Paramedic decision making: prehospital thrombolysis and beyond

Smith, Alyson M; Hardy, Pamela J; Sandler, David A.; Cooke, Justin

doi:10.1136/emj.2009.083766

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…Teamwork requires a 'contingency approach' rather than existing on a linear hierarchical perspective of bad to good 17 with a more graded understanding of the team and context, and how the team complements the clinical needs of the local population: in essence, how the team is adaptable to the presenting context. The concept of this 'adaptive zone' has been identified in complexity leadership, existing in the overlap between standalone operational and innovation spaces, as a temporary area permitting freedom of movement for information to facilitate the creation of new ideas.…”

Section: Teamworkmentioning

confidence: 99%

“…Speed of decision-making: the nature of a patient's presentation will impact the need for team adaptation. For example, paramedic decision-making for prehospital thrombolysis may require rapid decision-making, 17 while discussing the use of antidepressants may permit more reflective practice and so an opportunity to broaden team input. With the exception of ultra-rapid genomics for example, urgent childhood brain cancer, decisionmaking in clinical genomics does not need to be instant allowing discussion on optimal variant interpretation or clinical management.…”

Section: Teamworkmentioning

confidence: 99%

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Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting

Best

Brown

Stark

et al. 2021

Evaluation Clinical Practice

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Rationale, aims and objectives: Teamworking across sociotechnical boundaries in healthcare is growing as technological advances in medicine abound. With this progress, teams need to find new ways of working together in non-traditional settings.The novel field of clinical genomics provides the opportunity to rethink the existing approach to teamworking and how it needs to evolve. Our aim was to identify the key factors influencing teamworking in the emerging field of clinical genomics and how can they be applied in practice. Method: We drew on three qualitative datasets from interviews undertaken in Australia, 2018/2019, that explored determinants of implementation of clinical genomics with laboratory scientists (n = 7), service and programme leads (n = 21), project officers (n = 2), clinical genetics staff (n = 26) and other medical specialists (n = 21). Data were analysed using a theory-informed matrix approach to identify themes related to teamworking. Results: We identify that teams in clinical genomics work in an elongated adaptive context where there is rapid evolution of the knowledge base, shifting expectations of staff roles, and fast changes of technology. Delivering care in this setting brings additional challenges to teamworking as members strive to stay abreast of current knowledge and technology. We identify four themes: (a) the role of the team in keeping knowledge up-to-date; (b) professional identity; (c) team adaptability, and (d) practical/organisational considerations. Conclusion:Challenges to teamworking that arise in the elongated adaptive context do not always fit traditional ways of working, and innovative strategies will need to be adopted to ensure the diagnostic advances of clinical genomics are realised. Provision of time and permission for team members to share knowledge and evolve, promoting capacity building, nurturing trustful relationships and establishing boundaries are amongst the practice recommendations for organisational and team leaders, even though these activities may disrupt existing ways of working or hierarchical structures.

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Section: Teamworkmentioning

confidence: 99%

Section: Teamworkmentioning

confidence: 99%

Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting

Best

Brown

Stark

et al. 2021

Evaluation Clinical Practice

View full text Add to dashboard Cite

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“…For these reasons the delivery of thrombolysis in the pre-hospital setting by trained paramedics has been conceptualised as a means to bring this treatment to the patient and reduce total ischaemic time. Paramedics are often the first health practitioners to attend patients experiencing an acute myocardial infarction (AMI), and are therefore well positioned to expedite the process of STEMI recognition and acute treatment/management (3,4). Paramedic-delivered pre-hospital thrombolysis (PHT), both in New Zealand and elsewhere, has been shown to significantly reduce morbidity and mortality among STEMI patients compared to those who receive the treatment in-hospital after ambulance transport from the field (2,(5)(6).…”

Section: Introductionmentioning

confidence: 99%

New Zealand Paramedics are Ready for An Autonomous Pre-Hospital Thrombolysis Protocol

Davis

Howie

Dicker

2017

Australasian Journal of Paramedicine

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IntroductionInternationally, autonomous paramedic-delivered pre-hospital thrombolysis (PHT) administration for ST-elevation myocardial infarction patients has proven to be a highly effective strategy in facilitating expedited delivery of this treatment modality. However, current New Zealand models rely on physician authorised telemetry-based systems which have proved problematic, particularly due to technological failings. The aim of this study is to establish whether current paramedic education in New Zealand is sufficient for the introduction of an autonomous paramedic clinical decision-making model of PHT.MethodsA one-hour workshop introduced a new PHT protocol to 81 self-selected paramedic participants – both rural and metropolitan based – from New Zealand. Paramedics were then tested in protocol application through completion of a scenario-based standardised written test. Four written scenarios constructed from actual field cases assessed 12-lead electrocardiogram interpretation, understanding of protocol inclusion/exclusion criteria, and treatment rationale. Ten multiple-choice questions further tested cardiac and pharmacology knowledge as well as protocol application.Results Overall clinical decision-making showed a sensitivity of 92.0% (95% CI: 84.8–96.5), and a specificity of 95.6% (95% CI: 89.1–98.8). Electrocardiogram misinterpretation was the most common error. University educated paramedics (n=44) were significantly better at clinical decision-making than in-house industry trained paramedics (n=37) (p=0.001), as were advanced life support paramedics (n=36) compared to paramedics of lesser practice levels (n=45) (p=0.006).Conclusion Our New Zealand paramedic sample demonstrated an overall clinical decision-making capacity sufficient to support the introduction of a new autonomous paramedic PHT protocol. Recent changes in paramedic education toward university degree programs are supported.

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“…Acute myocardial infarction (AMI) is among the leading causes of death and physical incapacity worldwide [ 1 ]. In 2005, for instance, cardiovascular diseases accounted for 30% of deaths globally [ 2 ]. It is also known that morbidity and mortality of patients experiencing AMI may be lessened by decreasing the interval from symptom onset and its recognition to treatment [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…To quote Stone [ 11 ], “[o]ne of the longest running debates in cardiology has concerned the best reperfusion therapy in patients with evolving acute myocardial infarction (AMI).” According to the current guidelines [ 13 ], PPCI is the preferred form of reperfusion treatment for patients with STEMI. However, there is consensus that (i) reducing the time from first contact with the health care system to the initiation of reperfusion therapy (the so-called system delay ) is key [ 10 ]; (ii) early administration of prehospital thrombolysis (PHT) is an alternative to PPCI that may produce similar outcomes at a reduced cost [ 14 ]; (iii) if the patient is thrombolytic eligible, then the combination of PHT delivery with PPCI as a secondary intervention after hospital admission achieves prominent results [ 2 ]—for example, Arntz [ 15 , p. S93] reports on a study where TIMI grade III flow (TIMI stands for “Thrombolysis In Myocardial Infarction” and is the name of a study group coordinating several trials, particularly focusing on percutaneous coronary intervention, thrombolysis, and cardiovascular disease in general. TIMI grade III flow means complete perfusion, that is, a normal flow has been restored to fill the distal coronary bed completely.…”

Section: Introductionmentioning

confidence: 99%

AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

Correa

Gonçalves

Teixeira

et al. 2011

International Journal of Telemedicine and Applications

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The latest population-based studies in the medical literature worldwide indicate that acute myocardial infarction (AMI) patients still experience prolonged delay to be rescued, which often results in morbidity and mortality. This paper reports from a technological standpoint a teleconsultation and monitoring system named AToMS. This system addresses the problem of prehospital delivery of thrombolysis to AMI patients by enabling the remote interaction of the paramedics and a cardiologist available at a Coronary Care Unit (CCU). Such interaction allows the diagnosis of the patient eligibility to the immediate application of thrombolysis, which is meant to reduce the delay between the onset of symptoms and the eventual application of proper treatment. Such delay reduction is meant to increase the AMI patient's chances of survival and decrease the risks of postinfarction sequels. The teleconsultation is held with the support of wireless and mobile technologies, which also allows the cardiologist to monitor the patient while he/she is being taken to the nearest CCU. All exchanged messages among paramedics and cardiologists are recorded to render an auditable system. AToMS has been deployed in a first stage in the city of Rio de Janeiro, where the medical team involved in the project has conducted commissioned tests.

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Paramedic decision making: prehospital thrombolysis and beyond

Cited by 7 publications

References 18 publications

Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting

Teamwork in clinical genomics: A dynamic sociotechnical healthcare setting

New Zealand Paramedics are Ready for An Autonomous Pre-Hospital Thrombolysis Protocol

AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

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