PurposePrevious research has shown that paramedics form intuitive impressions based on limited “pre-arrival” dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied.Design/methodology/approachThis was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years' experience (Range: 1–32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS) and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.FindingsMore participants exposed to the likely pre-arrival vignette recorded a final diagnosis of ACS, than those exposed to unlikely pre-arrival information (0.85 [95%CI: 0.78, 0.90] vs 0.74 [95%CI: 0.66, 0.81]; p = 0.03). This effect was greater in paramedics with more than 14 years' experience (0.94 [95%CI: 0.78, 0.99] vs 0.67 [95%CI: 0.48, 0.81]; p = 0.01). Answer fluency and confidence were associated with the impression, while the impression and confidence were associated with final diagnosis.Practical implicationsThe authors have experimentally shown that pre-arrival information can affect subsequent diagnosis. The most experienced paramedics were more likely to be affected.Originality/valueThis is the first experimental study of diagnostic decision-making in paramedics and paramedic students.

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Introduction. Paramedics care for the sick and injured in a variety of settings and have been observed to form an impression of their patient prior to meeting them based on limited information. We report an experiment using Australian paramedics (n=64) and Australian paramedicine undergraduates (n=44), which considered the processes underlying the formation of an intuitive diagnostic impression. Previous research has signalled roles for objective likelihood of the disease, subjective typicality of the disease, and the ease with which the impression comes to mind (answer fluency) as important in impression formation. Method. Participants completed four brief written clinical vignettes under time pressure and with a concurrent navigation task to simulate conditions faced by paramedics prior to meeting a patient. The vignettes varied the objective likelihood of a diagnosis of Acute Coronary Syndrome (ACS), a condition often encountered by paramedics characterised by ambiguity and a need for accuracy. Diagnostic impression, confidence and subjective typicality of the vignette were self-reported while answer fluency was measured. Results. Likelihood, answer fluency, self-reported typicality and confidence predicted the impression but there was no effect of experience. Students and experienced paramedics had comparable accuracy and performance. Conclusion.The results support a role for answer fluency and confidence in forming that impression. We have shown it is possible to experimentally manipulate various factors associated with paramedic diagnostic impressions. These experimental methods can form the basis for additional studies into paramedic decision making.

Purpose Paramedics play important roles in healthcare, yet little is known about their decision-making. There is evidence that thinking style is associated with individual preference for intuitive or deliberative decision-making.Design/methodology/approach Australian and New Zealand paramedics (n = 103; mean age: 38.7; mean 12 years’ experience; 44% female) and paramedic students (n = 101; mean age: 25.7; 59% female) completed a thinking style survey measuring active open-mindedness (AOT), close mindedness (CMT), preference for intuitive thinking (PIT) and preference for effortful thinking (PET). Participants also completed the 7-item Cognitive Reflection Test (CRT) to assess ability to override an attractive but incorrect intuition.Findings With prior exposure to the CRT controlled, regression analysis found increasing AOT and decreasing age predicted cognitive reflection across all participants (R2/R2 adjusted: 0.198/0.157; F(10, 192) = 4.752, p < 0.001). There were moderate correlations between CMT, age and paramedic experience. There was no difference between paramedics and student performance on the CRT, though more students reported prior exposure to the items (33.7 vs 16.5%; Chi-square (2) = 8.02, p = 0.02). Those who reported prior exposure to the CRT scored significantly higher than those who had not (5.08 [1.44] vs 3.87 [1.70]; F(2, 201) = 14.34, p < 0.001).Originality/value Self-reported AOT was associated with cognitive reflection and indicates a role for open-mindedness in paramedics to support decision-making.

Introduction. Previous research has shown that paramedics form intuitive impressions based on limited ‘pre-arrival’ dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied. Method. This was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years’ experience (Range: 1 – 32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS), and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.Results. There was a difference in the proportion of participants diagnosing ACS according to what pre-arrival information was seen (.85 [95%CI: .78, .90] vs .74 [95%CI: .66, .81]; p = .03). Paramedics with greater than 14 years’ experience, were more likely to be affected by pre-arrival information in their diagnosis (.94 [78, .99] vs .67 [95%CI .48, .81]; p = .01). Answer fluency and confidence predicted impression, while the impression and confidence predicted final diagnosis.Conclusion. We have experimentally shown that pre-arrival information can affect subsequent diagnosis, increasing the chance of diagnostic error. The most experienced paramedics were most likely to be affected.