An exploration of the views of paramedics regarding airway management

Abstract

BackgroundParamedics are a skilled group of clinicians with expertise in airway management. Our research group has completed a trial comparing supraglottic airway devices with tracheal intubation during out of hospital cardiac arrest. This is a contentious topic amongst paramedics in the United Kingdom (UK). We explored the customs and beliefs of UK paramedics in relation to airway management, and whether tracheal intubation contributes to and sustains paramedic professional identity.MethodsThe study took place within South Western Ambulance Service NHS Foundation Trust. We used a qualitative approach, conducting interviews and focus groups with paramedics. The themes arising from interviews were discussed in focus groups, developing a deeper understanding and providing insight and recommendations for future research and policy. Purposive sampling accounted for differing training and for participation in the main trial. There were 17interviews and five focus groups with a further 17 participants. Data saturation was achieved.ResultsFour domains were identified. Pride - The ability to use a life-saving skill in austere conditions. Utility - Different training routes and experience have led to different attitudes towards airway management. Inconsistent expectations - Paramedics felt that there were different perceptions of their abilities amongst hospital staff and the general public. Professionalization - Debate over airway management is not founded on good evidence.ConclusionWe have demonstrated that UK paramedics have a wide range of views regarding airway management, and that these are based on evidence and experience rather than dogma. Airway management contributes to paramedics’ professional identity, but is not reliant on this.

Variations in stakeholders' priorities and views on randomisation and funding decisions in out‐of‐hospital cardiac arrest: An exploratory study

“…Participation in research was seen as consistent with their professional identity as modern and effective health care providers, yet threatened this very identity if negative results ensued. This finding is consistent with previous studies of paramedic involvement in prehospital research, and is an important aspect to consider …”

“…JVVF and JB work as emergency medicine and prehospital physicians, and have published largely quantitative research with an underlying positivist epistemology . JBR is a research fellow who has focused on qualitative research in a variety of health care settings and has previously worked with JB on a qualitative study in prehospital care . This exploration of stakeholders' views of prehospital critical care for OHCA is nested within a quantitative analysis of the effects of this complex intervention on survival after OHCA.…”

“…10,11 JBR is a research fellow who has focused on qualitative research in a variety of health care settings 12 and has previously worked with JB on a qualitative study in prehospital care. 13 This exploration of stakeholders' views of prehospital critical care for OHCA is nested within a quantitative analysis of the effects of this complex intervention on survival after OHCA. The limitations and challenges of research in prehospital care and particularly OHCA require a certain degree of flexibility to the methods used.…”

Qualitative study of paramedics' experiences of managing seizures: a national perspective from England

“…The previous study on the topic16 and indeed qualitative studies looking at paramedics practice more generally (eg,68–70) have recruited from only single sites. Paramedics for this study were recruited from five different services and so it is likely the issues reported do not relate to isolated, local concerns, but reflect practice across the country.…”

Does Medical Staffing Influence Perceived Safety? An International Survey on Medical Crew Models in Helicopter Emergency Medical Services

“…This categorization was chosen because airway control has the highest treatment priority in emergency medicine, is considered the single most important factor for good outcomes, 30,31 and contributes to paramedics' professional identity. 32 In this study, crewmembers unavailable to assist the medical crew in patient treatment during flight were not included as part of the medical crew. Nurses and EMTs/paramedics with a combined role as a medical assistant and a pilot's assistant during flight and obliged to sit in the cockpit under normal flight operations were categorized as an HEMS crewmember (HCM).…”