The Consequences of a Single Story in Paramedic Education

Bobby Garvie, Lecturer in Paramedic Science, University of Stirling

Jennifer McGlashan, Lecturer in Paramedic Science, University of Stirling

Gary Rutherford, Senior Lecturer in Paramedic Science, University of Stirling

October 2024

Students undertaking BSc paramedic science programmes at higher education institutions across the United Kingdom are usually taught how to recognise and manage opiate overdoses.  However, there is a danger that the reliance on a single narrative in practical scenarios could negatively affect students’ professional development and psychological safety in the classroom.  This narrative usually describes a young male, living in a deprived area, using injectable substances.  In this blog post we describe why we need to change and challenge this single narrative of who is at risk of an overdose.

Using scenarios in paramedic teaching

Students’ skills and patient assessments are regularly practiced through simulated scenarios in the classroom.  Where props and scenery are limited, they typically rely on a verbal description of the patient and environment.  It is common for simulated scenarios about overdose to involve the description of a young male found in an unkempt or unpleasant environment, often in public, with obvious signs of injectable drug use such as syringes and needles nearby.  Whilst it is difficult to estimate injectable drug use across the UK, a study by Trayner et al (2020) demonstrated a decreasing trend in public injecting.  The single story of a stereotyped injecting drug user could make it difficult for paramedic science students to consider opiate overdose in other parts of the population and via other methods of administration (Adichie 2009).

Simulated scenarios may continue to add to the stigmatisation and limit understanding of problematic drug use by presenting a single stereotype to impressionable students who may carry this into their professional practice.  While drug death rates are often linked to deprivation, there is a danger with a single story that students may fail to recognise or understand problematic drug use in other societal groups and may make assumptions about people who use drugs or miss life-endangering health behaviours in people based on a lack of stereotypical characteristics.

Does data support these stereotypes?

Literature also supports the rationale for a wider understanding of problematic drug use in the UK.  In England and Wales in 2022, the highest rate of drug related deaths was in the 40 to 49 year age group (average 44.5 for males and 46.5 for females) (Office for National Statistics 2023), and in Scotland it was people aged 35 to 53 who were most likely to die from drug use (average age 45).  Only 19% of drug related deaths in Scotland in 2022 were under the age of 35, and there was a 26% reduction in deaths among males, compared to only 10% reduction among females (National Records of Scotland 2023).  These statistics clearly refute the idea that it is only young males who experience overdose.

This single story could also be harmful to individual students.  Student paramedic cohorts are typically socioeconomically diverse groups of people with even more diversity in their personal backgrounds.  It is estimated that over 57,000 people between the ages of 15 and 64 years old in Scotland have a problem with drug use (Scottish Government 2022).  Therefore, some students on paramedic science programmes may have lived experience of, or exposure to, harmful drug behaviours.  Continuing to stereotype simulated patients may be unintentionally harmful to students by not representing their individual stories (Adichie 2009).

Changing the narrative and challenging stereotypes

It is as equally important to alter the stereotypical narrative for the students who cannot relate in any way to the consequences of harmful drug behaviours.  Bolster et al. (2023) demonstrated that effective undergraduate education influences the levels of empathy new paramedics have for people who use drugs and can destigmatise drug use in paramedic practice.  Educators should reflect on this area of paramedic education, making efforts to help students realise that stereotypes are only part of the story of problematic drug use, and not the only story.

Paramedic educators, as well as educators across nursing, medicine and social care, should also consider how they address accidental drug harm in the classroom, for example in the ageing population, where increasing levels of comorbidity and polypharmacy increase the risk of adverse events such as accidental overdose (Partridge et al. 2018; Salkar et al. 2021; Smaje et al. 2018).  As a starting point, educators responsible for simulation scenario creation could consider aligning patient demographics with the data presented above, for example middle-aged men and women.  Scenarios should also reflect broad perspectives of society including cases of people with long-term conditions who may use prescribed medications in harmful ways, accidentally and intentionally.  The narrative can be challenged even further in scenarios by utilising virtual reality technology, where images of more affluent household interiors could be projected on to walls, moving away from the stereotypical deprived settings.

The challenge should also extend beyond simulation.  Educators should consider embedding drug harm reduction content within curriculums. For example, at the University of Stirling we liaise with ambulance service drug harm teams when developing content and lectures, and we arrange practice placements for students within community addiction services.  Lastly, higher education institutions could also consider employing the expertise of individuals with lived experience of drug harm behaviours when developing curriculums and content.

All narratives have their place, but it is important as educators to avoid defaulting to a single stereotype.

References

Adichie, C.N. (2009) The danger of a single story. TED [Online video] YouTube, 7 October. Available: https://www.youtube.com/watch?v=D9Ihs241zeg [Accessed: 29 October 2023].

Bolster, J., Armour, R., O’Toole, M., Lysko, M. and Batt, A.M. (2023) The paramedic role in caring for people who use illicit and controlled drugs: A scoping review. Australasian College of Paramedicine, 20 (4), pp. 117-127. Available: https://www.doi.org/10.1177/27536386231171813 [Accessed: 29 October 2023].

National Records of Scotland (2023) Drug-related deaths in Scotland in 2022. Edinburgh: National Records of Scotland. Available: https://www.nrscotland.gov.uk/files/statistics/drug-related-deaths/22/drug-related-deaths-22-report.pdf [Accessed: 24 June 2024].

Office for National Statistics (2023) Deaths related to drug poisoning in England and Wales: 2022 registrations. ONS Statistical bulletin. London: Office for National Statistics. Available: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2022registrations[Accessed: 24 June 2024].

Partridge, L., Deelen, J. and Slagboom, P.E. (2018) Facing up to the global challenges of ageing. Nature, 561, pp. 45-56. Available: https://doi.org/10.1038/s41586-018-0457-8 [Accessed: 24 June 2024].

Salkar, M., Ramachandran, S., Bentley, J.P., Eriator, I., McGwin, G., Twyner, C.C. and Yang, Y. (2021) Do Formulation and Dose of Long-Term Opioid Therapy Contribute to Risk of Adverse Events among Older Adults? Journal of General Internal Medicine, 37, pp. 367–374. Available: https://doi.org/10.1007/s11606-021-06792-8 [Accessed: 24 June 2024].

Scottish Government (2022) National Mission on Drug Deaths: Plan 2022-2026. Improving Scotland’s Health. Edinburgh: Scottish Government. Available: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2022/08/national-drugs-mission-plan-2022-2026/documents/national-mission-drug-deaths-plan-2022-2026/national-mission-drug-deaths-plan-2022-2026/govscot%3Adocument/national-mission-drug-deaths-plan-2022-2026.pdf[Accessed: 8 May 2024].

Smaje, A., Weston-Clark, M., Raj, R., Orlu, M., Davis, D. and Rawle, M. (2018) Factors associated with medication adherence in older patients: A systematic review. Aging Medicine, 1 (3), pp. 254-266.

Trayner, K.M.A., McAuley, A., Palmateer, N.E., Goldberg, D.J., Shepherd, S.J., Gunson, R.N., Tweed, E.J., Priyadarshi, S., Milosevic, C. and Hutchinson, S.J. (2020) Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs. International Journal of Drug Policy, 77, 102663. Available: https://doi.org/10.1016/j.drugpo.2020.102663 [Accessed: 24 June 2024].