ArticleBMC emergency medicine2018
Creative adapting in a fluid environment: an explanatory model of paramedic decision making in the pre-hospital setting.
Article in BMC emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 67 citations in OpenAlex.
- Review article: Use of prehospital early warning scores to predict short-term mortality: A systematic review.Emergency medicine Australasia : EMA · 2025Pooled it
- Workplace violence from the ambulance personnel's perspective, a qualitative study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Paramedics' views on the skills, knowledge and attributes required for effective preceptorship: a cross-sectional study.BMC medical education · 2026Article
- Characterization and Application of Statewide Emergency Medical Services Advanced Life Support Protocols.Cureus · 2025Article
- Ambulance professionals' adaptations in prehospital services: a critical incident study.BMC emergency medicine · 2025Article
- Exploring care pathways of patients conveyed by emergency medical services (EMS) through electronic health records.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- The role of human factors in paramedics' clinical judgement - A modified Delphi study.PloS one · 2025Article
- The impact of shift work on paramedics and their practice: Protocol for a simulated paramedic shift work study.PloS one · 2025Article
- Paramedic perceptions of barriers and facilitators to the use of ambulance service appropriate care-referral pathways in Northern Ireland: a qualitative study.British paramedic journal · 2024Article
- A qualitative exploration of the views of paramedics regarding the use of dark humour.British paramedic journal · 2024Article
- Human errors in emergency medical services: a qualitative analysis of contributing factors.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Acil servis tanıları ile paramediklerin ilk değerlendirme tanılarının karşılaştırılması.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2024Observational
- Article
- Electronic field protocols for prehospital care quality improvement in Lithuania: a randomized simulation-based study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2023Article
- Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services.BMC emergency medicine · 2023Article
- Looking back to inform the future: a review of published paramedicine research.BMC health services research · 2023Review
- Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.Kansas journal of medicine · 2023Article
- The ways specialist nursing students understand the work in the ambulance service - a national Swedish phenomenographic study.International journal of qualitative studies on health and well-being · 2022Article
- Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner's theory.BMC emergency medicine · 2022Article
- Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics.International journal of environmental research and public health · 2021Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundParamedics 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.
methodThis 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.
resultsThe 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.
conclusionParamedic 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.