Patriarchy is thriving in paramedicine

Women are slowly catching up to the men in the field of paramedicine, but is it catching up to them? Grace Cushnie talks to Izzy* about how patriarchy still affects the healthcare profession, and how being a woman influences her in the job role. 

She is amidst the wail of sirens. Every second is amplified. The world outside blurs into a frenetic painting of lights and shadows. She is making split-second decisions that determine life or death. Her sleeves are too long. They slip over her fingers. They test her patience with each jitter of the wheel. She is weighed down by a jacket too big for her.

It was made for a man, you see.

While she faces the relentless pressure of emergencies, 23-year-old paramedic Izzy* needs to navigate the road, situation, discrimination, and insidious whispers of doubt.

Paramedicine is a profession traditionally dominated by men. According to the College of Paramedics, women are slowly catching up, and now represent 42.5% of ambulance staff in England. While it is the only NHS profession with more male than female registrants, the gender imbalance should be addressed by the rising number of women enrolling of in pre-registration degree programs throughout the UK.

While this is positive news, Izzy warns that it is not quite time to stop burning our bras.

‘Paramedicine was built for the boys, of course,’ she says.

‘You can see it everywhere. I work in one of the older buildings, where the male changing rooms and toilets are based right beside the lockers. The women’s are significantly further, through other parts of the building. I have visited others which are outside, unattached to the actual station. It is like they are added as an afterthought. You can really see the changes in the newer stations, where it is not as obvious the profession was built for men.

‘Then there is the apparently unisex uniform. I have the smallest size available, yet the shirt sits just above my knees. The cuffs of my jacket are loose on my wrists, I cannot pull them up, they just drape over my hands. Even the basics, like gloves, which I wear an xs in. I scour the shelves each time I get into work…large, large, xl, large…they never have them! The times they do, I hide the whole box so that I can make sure I have the basic essentials for what I need to do my job. Something the men have readily available at all times.’

It is not just the job’s history that Izzy has to work against though, as there are the patriarchal forces at play in the mindsets of her patients.

She says: ‘I have experienced a fair amount of misogyny and discrimination while at work. I cannot lie, I don’t know how much of it is to do with my gender and how much it is to do with my age. Some of it is quite slight, like family members looking to my male coworker when they speak instead of me, even though I am the one who asked them the question. Or, there has been a few times where a patient has not believed I am a paramedic, and just assumed my male colleague, who is an ambulance support worker, was the paramedic on shift.

‘There is one instance I can think of that happened recently, I had just finished assessing a patient and was speaking to the family about what I thought was an appropriate course to go down. It was me and a crew mate who was quite new to the job, he had been there less than a month. He was an ambulance support worker, right at the beginning of his career within the service. At that point you have a limited range of skills you can use, you are there to support the clinicians, in this scenario, me. I had explained to the family what I thought was appropriate and they were not happy. They were demanding my male crew should assess the patient and see what he thought. I do not know how much of that came down to my gender or my age, but the way they spoke to my male crew mate was so vastly different. I felt like no matter what I said, they were not listening to me. They would not look at me. They had made a few comments, just about the fact that I was, you know, a young girl and like, what did I know? He tried to explain that I had studied paramedicine for years, and that he had only been here a month, stating he could not make the decision that needed to be made. I ended up having to phone a senior clinician for some help, I was getting nowhere. He agreed with me. I think it is really important to not let your pride get the better of you in that situation. As much as I was feeling very disrespected and quite belittled, ultimately I had to remember that these people were scared because their family member was unwell. As much as I would have liked to put my foot down and reiterate that it was my decision. Their opinion of me was never going to change, so my focus was just on deescalating.

‘Patients have made sexual remarks towards me, and been sexually inappropriate with me, which was obviously quite upsetting at the time. I have come to help them, and they are acting inappropriate and sexualising me. It is very, very frustrating. You must still give a good service of care to that patient. As much as you want to turn around and say all the things going through your head, you have to remain professional.’

It is not even just the actions of her patients that upsets her, even silly jokes can be incredibly demeaning.

‘There are definitely some stereotypes and misconceptions of women paramedics’, she says. ‘I will always remember this one patient that, when I walked in with my male crew mate, said “oh, I was going to ask which one of you was the paramedic and who was the driver.” He then looked at me and said, “I’m having a hard time thinking that you would be the paramedic, but I also cannot see you as an ambulance driver.” At this point my crew member stated we were both paramedics, shutting the conversation down. I am sure it was just a joke, I did not think much of it, but there are definitely stereotypes that show themselves in odd ways.

‘There is also the stereotype that women are emotional messes. I am often asked how I can be in this job and see such horrible things, does it not make me too emotional? Especially anything to do with children. The amount of people who have thought I would struggle to attend a really poorly child because I am a woman. It is quite an interesting viewpoint, it sort of implies that men would not find that sad, when in reality the majority of jobs I have attended with poorly children, I have afterwards had to check on my male crew mate because they have children and I do not. It is not a case of gender, it is a case of how it applies to your life. Yet, these ideas of women tend to skew people’s conception.’

This fight for authority over her job role is something Izzy frequently has to combat.

She says: ‘I often get called a nurse while my coworkers are referred to as paramedics. That is not to put any kind of slide on nurses, who are incredibly talented and important, but I am not a nurse. My job title is on my coat. I have trained for years to be in this position, it would be nice to be referred to as my job title.’

Her fight against patriarchal ideas is not just with her patients, they follow her into the doors of the station.

‘There is a popular viewpoint of paramedicine having a boys club culture,’ she says. ‘Unfortunately, I have been warned about many male paramedics. Sometimes it has just been a oh, he might be a bit flirty with you or he might ask for your number, just don't give it to him, he does it to everyone. For others it has been a little bit more severe, an oh, be careful with that paramedic, he has done it twice. It is a shame to say that I have been warned about male paramedic, and that I have also had to do some warning.’

It is apparent that several women healthcare workers struggle under the patriarchal structure of their roles. This is something happening not just within paramedicine, but what follows patients from the ambulance to the walls within a hospital.

The BMA produced a survey in 2021 which found that 91% of women doctors reported experiencing sexism in the last two years, and 47% felt as if they had been discriminated against because of their sex. Statistics so shocking that it resulted in an incredible charity, Surviving in Scrubs, who arose to fight against it.

There may just be a light at the end of the tunnel, though.

With more women signing up to study paramedicine, things can only improve. There are more possibilities for women to fill leadership roles in the profession, which are predominantly held by men (NHS Digital, 2018).

Izzy urges women to sign up and study paramedicine.

She says: ‘go for it! I may have shared some negative anecdotes, but that is not every day. Obviously, you will have bad days at work, you would in any job. Yet, you get some really, really rewarding days. You will come home and think, wow, I have changed someone’s life today. I have saved someone’s life today.’

Izzy's* name has been changed for confidentiality, protecting her job role.