Emergency Care Assistant - The Future of The ECA Role

The Future of The ECA Role

ECAs are now slowly becoming more accepted into the ambulance service, and appear to be a fundamental part of the future of NHS ambulance services. The ECA's Scope of Practice in the East Midlands Ambulance Service NHS Trust states that "As the responsible clinician it is an individual decision as to which patients are suitable to be transferred with an ECA attendant and it is accepted that this will occur more frequently with experienced paramedics especially when they are confident in the ability of the ECA they are working with." Many trusts however operate a policy preventing any clinical responsibility being delegated to the ECA as they have often have no formal medical qualification.

At the other extreme, because of current a lack of paramedic numbers, some ambulance Trusts are using ECAs increasingly as solo responders when under operational pressure. Justification for this is taken from the use of first responders, who have minimal training and are not usually ambulance trust employees. The rationale being that if a first responder can be sent to a 999 call with two days training, then an ECA, with 6 weeks training should be sent. Whilst this is possibly defensible in extremis, regular use of solo ECAs in a clinical role leads to a decline in clinical quality, plus unacceptable levels of stress in ECAs themselves.

West Midlands Ambulance Service NHS Trust, one of the initial pioneers of the ECA role, announced in late 2009 that it would no longer be employing direct entry staff as emergency care assistants. A new role of 'student paramedic' has since been created which allows staff to become a state registered paramedic within two years, undertaking a training course at a partner university while being employed full-time by the ambulance service. This role, however, looks to have now been discontinued also.

Progression for ECAs is becoming less easily available possibly due to increasing numbers of graduate paramedics, which a Trust can employ with free from training cost implication.