Qualitative study of paramedics' experiences of managing seizures: a national perspective from England
Noble, Adam J. Snape, Darlene Goodacre, Steve Jackson, Mike Sherratt, Frances C. Pearson, Mike Marson, Anthony G.
Noble, Adam J.
Snape, Darlene
Goodacre, Steve
Jackson, Mike
Sherratt, Frances C.
Pearson, Mike
Marson, Anthony G.
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Abstract
Objectives: The UK ambulance service is expected to
now manage more patients in the community and
avoid unnecessary transportations to hospital
emergency departments (ED). Most people it attends
who have experienced seizures have established
epilepsy, have experienced uncomplicated seizures and
so do not require the full facilities of an ED. Despite
this, most are transported there. To understand why,
we explored paramedics’ experiences of managing
seizures.
Design and setting: Semistructured interviews were
conducted with a purposive sample of paramedics
from the English ambulance service. Interviews were
transcribed and thematically analysed.
Participants: A diverse sample of 19 professionals
was recruited from 5 different ambulance NHS trusts
and the College of Paramedics.
Results: Participants’ confirmed how most seizure
patients attended to do not clinically require an ED.
They explained, however, that a number of factors
influence their care decisions and create a momentum
for these patients to still be taken. Of particular
importance was the lack of access paramedics have to
background medical information on patients. This, and
the limited seizure training paramedics receive, meant
paramedics often cannot interpret with confidence the
normality of a seizure presentation and so transport
patients out of precaution. The restricted time
paramedics are expected to spend ‘on scene’ due to
the way the ambulance services’ performance is
measured and that are few alternative care pathways
which can be used for seizure patients also made
conveyance likely.
Conclusions: Paramedics are working within a
system that does not currently facilitate nonconveyance of seizure patients. Organisational,
structural, professional and educational factors impact
care decisions and means transportation to ED remains
the default option. Improving paramedics access to
medical histories, their seizure management
training and developing performance measures for the
service that incentivise care that is cost-effective for all
of the health service might reduce unnecessary
conveyances to ED.
https://bmjopen.bmj.com/content/bmjopen/6/11/e014022.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2016-014022