Paramedical risk framing during field referral of acute stroke and S–T elevation myocardial infarction patients

Campeau, Anthony

doi:10.1136/emermed-2015-205385

Emerg Med J

2016

DOI: 10.1136/emermed-2015-205385

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Paramedical risk framing during field referral of acute stroke and S–T elevation myocardial infarction patients

Anthony Campeau

Abstract: Field referral of emergency ambulance patients by paramedics on a widespread basis is a relatively new aspect of paramedicine. Its implementation involves a significant revision to paramedics' clinical responsibilities and level of interaction with medical specialists. Using grounded theory methodology, this qualitative study uses interviews with paramedics from Ontario, Canada, to explore the framing of risk associated with these referrals in the context of caring for patients with two highstakes medical cond… Show more

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Cited by 2 publications

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

et al. 2016

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ObjectivesThe UK ambulance service is expected to now manage more patients in the community and avoid unnecessary transportations to hospital emergency departments (ED). Most people it attends who have experienced seizures have established epilepsy, have experienced uncomplicated seizures and so do not require the full facilities of an ED. Despite this, most are transported there. To understand why, we explored paramedics’ experiences of managing seizures.Design and settingSemistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed.ParticipantsA diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics.ResultsParticipants’ confirmed how most seizure patients attended to do not clinically require an ED. They explained, however, that a number of factors influence their care decisions and create a momentum for these patients to still be taken. Of particular importance was the lack of access paramedics have to background medical information on patients. This, and the limited seizure training paramedics receive, meant paramedics often cannot interpret with confidence the normality of a seizure presentation and so transport patients out of precaution. The restricted time paramedics are expected to spend ‘on scene’ due to the way the ambulance services’ performance is measured and that are few alternative care pathways which can be used for seizure patients also made conveyance likely.ConclusionsParamedics are working within a system that does not currently facilitate non-conveyance of seizure patients. Organisational, structural, professional and educational factors impact care decisions and means transportation to ED remains the default option. Improving paramedics access to medical histories, their seizure management training and developing performance measures for the service that incentivise care that is cost-effective for all of the health service might reduce unnecessary conveyances to ED.

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

et al. 2016

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Paramedics' views on their seizure management learning needs: a qualitative study in England

et al. 2017

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IntroductionThe UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at scene or by using alternative care pathways. Most though are transported to ED. One factor that helps explain this is paramedics can have low confidence in managing seizures.ObjectivesWith a view to ultimately developing additional seizure management training for practicing paramedics, we explored their learning needs, delivery preferences and potential drivers and barriers to uptake and effectiveness.Design and settingSemistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed.ParticipantsA diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics.ResultsParticipants said seizure management was neglected within basic and postregistration paramedic training. Most welcomed additional learning opportunities and identified gaps in knowledge. This included how to differentiate between seizure types and patients that do and do not need ED. Practical, interactive e-learning was deemed the most preferable delivery format. To allow paramedics to fully implement any increase in skill resulting from training, organisational and structural changes were said to be needed. This includes not penalising paramedics for likely spending longer on scene.ConclusionsThis study provides the first evidence on the learning needs and preferences of paramedics regarding seizures. It can be used to inform the development of a bespoke training programme for paramedics. Future research should develop and then assess the benefit such training has on paramedic confidence and on the quality of care they offer to seizure patients.

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Paramedical risk framing during field referral of acute stroke and S–T elevation myocardial infarction patients

Cited by 2 publications

References 14 publications

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

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

Paramedics' views on their seizure management learning needs: a qualitative study in England

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