What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

Abstract

Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community.Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making.Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis.Results: <list id="list1" list-type="bullet"> <list-item>Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints.</list-item> <list-item>Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group.</list-item> <list-item>Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department.</list-item> <list-item>Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals.</list-item> </list>Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services.

Factors Affecting Paramedic Personnel in the Assessment and Management of Emergency Pediatric Patients within the Prehospital Settings in the United Kingdom

“…Additionally, the findings published by the London Ambulance Service (LAS) which serves a population of approximately 9 million people, reports that in the year 2018 – 2019, LAS clinicians carried out resuscitation on 4,004 patients, where only 54 were for patients under one year of age. 14 Hetherington and Jones 15 believe a stronger focus on paramedic education in terms of reflective practice can help some of the ongoing issues relating to pediatric emergency care. Introducing innovative solutions such as further development of guidelines could help contribute to mitigating barriers paramedics face in pediatric patients.…”

“…Introducing innovative solutions such as further development of guidelines could help contribute to mitigating barriers paramedics face in pediatric patients. 15 …”