Paramedics’ Experience on Clinical Decision-making in the Pre-hospital Settings: Qualitative Systematic Review

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Abstract Background In prehospital environment, paramedics regularly respond to patients in dynamic situations, usually with limited resources and information. Patient safety in the paramount in these situations when paramedics assess and make clinical decisions. The primary goal of this qualitative systematic review was to explore, identify and evaluate the published research then synthesis the findings to answer what are the paramedics’ experiences on clinical decision making in the prehospital care. Methods Systematic search was conducted in databases such as MEDLINE, CINHAL and Embase to reach the literature on paramedics’ experience on clinical decision making in the prehospital setting. Full text and articles were included as per the inclusion criteria. Studies that focus on certain context/population during an emergency were excluded as well as to those focus on students or involve other healthcare providers rather than paramedics. Limits were set to include articles written in English language only with no date limit. Results 407 abstracts and titles were screened, 20 articles were assessed for eligibility, and four qualitative studies were found to answer the review question. The results showed that paramedics practice two types of decision making in the prehospital care; the first category is protocol driven decision making while the other category involve unsuitable patients for paramedics’ response, treatment and conveyance. Conclusion Paramedics experience on clinical decision making is complicated due to constant emerging elements and factors in the prehospital environment, including patients, relatives, paramedics and the prehospital system. implications for the practice involve encouraging trust culture among paramedics and EMS authorities, educational curriculums that focus on leadership and critical decision-making principles in stressful environments. Future research to contain other healthcare providers in the system, such as emergency physicians and emergency nurses, for better insight is needed.