Your First Ambulance Placement: What Nobody Really Tells You

Written by Alice Cheeseman | HCPC-registered paramedic

You've polished your boots, ironed your uniform, packed enough pens to supply an entire ambulance station and spent an unreasonable amount of time wondering what you're supposed to put in your pockets. You’ve probably also checked the route to your placement station several times, despite knowing perfectly well where it is. What you've forgotten is that the key thing is snacks!! And lots of them.

Your first ambulance placement is exciting, you're ready for the fast driving, medical emergencies and chaos, but there's also the slightly uncomfortable realisation that you're about to go from practising assessments on your classmates to speaking to actual patients. Especially when they haven't been given a script and may not be particularly interested in helping you remember your history-taking framework - cue Doris who is more excited to tell you all about her grandson who is visiting next week.

There's plenty of advice about preparing for placement, but some things are difficult to appreciate until you've experienced them. So, from people who've been on both sides of the student–practice educator relationship, here's what we'd want you to know.

You don't need to know everything (but you do need to get involved)

Let's deal with the biggest worry first. Nobody should expect a first-year student paramedic to turn up on day one and independently manage a critically unwell patient. You're there to learn, and your responsibilities should reflect your stage of training and level of competence - so DON'T PANIC! Your crew/mentor will probably ask what you've covered at university, which skills you're comfortable with and what you'd like to work on... they may also tease/challenge you a bit to test the boundaries (we're sometimes a little mean). It's absolutely fine if the answer is that you've practised manual blood pressures a handful of times and would quite like to get one without the patient asking whether you've finished yet.

What matters to the crew is that you're willing to have a go, ask questions and take feedback. There will be things you don't know (lots of them), and occasionally your brain will decide to forget something you've successfully explained to a lecturer the week before. It's much better to admit you're unsure than to invent an answer and hope nobody notices - as I promise they will. You’ll also discover that there's a difference between being enthusiastic and trying to do everything at once. If you're asked to take a set of observations, concentrate on doing that properly rather than simultaneously attempting to take a history, interpret the ECG and locate equipment you've never seen before.

Your first ambulance placement probably won't be particularly exciting

You've spent months learning about cardiac arrests, major trauma and medical emergencies, so naturally you're imagining your first job will involve something suitably dramatic... that's what all the TV programmes show isn't it?!

It might. Equally, you could spend 45 minutes helping someone who's fallen between their toilet and the shower (the bermuda triangle of emergency medicine), followed by a lengthy conversation about their medication, social care arrangements and whether they've got enough food in the house. And there's a good chance you'll learn more from that job than you expected.

Prehospital care involves far more than recognising life-threatening conditions and performing clinical interventions. Understanding a patient's normal level of function, identifying safeguarding concerns, assessing falls risk and making appropriate decisions about ongoing care are all important parts of the role. Your first placement is an opportunity to appreciate the sheer variety of patients paramedics encounter. The jobs that initially seem straightforward can become particularly interesting when you start considering the clinical reasoning behind them. Besides, even the apparently simple jobs have a habit of becoming complicated when someone casually mentions they've also had chest pain for the last three days. Lastly, there will always be one person that comes back to university having been to ALL the 'exciting' jobs... don't worry, your time will come and sometimes it's better that you dont get exposed to the big jobs straight away.

The equipment will suddenly become impossible to find

You can learn the contents of an ambulance inside out during university teaching, but the moment someone asks you to retrieve something on a real job, there's a reasonable chance you'll forget which cupboard it's in. You'll open three different compartments, find something completely unrelated and eventually discover that the item you needed was right in front of you.

Don't worry, we've all been there.

Every ambulance service has its own equipment arrangements, and even vehicles within the same service can be organised slightly differently. Spend some time at the start of your shift familiarising yourself with the vehicle, particularly the emergency equipment, monitoring devices and anything your crew expects you to help prepare. If you don't know where something is, say so. In an emergency, it's far more useful for your crew to know that you need direction than to have you silently searching every cupboard in the back of the ambulance. And when someone asks you to grab a particular piece of kit, there's absolutely no shame in asking them to point you in the right direction. Ideally before you've unpacked half the vehicle... we find that a lot more frustrating!!

There's a lot more talking than you might expect

It's easy to underestimate how much of the job involves communication. You'll speak to patients, relatives, care home staff, other healthcare professionals and occasionally someone who wasn't expecting an ambulance to arrive and would quite like to know why you're standing in their hallway.

You'll also meet patients who are frightened, embarrassed, frustrated, confused or simply having a dreadful day. Please remember that this is their emergency... even if it seems small to you.

Initially, taking a history can feel rather unnatural. You're trying to remember all the relevant questions while also listening to the answers, documenting information and maintaining something resembling a normal conversation. You may find yourself asking whether a patient has any medical conditions, receiving a detailed account of their neighbour's recent hip replacement and then realising you've completely forgotten what you were going to ask next. Experienced clinicians don't necessarily follow a rigid script - so you might find it hard to follow your mentors structure. They adapt their questions to the patient, explore relevant information and gradually build a picture of what's happening. Watching how your crew does this can be incredibly useful, particularly when a patient is giving a complicated or seemingly unrelated history. Communication is a clinical skill in its own right, and you'll get better at it with practice.

Also - bring a notebook!! It makes life far easier if you write down some key statements the patient has made.

You will probably feel useless at some point

There's likely to be a job where you're not quite sure where to stand, what to do with your hands or whether you should be helping with something. You might find yourself holding a bag, moving furniture or standing in a corner while your crew deals with a situation you've never encountered before BUT that doesn't mean you're not learning. In the early stages of placement, observation is valuable. Watching how experienced clinicians approach a patient, allocate tasks, communicate and manage a scene can teach you things that are difficult to replicate in a classroom.

Of course, standing back shouldn't become your entire placement experience. As your confidence and competence develop, you should have opportunities to take a more active role under appropriate supervision. If you're unsure what you could be doing, ask your practice educator. Sometimes there genuinely isn't a suitable task for you at that moment - and that is okay. Other times, they'll be perfectly happy for you to take the next set of observations, gather a history or deliver part of the handover. It’s also worth remembering that being useful doesn't always mean doing something technically impressive. Helping an older patient find their glasses, making sure someone understands what's happening or noticing that a relative is struggling can make a real difference. If you are compassionate and caring your mentor will notice this - it is a great attribute to have.

The station has its own set of unwritten rules

Every ambulance station is different, but you'll quickly discover that there's more to settling in than learning where the equipment lives. For example, you'll need to establish which mug belongs to whom (do not use the wrong one), whether the milk in the fridge is communal and how the microwave works. For me, the microwave is key... my station has an industrial (nuclear) one - my spagbol was black and crispy after only 2 minutes...!! You'll probably also encounter a chair that everyone avoids sitting in, although nobody seems particularly willing to explain why.

More seriously, take the time to get to know the people you're working with. Introduce yourself, be respectful of everyone's role and remember that good ambulance crews depend on far more than clinical qualifications. Paramedics, technicians, emergency care assistants and other colleagues bring different skills and experiences to the team, and there's plenty to learn from all of them. Don't make the mistake that a lot of student do by ignoring roles other than paramedics. I learnt some of my best lessons from ECA's that had been in the job since before I was born. No one can plan a good extrication quite like them.

You'll also discover that ambulance humour can be quite different from what you're used to. Humour is often part of how crews get through demanding shifts, but professionalism and respect for patients should never disappear, regardless of how relaxed the atmosphere might seem. And if you offer to make a round of tea, be prepared to remember approximately nine different orders.

Ask questions, but pick your moments

One of the best things you can do on placement is ask why your crew made particular decisions. Understanding their clinical reasoning will help you develop your own approach to patient assessment and management. That said, there's a time and place. While your practice educator will generally welcome questions, the middle of a time-critical emergency probably isn't the best opportunity for a detailed discussion about the pharmacodynamics of a particular medication... you may well get your head bitten off.

Make a mental note and ask afterwards (here is where the notebook comes in handy!!), when the patient has been handed over and everyone has a little more time. You might also discover that qualified clinicians occasionally disagree about the best approach to a situation. This can be a useful learning opportunity, provided the discussion is respectful and grounded in current evidence, guidelines and the patient's needs. Clinical practice isn't always as straightforward as the textbook suggests, and understanding how clinicians navigate uncertainty is an important part of your education.

Some shifts will be brilliant. Others won't.

There will be shifts where you come home feeling like you've learnt more in twelve hours than you have in weeks of university teaching. You'll meet interesting patients, experience new clinical presentations and perhaps perform a skill successfully for the first time. There will also be shifts where you're tired, hungry, overwhelmed or slightly disappointed that you've spent most of the day sitting in a hospital corridor. You might have a difficult interaction with a patient, struggle to answer a question or receive feedback that knocks your confidence. Sometimes you'll encounter situations that stay with you long after your shift has finished.

Placement isn't just about developing clinical knowledge. It's also about learning how to work within a demanding healthcare environment, recognise when you need support and look after your own wellbeing. If something has upset you, speak to your practice educator, university or another appropriate source of support. You don't have to pretend that everything is fine simply because the people around you appear accustomed to it. Make sure to reach out, we all talk to each other when we have been to bad jobs or even when we just generally feel a bit low. 12hrs in a cab is basically a free therapy session... don't be frightened to ask your mentors to just talk things through.

And please, take your breaks when you can. There's a reason ambulance crews tend to have quite strong opinions about food.

Make the most of being a student

One of the things you may not fully appreciate until later in your career is how valuable it is to have someone whose role includes supporting your learning. You have opportunities to ask questions, observe different approaches, practise skills under supervision and reflect on your decisions without being expected to carry the same responsibilities as a qualified paramedic. Keep track of the presentations you've encountered, identify areas you'd like to develop and ask for opportunities to practise when appropriate. If you struggle with a particular topic, go back to the underlying anatomy, physiology or clinical principles rather than simply trying to memorise the answer.

Most importantly, try not to compare your progress with everyone else on your course. Placement experiences vary enormously, and the student who attends three cardiac arrests in their first week isn't necessarily developing better clinical skills than someone who's spent their shifts managing falls, infections and social care concerns. Every patient presents an opportunity to learn something, even if that something is how difficult it can be to obtain an accurate blood pressure in the back of a moving ambulance. Your first placement doesn't need to be perfect. You'll make mistakes, ask questions that seem obvious afterwards and occasionally spend far too long trying to work out how to put a stretcher back together.

That's why you're there.

And before you know it, you'll be the person showing the next student where the blood pressure cuffs are kept. Although you'll probably still be looking for the thermometer.

A little extra support before placement?

At The Confident Paramedic, our HCPC-registered paramedic tutors support students at every stage of their training, from preparing for their first ambulance placement to developing more advanced clinical assessment and decision-making skills.

Whether you'd like to refresh your anatomy and physiology, build confidence with patient assessments or work through clinical scenarios before heading out on the road, our 1:1 tutoring sessions can be tailored to your learning needs.

We don't require a subscription, and you can book a free 15-minute introduction to discuss what you'd like to work on. Find out more at The Confident Paramedic.