hurry, but you do it without delay. The patient needs to get to the treatment facility quickly and the next call can already be waiting.
The care often happens in people’s homes. At first the researchers feared that getting the necessary permits would turn out to be difficult and that they would be unable to follow the paramedics into people’s homes. Instead, the paramedics thought it self-evident that the researchers would follow them indoors. All patients gave permission for videotaping.
- The paramedics really welcomed us researchers and made our job easy, Petra Auvinen says.
The playing card method works with busy people
The researchers developed a new kind of research methodology in the project which they called the playing card method. They interviewed paramedics at the workplace, where an incoming call could interrupt the interview at any moment. The researchers realised that the traditional question-answer model would not work in this situation.
They ended up making cards which had themes from the paramedics’ work written on them, such as job safety, Acuta, work partner and so on. The paramedics picked cards out of the pack and discussed the themes. If a call interrupted the interview, the researchers were able to continue with the same theme at a later time.
- We were told that even training the paramedics is challenging because they can only sit still for fifteen minutes maximum at a time, Auvinen laughs.
- This kind of a data collection method worked with them and we got positive feedback from the interviewees.
Scarcity of paramedics
In many fields, a private employer is the most attractive option for a worker. However, for paramedics this is different. All the paramedics interviewed by Hannele Palukka’s research group thought that the public sector is the better employer.
The paramedics thought that the working hours and conditions were better than with a private employer and all thought that the public sector takes better care of its employees. With the new Health Care Act, every municipality will in future need a 24-hour emergency call service to allow all Finnish citizens to be reached by an ambulance in equal time.
Palukka does not believe the smallest private companies will find it economically feasible to produce emergency call services round the clock. In sparsely populated areas, paramedics have worked during office hours from eight to four. In the evenings and nights they have been on-call so that they have come to work when needed.
A small hourly wage has been paid for the on-call hours, but round-the-clock service will naturally be more expensive.
- The role of providing emergency call services will fall more heavily on the public sector. Paramedics could even become scarce, Palukka predicts.
In towns and cities the main job of private patient transport services will be the transfer of patients e.g. from one treatment facility to another.
- It will be interesting to see whether emergency call services will in future be regarded as an area that will be tendered out more often than now. Or will it be thought that the state should guarantee that the service is equally available? Tiina Tiilikka asks.
As a rule of thumb, the private ambulance services have so far worked in the countryside, whilst in towns and cities this job has been taken care of by the local emergency services. In the private sector service, two large companies lead the market.
Text Tiina Lankinen
Picture Teemu Launis
Translation Laura Tohka
This story was originally published in Finnish in Aikalainen 12/2012
