Paramedics' non-technical skills: a literature review

Abstract

Healthcare organisations have started to examine the impact that the human worker has on patient safety. Adopting the Crew Resource Management (CRM) approach, used in aviation, the CRM or non-technical skills of anaesthetists, surgeons, scrub practitioners and emergency physicians have recently been identified to assist in their training and assessment. Paramedics are exposed to dynamic and dangerous situations where patients have to be managed, often with life-threatening injuries or illness. As in other safety-critical domains, the technical skills of paramedics are complemented by effective non-technical skills. The aim of this paper was to review the literature on the non-technical (social and cognitive) skills used by paramedics. This review was undertaken as part of a task analysis to identify the non-technical skills used by paramedics. Of the seven papers reviewed, the results have shown very little research on this topic and so reveal a gap in the understanding of paramedic non-technical skills.

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes

“…Examples included relationships with patients, their family, their health history and existing care plans (if any) [30], with other healthcare team members (directly or indirectly) [1, 3, 30–32], their (i.e., both patients and paramedics) position in the larger healthcare system as well as social and/or cultural context [33]: “ paramedics are part of a systems approach to health care, so a community system of care, an out of hospital system of care, and a hospital system of care, and they overlap.”[P-02] Others have discussed how inter-dependencies between the health care services have created a need for paramedicine to foster strong linkages with other stakeholders, including other health care professionals and regions [1], even suggesting that performance is dependent on being able to function in such a system: “[paramedics] are a part of a network of services…connected to a continuum of care. And so I think the ones that do well in the varied contexts are the ones that see themselves as part of a network.”[P-01] These relationships were positioned as ways of optimizing care and promoting patient centeredness while taking advantage of the unique point of contact: “you elevate the relationship of the paramedic and whichever specialist they are collaborating with in an interprofessional model to enhance that patient’s experience.” [P-13] The central thesis being that healthcare begins or continues with paramedics rather than serving as a bridge to healthcare and that paramedics have the added advantage of engaging with patients in their particular context.…”

“…This concept extends the clinician role by emphasizing safe and effective integrated healthcare, where paramedics are functionally involved in and responsible for health and health care systems (or networks) of care and providing team-based care in broad interprofessional settings [1, 32]: “This expansion of their scope and role is predicated on a collaborative practice model that they can't do in isolation, they need to have this integrated teamwork.” [P-02] Engaging paramedics into these integrated and collaborative heath networks was discussed at the system level, but with implications for paramedicine. Optimizing care meant, for some, recognizing that paramedics work (or should work) within networks of services, within a community connected to a continuum of care: “I think with paramedicine there’s going to be a lot more interaction with doctors and nurses and less transport for the benefit of patients.…”

“…Optimizing care meant, for some, recognizing that paramedics work (or should work) within networks of services, within a community connected to a continuum of care: “I think with paramedicine there’s going to be a lot more interaction with doctors and nurses and less transport for the benefit of patients. And I think that’s going to be a very huge component…I think we’re going to have to look at all sorts of alternates for the system to function properly.” [P-16] “This involves inter-professional collaboration and how to work appropriately with nursing and dietary and medicine and physiotherapy…and all those other health care professions.” [P-15] This “Team Member” role included language related to a deeper understanding of the broader healthcare system and the ability to work in multiple forms of collaborative environments, building short and long-term relationships with patients and family members, as well as other responders and health providers to meet common goals [3, 32]. Abilities related to shared leadership, collaboration, and synchronous and asynchronous teamwork were also described in this context of being an effective team member [31, 32].…”

“…Paramedicine is an autonomous, evolving and ever changing profession with expanding expectations in complex and rich practice contexts [1, 3, 32, 36, 41]. Linked to some extent with other roles (e.g., clinician) many discussed an obligation to be reflective about one’s practice.…”

“…These were “patient safety”, “compassion”, “adaptability” and “communication”. In the stakeholder interviews in particular but also across a number of publications, [1, 3, 31, 32, 34, 37, 40, 43–46] these concepts were discussed but with varying emphasis across the roles. For instance within the clinician role and team members roles, patient safety was discussed as something to be expected, unquestionably, and that quality care and promoting compassion and communication be the developmental focus.…”