First reported 9 Apr 2014•Latest report 16 Sep 2025
Definition
What this concern includes
Includes failures of paramedic foundation training, initial training, refresher training, continuing professional development, clinical-skills education or competence preparation where they impair safe emergency assessment, recognition, decision-making or treatment by paramedics, including the anchor's failure to cover atypical myocardial infarction signs and distinct gaps concerning other emergency presentations.
Not included
Excludes training deficiencies concerning non-paramedic workforces unless the report explicitly identifies paramedic training as the deficient system.
Excludes generic ambulance staffing, equipment, governance or communication failures that are not directly part of paramedic training or competence preparation.
Excludes deficiencies confined to one clinical condition's pathway where paramedic training is not the shared unsafe condition.
Excludes failures by paramedics to apply adequate training in practice when the training system itself is not deficient.
Excludes specialist clinical treatment or referral failures occurring after paramedics have received and can apply the relevant training.
Reports
9
Distinct published reports
Individual concerns
9
A report can raise multiple concerns
Date range
2014–2025
First to latest report issue date
Stated actions
21
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Association of Ambulance Chief Executives4
East Midlands Ambulance Service NHS Trust3
Department of Health and Social Care2
Health and Care Professions Council2
East of England Ambulance Service NHS Trust1
Epsom Hospital1
Essex Partnership University NHS Foundation Trust1
General Chiropractic Council1
Health Services Safety Investigations Body1
Kettering General Hospital1
Mid and South Essex NHS Foundation Trust1
NHS Birmingham and Solihull Integrated Care Board1
NHS Black Country Integrated Care Board1
NHS Coventry and Warwickshire Integrated Care Board1
NHS Derby and Derbyshire Integrated Care Board1
NHS trust8
Health-sector membership body4
Health and care professional regulator3
Integrated care board3
Executive non-departmental public body2
Healthcare site2
Ministerial department2
Coronial office1
Type not available1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Birmingham and Solihull
Concerns raised1
Lack of mandatory and comprehensive paramedic training in obstetric emergencies
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Provide regulated obstetric-emergency and breech-birth training through the AAP and Graduate Paramedic Induction programmes.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 September 2025.
Action
Deliver practical breech-birth simulation sessions using Victoria mannequins and other maternity training equipment, updated following the new guidance.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 September 2025.
Action
Purchase and deploy five Victoria birthing mannequins for realistic obstetric-emergency simulation training.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 September 2025.
Action
Include obstetric emergencies, including breech birth, in mandatory face-to-face refresher training for all ambulance clinicians during 2026–2027.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 19 September 2025.
Action
Provide continuing professional development through maternity roadshows, themed maternity learning and expert-led obstetric-emergency simulation.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 September 2025.
Action
Relaunch the e-PROMPT obstetric-emergency course and make it available for clinicians to complete.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 19 September 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.6
Position
The e-PROMPT course was unavailable because guidance updates paused it, not because resourcing prevented clinicians from completing it.
Stated by West Midlands Ambulance Service University NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Relevant obstetric content in broader refresher training and CPD, alongside accessible JRCALC guidance, is considered sufficient without a standalone mandatory module.
Stated by West Midlands Ambulance Service University NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Responsibility for paramedic training and education falls outside AACE’s remit.
Stated by Association of Ambulance Chief ExecutivesOutside remitThe respondent said that this matter was outside its role or authority.
Position
Training concerns were shared with ambulance education and clinical networks for consideration by their organisations.
Stated by Association of Ambulance Chief ExecutivesRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Qualified paramedic maternity training is the responsibility of individual ambulance trusts.
Stated by Association of Ambulance Chief ExecutivesRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
AACE has no control over allocating specific funding for maternity training.
Stated by Association of Ambulance Chief ExecutivesUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Surrey
Concerns raised1
Inadequate paramedic training for mental capacity assessments
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Consider changes to the paramedic Standards of Proficiency during the next scheduled review in 2027–2028.
Stated by Health and Care Professions CouncilStated plannedThe respondent said that this action was planned when they made their response on 13 August 2025.
Action
Review the Standards of Education and Training governing preparation of learners for professional practice.
Stated by Health and Care Professions CouncilStated in progressThe respondent said that this action was in progress when they made their response on 13 August 2025.
Action
Launch a public consultation on proposed changes to the Standards of Education and Training.
Stated by Health and Care Professions CouncilStated plannedThe respondent said that this action was planned when they made their response on 13 August 2025.
Action
Launch an investigation into ambulance responses to mental health crisis calls via NHS 111 and 999, covering triage, training, capacity assessment, and conveyance decisions.
Stated by Health Services Safety Investigations BodyStated plannedThe respondent said that this action was planned when they made their response on 13 August 2025.
Action
Provide a half-day suicidality and mental health training session within the 2026/27 annual clinical update programme.
Stated by South East Coast Ambulance Service NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 13 August 2025.
Action
Deliver revised scenario-based mental health learning for new operational staff and clinicians, covering pathways, collaboration, law, capacity and complex presentations.
Stated by South East Coast Ambulance Service NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 13 August 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
Setting curricula and designing training courses are outside the respondent’s role.
Stated by Health and Care Professions CouncilOutside remitThe respondent said that this matter was outside its role or authority.
Position
Other bodies are responsible for setting paramedic curricula and designing training courses.
Stated by Health and Care Professions CouncilRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Clinical matters fall outside the commissioning organisation’s remit.
Stated by NHS Southwest London Integrated Care BoardOutside remitThe respondent said that this matter was outside its role or authority.
Position
Clinical matters are the responsibility of the relevant Trusts.
Stated by NHS Southwest London Integrated Care BoardRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The Surrey Safeguarding Board will lead the Safeguarding Adults Review, with the organisation participating.
Stated by NHS Southwest London Integrated Care BoardRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Gateshead and South Tyneside
Concerns raised1
Lack of paramedic training on transient stroke symptoms
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Feed back stroke-symptom learning to the attending paramedic.
Stated by North East Ambulance Service NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 23 January 2025.
Action
Issue a wider update to paramedics reminding them that stroke symptoms may dissipate over time.
Stated by North East Ambulance Service NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 23 January 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Paramedics are trained to recognise stroke and TIA symptoms, including symptoms that have resolved before assessment.
Stated by North East Ambulance Service NHS Foundation TrustDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
West Yorkshire (Western)
Concerns raised1
Lack of paramedic training in identifying herald bleeds
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Develop guidance on recognising infected surgical wounds near blood vessels and catastrophic bleeding, update the vascular emergencies guidance, and publish it through the clinical app.
Stated by Association of Ambulance Chief ExecutivesStated plannedThe respondent said that this action was planned when they made their response on 12 February 2024.
Essex
Concerns raised1
Failure to incorporate investigation learning into training and alerts
This report raised 10 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Include a case study in the Safety Matters Newsletter covering adrenaline, paediatric airway management and handover communication during critical asthma incidents.
Stated by East of England Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 12 December 2023.
Northamptonshire
Concerns raised1
Lack of paramedic training in the use of buccal midazolam
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Develop an action plan covering training for staff who access or administer buccal midazolam, including patient-held medication.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 20 January 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
No audit of buccal midazolam training was required because it was not in the medicines formulary at the time.
Stated by East Midlands Ambulance Service NHS TrustNo action considered necessaryThe respondent said that no further action was needed.
Birmingham and Solihull
Concerns raised1
Failure of paramedic foundation training to cover arm pain as an atypical sign of myocardial infarction
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Review the paramedic standards of proficiency for possible amendments addressing the concerns raised.
Stated by Health and Care Professions CouncilStated in progressThe respondent said that this action was in progress when they made their response on 19 February 2017.
Action
Liaise with the College of Paramedics about whether the paramedic standards of proficiency should be amended.
Stated by Health and Care Professions CouncilStated plannedThe respondent said that this action was planned when they made their response on 19 February 2017.
Nottinghamshire
Concerns raised1
Lack of training on placental abruption presentations and fetal risk despite reassuring maternal signs
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Nottinghamshire
Concerns raised1
Insufficient initial and refresher training for paramedic intubation
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Action
Develop a nationally recognised teaching standard for stepwise airway management, ventilation and paramedic intubation competency.
Stated by Association of Ambulance Chief ExecutivesStated plannedThe respondent said that this action was planned when they made their response on 9 April 2014.
Action
Implement annual reassessment of advanced airway skills using individual airway logs, performance frequency and problems encountered, including authority to continue intubation.
Stated by Association of Ambulance Chief ExecutivesStated plannedThe respondent said that this action was planned when they made their response on 9 April 2014.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Each ambulance service will decide whether intubation remains a core skill or is restricted to specialised and advanced paramedics.
Stated by Association of Ambulance Chief ExecutivesRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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Includes failures of paramedic foundation training, initial training, refresher training, continuing professional development, clinical-skills education or competence preparation where they impair safe emergency assessment, recognition, decision-making or treatment by paramedics, including the anchor's failure to cover atypical myocardial infarction signs and distinct gaps concerning other emergency presentations.
