I JOINED the Ambulance Service in the 1960s when treatment given by officers to patients was very mechanical and skills-based. In the 1980s paramedics were given increased responsibility, both to resuscitate patients and to administer pre-hospital clinical procedures. Immediately, patient care was improved and a further demand created for more advanced clinical training.

Today, qualified paramedics have a growing role in community medicine. The emphasis now is about taking care to the patient rather than the patient to hospital. I expect that, within 10-15 years, there will be very little difference between the training and skills of a graduate nurse and those of a graduate ambulance paramedic.

There are almost 7,000 paramedics in Britain who are able to offer their professional skills-based qualifications for credit towards a degree. For many of them, distance learning is the only practical route. This month 33 paramedics from Northumbria Ambulance Service graduated with degrees of Bachelor of Health Science (Pre-Hospital Care) awarded by the Australian institution, Charles Sturt University. Charles Sturt is the first university to provide an internationally recognised degree in this discipline.

In 1994-5 I was disappointed that none of our regional universities wanted to provide courses for working ambulance people. But I knew that Charles Sturt was running a course for the ambulance service in New South Wales. After some discussions with the Australian university the Northumbria Ambulance Service now has a course relevant to pre-hospital care, clinically focused to meet the requirements of a health science degree course, as well as the operational needs of modern ambulance services. The course also recognises the education and training needs of a large group of health professionals - ambulance officers - who hitherto have been ignored by the university sector.

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It is now open to British universities to complement the contribution which the Australia-based university is already making with its worldwide network. To date Charles Sturt University has enrolled 800 paramedics in Australasia, North America and the UK. Our paramedics in Northumbria are offered a partnership: we pay for their courses but they must study in their own time. Despite the distance a close relationship has developed between the students and the academic staff at Charles Sturt. Most of the academic staff have now taught support schools in Northumbria. The university uses videotapes so that students can visualise the campus and the staff with whom they will be studying. They have remote access via the Internet to library facilities.

British universities have the opportunity to cater on campus for would-be entrants to the profession, but they must be conscious of the distinction between nurse graduates, who work under clinical supervision, and ambulance paramedic graduates and technicians who work in hostile and stressful environments, largely unsupervised. Paramedics need maturity and common sense - basic life skills which a training programme can supplement.

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The UK has gone further than most in empowering paramedics to administer advanced clinical protocols, eliminating the need for doctors to accompany ambulance crews. British universities, too, now have a part to play and the exchange of knowledge need not only be one way. The CSU programme offers a long-overdue opportunity to tap into a body of knowledge from ambulance officers who operate at the point of acute service delivery. Here, they are controlled by strict protocols which may sometimes prevent them from treating patients in the light of their own experience-based judgement. This experience now needs to be converted, through the discipline of a degree course, from anecdote to evi-dence and published to stimulate debate.

Students must also be given opportunities to proceed to masters degrees or doctorates. These courses will be more readily deliverable on the Internet. Charles Sturt University has announced that it will provide masters degrees on the Internet during 1998.

As a member of the Association of Commonwealth Universities, Charles Sturt displays a rigour in assessing degrees of which Sir Ron Dearing would surely approve. Graduates from its courses are recognised throughout Australia and the world. However, the assessments of relevance and relative excellence in distance-learning courses and those delivered on campus may need to be expressed in the UK with a form of "kite-marking" or endorsement.

Laurie Caple is the Chief Executive of Northumbria Ambulance Service NHS Trust. He was awarded an Honorary Doctorate by Charles Sturt University for his work for ambulance services. The presentation was at the first graduation ceremony in Britain of 33 paramedics, held on 21 October, at Alnwick Castle, Northumberland.

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