Paramedic Judgement, Decision-Making and Cognitive Processing: A Review of the Literature

Perona, Meriem; Rahman, Muhammad Aziz; O’Meara, Peter

doi:10.33151/ajp.16.586

Cited by 41 publications

(69 citation statements)

References 72 publications

(136 reference statements)

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“…In addition to the complexity of scenarios, prehospital care providers are now faced with making decisions over different patient care options. EMTs vary in the level of care they can provide [ 22 ]. Around the world, many services focus on rapid transport to hospital, thereby de-emphasizing interventions in the field, whereas in certain locations, specialized medical teams are able to undertake highly advanced interventions, such as extracorporeal membrane oxygenation [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review

Kim¹,

Groombridge²,

Romero³

et al. 2020

J Med Internet Res

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Background Telemedicine offers a unique opportunity to improve coordination and administration for urgent patient care remotely. In an emergency setting, it has been used to support first responders by providing telephone or video consultation with specialists at hospitals and through the exchange of prehospital patient information. This technological solution is evolving rapidly, yet there is a concern that it is being implemented without a demonstrated clinical need and effectiveness as well as without a thorough economic evaluation. Objective Our objective is to systematically review whether the clinical outcomes achieved, as reported in the literature, favor telemedicine decision support for medical interventions during prehospital care. Methods This systematic review included peer-reviewed journal articles. Searches of 7 databases and relevant reviews were conducted. Eligibility criteria consisted of studies that covered telemedicine as data- and information-sharing and two-way teleconsultation platforms, with the objective of supporting medical decisions (eg, diagnosis, treatment, and receiving hospital decision) in a prehospital emergency setting. Simulation studies and studies that included pediatric populations were excluded. The procedures in this review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The Risk Of Bias In Non-randomised Studies–of Interventions (ROBINS-I) tool was used for the assessment of risk of bias. The results were synthesized based on predefined aspects of medical decisions that are made in a prehospital setting, which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently. Results Out of 42 full-text reviews, 7 were found eligible. Diagnostic support and medical direction and decision for treatments were often reported. A key finding of this review was the high agreement between prehospital diagnoses via telemedicine and final in-hospital diagnoses, as supported by quantitative evidence. However, a majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated within a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use; however, biases, due to preintervention confounding factors and a lack of documentation on quality assurance and protocol for telemedicine activation, make it difficult to determine the direct effect on patient outcomes. Conclusions The information-sharing capacity of telemedicine enables access to remote experts to support medical decision making on scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.

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Section: Introductionmentioning

confidence: 99%

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review

Kim¹,

Groombridge²,

Romero³

et al. 2020

J Med Internet Res

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“…Lack of those capabilities poses a challenge when the personnel should make clinical decisions and adversely affects the quality and safety of the care. Accordingly, it is necessary for pre-hospital emergency care administrators to take measures to improve the professional capabilities of their personnel [ 23 ]. Emergency Nurses Association (ENA) has always stressed that advances in technology, increase in professional knowledge, and work specialization mean that emergency care nurses’ clinical knowledge and performance need to be improved regularly.…”

Section: Discussionmentioning

confidence: 99%

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

et al. 2021

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Background Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. Methods The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. Results The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues. Conclusion The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel’s professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel’s clinical decision-making skill.

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“…This inevitably led to a delayed dispatch and a trend towards a longer 112/999-to-hospital time. Early clinical decision-making regarding triage and the need for HEMS assistance in paramedic practice for patients with LOC is therefore important [22]. This is stressed by the finding that HEMS interventions were as commonly performed in patients attended after crew request as in patients where HEMS was dispatched directly.…”

Section: Discussionmentioning

confidence: 99%

Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin

Mohindru¹,

Griggs²,

Coverly³

et al. 2020

BMC Emerg Med

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Background Sudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics. Methods We performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed. Results During the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85). Conclusion HEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage.

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Paramedic Judgement, Decision-Making and Cognitive Processing: A Review of the Literature

Cited by 41 publications

References 72 publications

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review

Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis

Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin

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