‘Promising changes’ to see female paramedics thrive in highly challenging and dangerous assignments

While around two in three paramedics are women, in specialist Hazardous Area Response Teams that take on the most challenging and dangerous rescues, that number is far lower.

But improved conditions and cultural changes look set to change that, says West Midlands Ambulance Service HART operative Louise Lancaster.

Louise Lancater with IRU vehicle

I have been a member of a Hazardous Area Response Team (HART) for over seven years. In this time, I have seen promising changes in culture from the stereotypical organisation that fails to accommodate the real emotional and physical needs of women, to one that is now proactively supporting women to thrive.

“When I first started, there were only a handful of female members of staff and the culture at the time was to evenly distribute females between teams which meant I very rarely worked or trained with another female member of staff.

This obviously means as a women, you can feel isolated within the team and the tendency is to not raise any issues in what is a male dominated environment.


“Whilst pregnancy is an exciting and special time, it also causes real emotional and physical stresses. When I became pregnant, there had only been two other members of staff that had been pregnant on the unit prior, resulting in very little shared knowledge of pre and post pregnancy experiences.

Since the introduction of the gender profile group, women have been given a platform to discuss their experiences and we have been provided with a support network within NARU to change culture and make positive changes to enable a better working environment.

I returned to full time work following nine months maternity leave and prior to this, I had completed seven months “alternative duties” for the duration of my pregnancy.

These were mainly officed based activities in order to reduce physical exertions whilst I was pregnant. This resulted in me being away from any exposure to training or my normal duties within my role for nearly 16 months.

At the time, there was no “flexible working hours” or part time working within our unit. It was understood that if individuals wanted to return to HART, they would have to come back full time. This meant that new mothers had to return to full time shift working duties or find an alternative posting within our trust.

Fitness levels

“Prior to returning to work, I was very anxious about my level of fitness. This was because I had to complete a Physical Competency assessment (PCA) on my first day back at work, which really played on my mind.

As a new mother and not being in the work environment with the necessary equipment, I was unable to prepare, nor measure my fitness prior to that first day at work. I felt I had a decline in my personal fitness as the opportunity to attend a gym had dramatically reduced once I had my child plus my body had changed and was still going through recovery.

To counter this, NARU has recently introduced Personal Training Instructors (PTIs) to support staff’s fitness within the unit. Additionally, they have also funded a “pre and post maternity” module for a number of PTI’s to support staff returning to HART following pregnancy.

This qualification will allow individuals to be professionally supported on their fitness journey following pregnancy but will also form part of a more structured approach to returning to work which should reduce anxieties for individuals.

Bespoke Equipment

“There are also simple practical steps that can be taken to improve the lives of female HART operatives returning to work after having a baby. I had a very traumatic birth which resulted in me having an emergency caesarean section.

I had a long recovery period following the birth of my daughter and even after nine months, the C section scar was still very painful. The problem is that dry suits we currently have for water response, have a zip around the lower abdomen, designed for men to be able to use the facilities without having to remove the dry suit.

Following a day of water training this zip ended up pressed against my scar which caused my lower abdomen to become bruised and swollen around the scar site.

As a part of the gender profile meeting, it was highlighted that there are “female dry suits” used by other services. These suits have a zip on the rear around the back, allowing females to use facilities without having to remove the whole suit. Our water leads have arranged to trial a sample of this suit on our next run of water training. (The male suit is pictured left, the female suit is shown on the right).

Fear of heights

“On returning to HART following maternity leave, I had also developed a slight fear of heights that I did not previously experience. I am unsure if this developed due to lack of exposure or being more emotionally self-aware and risk averse following childbirth.

On my first climb back, we were taken to a very challenging climb, and I did not feel the instructors were very sensitive to the issue and pushed me way out of my comfort zone, which further knocked my confidence.

This fear remained for a prolonged duration until a different instructor with a very different approach worked with me to rebuild my confidence and enabled me to perform my job better.”


“Following a few rota cycles back, I found it very difficult to manage my childcare requirements during the part of the rota that is “relief, training, relief”, as our shifts were not allocated within the time frame required by our nursery.

I approached the HART manager at the time, and it was agreed that I would leave HART and return to my local ambulance station as they could offer me more flexibility. HART then underwent a change in management.

I was recalled to HART duties due to region wide flooding and then a few weeks later, I was recalled to HART for a second time due to Covid-19. In total I was back on a road ambulance for seven weeks.

On my second recall to duty, the new management team approached me to offer me my place back on the HART unit. I was able to discuss the difficulties I had previously experienced and was offered the support I needed to allow me to not only return to the unit, but they also supported me through further progression and development.

This change of management taught me that there was more that could be done to support families if the management have an appetite to help or have the emotional intelligence to diversify their approach to staff.

Since my return, another member of staff has returned from maternity leave and is now on a part time rota. This was something we were conditioned to believe was not possible on HART.

Louise Lancaster working at height

The NARU gender profile programme is developing a blueprint that promises to reform and modernise HART teams up and down the country.

These reforms will mean all HART teams can thrive as diverse and gender equal workplaces, saving lives and improving clinical outcomes in the most effective and resilient way.

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