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Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting
BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238402/ https://www.ncbi.nlm.nih.gov/pubmed/30442096 http://dx.doi.org/10.1186/s12873-018-0194-1 |
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author | Reay, Gudrun Rankin, James A. Smith-MacDonald, Lorraine Lazarenko, Gerald C. |
author_facet | Reay, Gudrun Rankin, James A. Smith-MacDonald, Lorraine Lazarenko, Gerald C. |
author_sort | Reay, Gudrun |
collection | PubMed |
description | BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting. METHOD: This study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method. RESULTS: The resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted. CONCLUSION: Paramedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge. |
format | Online Article Text |
id | pubmed-6238402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62384022018-11-26 Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting Reay, Gudrun Rankin, James A. Smith-MacDonald, Lorraine Lazarenko, Gerald C. BMC Emerg Med Research Article BACKGROUND: Paramedics work in a highly complex and unpredictable environment which is characterized by ongoing decision-making. Decisions made by paramedics in the prehospital setting have implications for patient safety, transport, treatment, and health resource utilization. The objective of this study was; a) to understand how paramedics conduct decision-making in the field, and b) to develop a grounded theory of paramedic decision-making in the prehospital setting. METHOD: This study was conducted using classical grounded theory. Paramedics (n = 13) with five or more years’ experience, who worked in a large urban center in Western Canada were interviewed. Field observations were conducted, each lasting 12 h, with five different ambulance crews. The data were analyzed and coded using the constant comparative method. RESULTS: The resultant theory, Creative Adapting in a Fluid Environment, indicates paramedic decision-making is a fluid iterative process. Unpredictable and dynamic features of the prehospital environment require paramedics to use a flexible and creative approach to decision-making. The model consists of the three categories constructing a malleable model, revising the model, and situation-specific action. Two additional components, safety and extrication, are considered at each stage of the call. These two components in conjunction with the three categories influence how decisions are made and enacted. CONCLUSION: Paramedic decision-making is highly contextual and requires accurate interpretation and flexible cognitive constructs that are rapidly adaptable. Evaluation of paramedic decision-making needs to account for the complex and dynamic interaction between the environment, patient characteristics, available resources, and provider experience and knowledge. BioMed Central 2018-11-15 /pmc/articles/PMC6238402/ /pubmed/30442096 http://dx.doi.org/10.1186/s12873-018-0194-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Reay, Gudrun Rankin, James A. Smith-MacDonald, Lorraine Lazarenko, Gerald C. Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title | Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title_full | Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title_fullStr | Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title_full_unstemmed | Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title_short | Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
title_sort | creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238402/ https://www.ncbi.nlm.nih.gov/pubmed/30442096 http://dx.doi.org/10.1186/s12873-018-0194-1 |
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