Factors Affecting Emergency Medical Technicians’ On-Scene Decision-Making in Emergency Situations: A Qualitative Study

  • Meysam Safi-Keykaleh ORCID Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Davoud Khorasani-Zavareh ORCID Mail Workplace Health Promotion Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Katarina Bohm ORCID Department of Clinical Sciences and Education, Karolinska Institute, Stockholm, Sweden
Keywords:
Decision Making, Emergencies, Emergency Medical Services, Emergency Medical Technician, Qualitative Research

Abstract

Introduction: To save lives and reduce the disability and death of the patients, emergency medical technicians (EMTs) must make timely decisions in complex and, sometimes, life-threatening situations. Since the pre-hospital decision-making is a continuous and important process. Objective: The present study aims to identify the factors affecting EMTs’ on-scene decision-making in emergency situations. Methods: A qualitative approach using in-depth semi-structured interviews and field observations was employed to explore the factors influencing EMTs’ on-scene decision-making in emergency situations. Purposeful sampling was performed with 19 participants including 12 EMTs, 3 dispatchers, 3 medical directions physicians and one EMS manager as a policy maker. Interviews were conducted from October 2018 to March 2018 and the data were analyzed using Graneheim and Lundman’s content analysis approach. Results: Eight categories and 18 sub-categories emerged to describe the factors effective in emergency medical technicians’ on-scene decision-making. they  were cultural context (community’s culture and organizational culture), interactions (malingering, threat and violence and considerations), competencies (acquisitive and intrinsic); personal feeling (positive feeling and negative feeling), authority (structural and in processing),  education (public and professional), special conditions (patient’s clinical situation, weather conditions, mission’s time and mission’s location), and organizational resource (facility and equipment, and human resources). Conclusions: To facilitate EMTs’ on-scene decision-making, it is recommended to clarify the EMTs’ responsibilities, promote the community’s culture, modify people’s expectations, police monitoring and control and value the star of logo on EMTs' uniform. The EMTs’ on-scene decision-making process should also be explored.

Downloads

Download data is not yet available.

References

1. Sun KM, Song KJ, Shin SD, Tanaka H, Shaun GE, Chiang W-C, et al. Comparison of emergency medical services and trauma care systems among pan-Asian countries: an international, multicenter, population-based survey. Prehosp Emerg Care. 2017;21(2):242-51.
2. Al-Shaqsi S. Models of international emergency medical service (EMS) systems. Oman Med J. 2010;25(4):320.
3. Millin MG, Johnson DE, Schimelpfenig T, Conover K, Sholl M, Busko J, et al. Medical oversight, educational core content, and proposed scopes of practice of wilderness EMS providers: A joint project developed by wilderness EMS educators, medical directors, and regulators using a Delphi approach. Prehosp Emerg Care. 2017;21(6):673-81.
4. Regehr C, LeBlanc V, Jelley RB, Barath I. Acute stress and performance in police recruits. Stress Health. 2008;24(4):295-303.
5. Janka A, Duschek S. Self-reported stress and psychophysiological reactivity in paramedics. Anxiety Stress Coping. 2018;31(4):402-17.
6. Nilsson C, Bremer A, Blomberg K, Svantesson M. Responsibility and compassion in prehospital support to survivors of suicide victim–Professionals’ experiences. Int Emerg Nurs. 2017;35:37-42.
7. Halter M, Vernon S, Snooks H, Porter A, Close J, Moore F, et al. Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study. Emerg Med J. 2011;28(1):44-50.
8. Johnson M, O’Hara R, Hirst E, Weyman A, Turner J, Mason S, et al. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care. BMC Med Res Methodol. 2017;17(1):11.
9. Ekins K, Morphet J. The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region. Australas Emerg Nurs J. 2015;18(4):227-33.
10. Harjola P, Boyd J, Tarvasmäki T, Mattila J, Koski R, Kuisma M, et al. The impact of emergency medical services in acute heart failure. Int J Cardiol. 2017;232:222-6.
11. Chew KS. What's new in Emergencies, Trauma and Shock? Tackling prehospital delay to reperfusion therapy in ST-elevation myocardial infarction: A global problem, a glocal approach. J Emerg Trauma Shock. 2017;10(2):53-4.
12. Voskens FJ, van Rein EA, van der Sluijs R, Houwert RM, Lichtveld RA, Verleisdonk EJ, et al. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2018;153(4):322-7.
13. Snooks HA, Kingston MR, Anthony RE, Russell IT. New models of emergency prehospital care that avoid unnecessary conveyance to emergency department: translation of research evidence into practice? ScientificWorldJournal. 2013;2013:182102.
14. Nutt PC. Some Considerations in Selecting Interactive and Analytical Decision Approaches for EMS Councils. Med Care. 1979;17(2):152-67.
15. Wros PL, Doutrich D, Izumi S. Ethical concerns: Comparison of values from two cultures. Nurs Health Sci. 2004;6(2):131-40.
16. Andersen MS, Johnsen SP, Hansen AE, Skjaerseth E, Hansen CM, Sørensen JN, et al. Preventable deaths following emergency medical dispatch–an audit study. Scand J Trauma Resusc Emerg Med. 2014;22(1):74.
17. Lavery T, Greenslade JH, Parsonage WA, Hawkins T, Dalton E, Hammett C, et al. Factors influencing choice of pre‐hospital transportation of patients with potential acute coronary syndrome: An observational study. Emerg Med Australas. 2017;29(2):210-6.
18. Delshad V, Sabzalizadeh S, Moradian MJ, Safarpour H, Malekyan L, Shemshadi H, et al. Epidemiology of accidents in Tehran emergency medical service during 2012 to 2013. Trauma Mon. 2018;23(1):e61871.
19. Jensen A, Lidell E. The influence of conscience in nursing. Nurs Ethics. 2009;16(1):31-42.
20. Camargo CA. A Model Protocol for Emergency Medical Services Management of Asthma Exacerbations: Workgroup on EMS Management of Asthma Exacerbations. Prehosp Emerg Care. 2006;10(4):418-29.
21. Ebrahimian A, Seyedin H, Jamshidi-Orak R, Masoumi G. Exploring factors affecting emergency medical services staffs’ decision about transporting medical patients to medical facilities. Emerg Med Int. 2014;2014:215329.
22. Hosseini SMR, Maleki M, Gorji HA, Khorasani-Zavareh D, Roudbari M. Factors affecting emergency medical dispatchers’ decision-making: a qualitative study. J Multidiscip Healthc. 2018;11:391-8.
23. Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015;95:302-11.
24. Keykaleh MS, Safarpour H, Yousefian S, Faghisolouk F, Mohammadi E, Ghomian Z. The Relationship between Nurse's Job Stress and Patient Safety. Open Access Maced J Med Sci. 2018;6(11):2228-32.
25. Esmaeili-Vardanjani S, Cheraghi M, Masuodi R, Rabihi L, kayvani A. Decision Making in Prehospital Emergency Nurses:A Qualitative Research. J Rescue Relief. 2011;3(1 and 2):19-32.
26. Arnold DH, Gebretsadik T, Abramo TJ, Sheller JR, Resha DJ, Hartert TV. The Acute Asthma Severity Assessment Protocol (AASAP) study: objectives and methods of a study to develop an acute asthma clinical prediction rule. Emerg Med J. 2012;29(6):444-50.
27. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.
28. Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description–the poor cousin of health research? BMC Med Res Methodol. 2009;9(1):52.
29. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: trustworthiness and publishing. Eur J Gen Pract. 2018;24(1):120-4.
30. Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJ. Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med. 2009;9(1):8.
31. Jat TR, Deo PR, Goicolea I, Hurtig AK, Sebastian MS. Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens. Glob Health Action. 2015;8(1):24976.
32. Bergeron WP. Considering culture in evacuation planning and consequence management. J Emerg Manag. 2015;13(2):87-92.
33. Bigdeli M, Khorasani-Zavareh D, Mohammadi R. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study. BMC Public Health. 2010;10:406.
34. Norberg Boysen G, Nyström M, Christensson L, Herlitz J, Wireklint Sundström B. Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective. Int J Qual Stud Health Well-being. 2017;12(1):1356674.
35. Ruotsalainen P, Blobel B. Trust-Essential Requirement and Basis for pHealth Services. Stud Health Technol Inform. 2017;237:25-33..
36. Verpeet E, De Casterle BD, Arend AVd, Gastmans CA. Nurses’ views on ethical codes: a focus group study. J Adv Nurs. 2005;51(2):188-95.
37. Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015;95:302-11.
38. von Vopelius-Feldt J, Benger J. Who does what in prehospital critical care? An analysis of competencies of paramedics, critical care paramedics and prehospital physicians. Emerg Med J. 2014;31(12):1009-13.
39. Flaherty EG, MacMillan HL, Abuse CoC, Neglect. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics. 2013;132(3):590-7.
40. Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41:20-8.
41. Tozzo P, Picozzi M, Caenazzo L. Munchausen Syndrome by Proxy: balancing ethical and clinical challenges for healthcare professionals Ethical consideration in factitious disorders. Clin Ter. 2018;169(3);169(3):e129-34.
42. Bass C, Halligan P. Factitious disorders and malingering: challenges for clinical assessment and management. Lancet. 2014;383(9926):1422-32.
43. Stone J, Warlow C, Sharpe M. Functional weakness: clues to mechanism from the nature of onset. J Neurol Neurosurg Psychiatry. 2012;83(1):67-9.
44. Salmon P. Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Educ Couns. 2007;67(3):246-54.
45. Chang YT, Tsai KC, Williams B. Development of new core competencies for Taiwanese Emergency Medical Technicians. Adv Med Educ Pract. 2018;9:147-58.
46. Mishra A. ‘Trust and teamwork matter’: Community health workers' experiences in integrated service delivery in India. Glob Public Health. 2014;9(8):960-74.
47. Hosseinikia SH, Zarei S, Najafi Kalyani M, Tahamtan S. A cross-sectional multicenter study of workplace violence against prehospital emergency medical technicians. Emerg Med Int. 2018;2018:7835676.
48. Maguire BJ, O'Meara P, O'Neill BJ, Brightwell R. Violence against emergency medical services personnel: A systematic review of the literature. Am J Ind Med. 2018;61(2):167-80.
49. Pourshaikhian M, Gorji HA, Aryankhesal A, Khorasani-Zavareh D, Barati A. A systematic literature review: workplace violence against emergency medical services personnel. Arch Trauma Res. 2016 Mar;5(1):e28734.
50. Bigham BL, Jensen JL, Tavares W, Drennan IR, Saleem H, Dainty KN, et al. Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: a mixed-methods cross-sectional survey. Prehosp Emerg Care. 2014;18(4):489-94.
51. Rahmani A, Dadashzadeh A, Namdar H, Akbari M, Allahbakhshian A. Violence in workplace against emergency care personnel in east azarbaijan province. Ir J Forensic Med. 2009;15(2):100-7.
52. Koohestani H, Baghcheghi N, Rezaii K, Ebrahimi Fakhar H. Risk factors for workplace violence in emergency medical technician students. Iran Occup Health. 2012;9(1):68-75.
53. Milaniak I, Wilczek-Rużyczka E, Przybyłowski P, editors. Role of Empathy and Altruism in Organ Donation Decisionmaking Among Nursing and Paramedic Students. Transplantation proceedings; 2018: Elsevier.
54. Jose MM. Cultural, ethical, and spiritual competencies of health care providers responding to a catastrophic event. Crit Care Nurs Clin North Am. 2010;22(4):455-64.
55. Brennan N, Barnes R, Calnan M, Corrigan O, Dieppe P, Entwistle V. Trust in the health-care provider–patient relationship: a systematic mapping review of the evidence base. Int J Qual Health Care. 2013;25(6):682-8.
56. McCullough MB, Petrakis BA, Gillespie C, Solomon JL, Park AM, Ourth H, et al. Knowing the patient: A qualitative study on care-taking and the clinical pharmacist-patient relationship. Res Social Adm Pharm. 2016;12(1):78-90
57. Glow SD, Colucci VJ, Allington DR, Noonan CW, Hall EC. Managing multiple-casualty incidents: a rural medical preparedness training assessment. Prehosp Disaster Med. 2013;28(4):334-41.
58. Khankeh H, Alinia S, Masoumi G, Ranjbar M, Daddoost L, Hosseini S, et al. Prehospital services by focus on road traffic accidents: Assessment developed and developing countries. J Health Promot Manag. 2013;2(2):71-9.
59. Khankeh H, Ranjbar M, Khorasani-Zavareh D, Zargham-Boroujeni A, Johansson E. Challenges in conducting qualitative research in health: A conceptual paper. Iran J Nurs Midwifery Res. 2015;20(6):635-41.
Published
2020-04-14
How to Cite
1.
Safi-Keykaleh M, Khorasani-Zavareh D, Bohm K. Factors Affecting Emergency Medical Technicians’ On-Scene Decision-Making in Emergency Situations: A Qualitative Study. Adv J Emerg Med. 4(4):e88.
Section
Original article