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

Abstract

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.

Exploring epilepsy attendance at the emergency department and interventions which may reduce unnecessary attendances: A scoping review

“…These interventions have not been tested to see if they have an impact [28]. Paramedics felt there was limited formal training on seizure management pre and post registration with E-learning felt as the most appropriate method of learning [29]. In agreement with this paper was a conclusion from the service evaluation of a new care pathway made available to paramedics within an urban area of the UK.…”

“…Three of the included reports assessed the role of ambulance staff, within the UK, in managing seizures were qualitative [28][29][30] with two further quantitative reports [31,32]. Whilst two of the studies included staff across five NHS organizations, the total number of participants for each was small.…”

“…Paramedics are not expected to transport all people they attend to hospital but to assess, treat and consider non-emergency alternatives where suitable [28]. The most common seizure presentation attended by ambulance is in a person with epilepsy, experiencing an uncomplicated seizure, resulting in ED attendance [29]. Clinical need is not, therefore, the only driver for transportation [30].…”

Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

“…Data from some regional ambulance services on conveyance rates for seizures has been published. It indicates ambulance staff are recommending conveyance of nearly every person they attend for a suspected seizure to ED,41–43 despite most not demonstrating a clinical need (eg, seizures have self-terminated before ambulance arrival in ~90% of cases),42 One reason for this is paramedics lack access to alternatives 44–46. There is a vision therefore of what could help: ambulance service access to some form of ‘Alternative Care Pathway’ (ACP) whereby those seeking help for an epileptic seizures judged not to require ED are cared for within less costly, alternative environments.…”

“…In the case of epilepsy, qualitative research44–46 provides the beginnings of a theoretical basis for the use of an ACP in epilepsy with the mechanisms by which it could make a difference being that it may: increase awareness and likelihood that paramedics will consider non-conveyance and referral pathways as an option in appropriate cases; increase paramedics’ clinical knowledge of how to make appropriate non-conveyance decisions; increase paramedics’ knowledge of alternative care providers that are acceptable to service users; and increase paramedics’ confidence about making a non-conveyance decision and reducing anxiety about risk.…”