References
Paramedic clinical decision-making: results of two Canadian studies
Abstract
Paramedics make many decisions while caring for patients in the out-of-hospital setting, including clinical judgments, such as assessment, treatment and transport decisions. As the decisions paramedics make can have an impact on patient safety and clinical outcome, it is important to focus on which clinical decisions are most important, when paramedics are required these, and how paramedics make clinical decisions, that is, what thinking strategies they rely on. This article will present the results of two recent Canadian studies, and will discuss the implications for paramedic clinical practice, education and research on this topic.
Paramedics are responsible for treating and transporting patients in need of urgent care. In North America, paramedics have been referred to as the backbone of the out-of-hospital emergency care system (Institute of Medicine (IoM), 2006), and the safety net of healthcare (Ross, 2010). The decisions paramedics make while assessing and treating patients can have a major impact on the care delivered and the resultant clinical outcome (morbidity and mortality) and safety of the patient (IoM, 2006). This is especially true as the diagnostics and interventions paramedics administer become more complex and their scope of practice continues to evolve and expand (Paramedic Association of Canada, 2001; Emergency Medical Services Chiefs of Canada, 2006).
In most Canadian emergency medical services (EMS) systems, clinical protocols or medical directives direct paramedic care. EMS medical directors create these documents, based on existing norms and standard practice, using their judgment on what will be most successful in the local system. Protocols are often presented in algorithm format, and are analogous to ‘practice standards’, which are definitions of the correct practice, with few treatment options intended to be followed explicitly (Eddy, 1990). Adherence to protocols are often a main measure of the quality of care delivered.
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