Having an impact

Ziad Nehme is a paramedic who decided to stretch his career into research and making his profession more effective at saving lives

DR ZIAD Nehme knew very early on that he wanted to make an impact on society.

“When I was in Year 12 I wondered what I was going to do to make an impact,” he tells the MJA.

“My cousin’s husband was a GP and he suggested that I should think about becoming a paramedic, and that seemed like a great idea.”

He studied at Monash University’s Peninsular campus, completing a Bachelor’s and Honours degree in Emergency Health (Paramedic) and now has over 7 years as an advanced life support paramedic with the Ambulance Service Victoria and 5 years as a clinical educator.

“I was driven at the outset by adrenaline,” Dr Nehme says. “But, of course, when you’ve been in the job a few years you realise that it’s not all about lights and sirens.

“As I matured through my professional education I started to really want to make an impact in terms of research. I realised particularly in the last year of my studies there was a really big gap in my knowledge.

“The community often consider [paramedics] to be life savers. But how many lives we actually save? That’s something that’s always interested me. Do we actually save lives? Because when I thought about the number of people who survive a cardiac arrest, they are very, very few. And naturally that led me to want to try and quantify what the effect of some our interventions are, particularly around the cardiac arrest setting.”

Dr Nehme’s honours research assessed competency in ventilating patients in cardiac arrest and followed that with postgraduate work on clinical epidemiology which led him on to his PhD.

“That work was about how do we optimise a system to respond to a cardiac arrest patient to improve outcomes. And it’s not just about calling 000 or the effectiveness of 000 and the hospital system.

“It’s about how do we teach patients the warning signs of a heart attack so they’re more educated and more likely to call and more likely to circumvent their cardiac arrest.”

Some of the results of that research are published in this issue of the MJA.

“We never knew that providing an educational intervention could potentially circumvent one of the significant health complications in Western countries,” Dr Nehme says.

Research continues to drive Dr Nehme, who is now the research coordinator for Ambulance Service Victoria.

“I could do an entire week on the road and not have that adrenalin feeling, but sometimes when you work on a piece of research and you deliver a finding that changes practice, you have that adrenalin feeling for a lifetime.”

Is he ever tempted to move into medicine from paramedicine?

“I’ve thought about it a lot,” he says.

“We have an extraordinary opportunity in pre-hospital care. This is only the start. We’ve started putting CT scanners on ambulances to screen stroke patients in the field. Can you image where that’s evolving?

“Thrombolysis has a long, long way to go. We’re only starting to touch on the real modern evolution of pre-hospital care.

“It’s among the most exciting areas of medicine to be working in – that time before a patient reaches the front doors of a hospital. And if I’m right, in 10 years my job will look drastically different to what it was when I started.”

Putting doctors on every ambulance isn’t the way to go, Dr Nehme believes.

“It’s not good for us if we want to establish our own identity. Putting doctors on ambulances is a ludicrous idea because their skills and knowledge will be largely underused. We need specialist clinicians who work in the [pre-hospital] field.”

Dr Nehme has no hesitation is saying he would recommend the life of a paramedic to students.

“Always. At some universities paramedicine is often ranked among the top three most sought-after degrees. What I would say though, is that you need to have a bit of a level head when you enter the degree and really understand what it is you’re going to be doing. If you enter thinking it’s all going to be lights and sirens and trauma, you’ll be horribly mistaken. Most of our work is not trauma, it’s medical patients – chest pain, shortness of breath, etc.

“Mental health is becoming really exciting and fast-growing areas that are accessing pre-hospital care. That’s really challenging for young paramedics to deal with.”

And it’s not necessarily trauma that causes the most emotional stress for paramedics, either.

“It’s often a story that has a connection with you personally. When you see similarities between the patient’s life and your own. When you see people in their own environment, you can be even more influenced,” Dr Nehme says.

“When it reminds you of your mother, or your grandmother, or daughter – that’s when it’s challenging.”

It used to be that ambulance officers would get through 10 or 15 jobs in a 10-hour shift, but now delays, ramping, lack of hospital beds have all worked to change the way paramedics work.

“Now, often paramedics can tell you they spend most of their time in the corridors of a hospital. We can now do 5 jobs in a 10-hour shift and that’s a busy day.

“It’s a challenging issue. When you’re paying very skilled people to sit in corridors supervising relatively non-critical patients, you’ve got to wonder which three suburbs are doing without an ambulance as a result.”

A podcast of the interview with Dr Ziad Nehme is available at www.mja.com.au/multimedia/podcasts.