scholarly journals A qualitative study to identify factors that influence patients’ decisions to call Emergency Medical Services for syncope

2020 ◽  
Author(s):  
Tamara M. Williamson ◽  
Mary Runte ◽  
Tigana Runte ◽  
Satish Raj ◽  
Ian Blanchard ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Medical Services ◽  
Contextual Factors ◽  
Diagnostic Testing ◽  
Medical Services ◽  
Attitudes And Beliefs ◽  
Structured Interviews ◽  
Emergency Medical ◽  
Starting Point ◽  
Past Experiences

Abstract BACKGROUND Emergency medical services (EMS) assessment and presentation to the emergency department (ED) for syncope (fainting) often results in hospital admission and costly diagnostic testing that rarely benefits patients. Protocols that support paramedics to assess, treat and refer low-risk syncope may allow for ED transport of only high-risk patients. The development and successful uptake of such protocols is limited by a dearth of information about factors patients consider when deciding to seek EMS care following syncope. OBJECTIVE We aimed to explore decision-making processes of individuals with syncope when deciding whether (or not) to call EMS after fainting as a starting point in the development of prehospital risk-stratification protocols. METHODS Twenty-five adults (aged 18–65 years) with a history of ≥ 1 syncopal episode were recruited across four Canadian provinces. Individual semi-structured interviews were conducted, recorded, and transcribed. Straussian grounded theory methods were used to identify common themes and a core (overarching) category. RESULTS Four common themes were identified: (a) previous experiences with the healthcare system (e.g., feeling dismissed), (b) individual patient factors (e.g., age, comorbidities), (c) attitudes and beliefs (e.g., concerns about burdening the health care system, believing syncope is “not serious enough” to seek care), and (d) contextual factors (i.e., influence of important others, symptom severity). Perceived judgement of the patient by EMS was identified as the overarching core category that influenced patients’ decision-making to seek care. CONCLUSION The decision to seek EMS care after syncope is a complex process involving patient consideration of past experiences, pre-existing attitudes and beliefs, and individual- and contextual factors. Patients’ previous experiences of judgement and dismissal by EMS for fainting may interfere with patient receptiveness to traditional EMS protocols for syncope. These barriers could be targets for training and education for paramedics and help to inform the development of prehospital protocols to improve care and satisfaction among patients with syncope.

Naturalistic Decision-Making in Emergency Medical Services

2017 ◽  
pp. 41-52
Author(s):  
Michael A. Rosen ◽  
Ian Coffman ◽  
Aaron Dietz ◽  
P. Daniel Patterson ◽  
Julius Cuong-Pham
Keyword(s):  
Decision Making ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Naturalistic Decision Making ◽  
Emergency Medical

scholarly journals The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia

Organizacija ◽  
2015 ◽  
Vol 48 (4) ◽  
pp. 247-258 ◽  
Author(s):  
Tatjana Kitić Jaklič ◽  
Jure Kovač
Keyword(s):  
Emergency Medical Services ◽  
Planning Process ◽  
National Level ◽  
Social Factor ◽  
Software Tool ◽  
Medical Services ◽  
Emergency Medical ◽  
Rate Of Increase ◽  
Starting Point ◽  
The Impact

Abstract Background and Purpose: The modern environment requires that organizations (profit and non-profit) continually harmonize their organizational models with changes in their respective environments and with their own visions and strategies for further development. The organizational structure of Emergency Medical Services (hereinafter EMS) is currently a very topical issue in Slovenia, given that a project to establish a new organization of EMS is currently underway at the national level. By examining the case of one region in Slovenia, this article presents an analysis of factors that impact on the number and types of EMS activities and depicts a forecast of future trends for the requirement of EMS. The analysis presents the initial phase of a strategic planning process for the mentioned activity and consequently, a starting point for the formation of an organizational EMS model. Methodology: This article presents an analysis of factors that impact on the formulation of an EMS model on the basis of research carried out for one geographical region of Slovenia. For the previous period, data was collected from 2002 to 2014. The software tool used for the analysis was STATA 13.0. For the purpose of forecasting a five-year period trend we used statistical package RStudio and Hyndman’s Forecast package given that this package contains algorithms for forecasting univariate time series including exponential smoothing using automated spatial models and ARIMA modelling. Results: The research has confirmed a correlation between social/environmental factors and the rate of increase in the demand for EMS. A population’s age structure has been identified as the key social factor that increases the need for EMS. On the basis of this finding, this article presents a model for forecasting growth trends in the scope of EMS activities. Conclusion: The research study has identified some important elements that are imperative to take into consideration when formulating an EMS network at the prehospital level. Population ageing has emerged as a key social factor. In the accordance with forecasted trends, an increase in the burden placed on EMS activities may also be anticipated in the future.

scholarly journals Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 220-229
Author(s):  
Jan L. Jensen ◽  
Andrew H. Travers
Keyword(s):  
Decision Making ◽  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Systems Of Care ◽  
National Level ◽  
Policy Decision ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
Patient Health

AbstractNationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.

scholarly journals MANAGING DEATH IN THE FIELD: HOW EMERGENCY MEDICAL SERVICES TEAMS PROVIDE END-OF-LIFE CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S499-S499
Author(s):  
Deborah P Waldrop ◽  
Jacqueline M McGinley ◽  
Brian M Clemency
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Emergency Medical Services ◽  
End Of Life ◽  
End Of Life Care ◽  
Medical Services ◽  
Life Care ◽  
Serious Illness ◽  
Emergency Medical ◽  
Seriously Ill

Abstract Emergency medical services (EMS) providers respond more frequently to calls for older adults with serious illness than for people in other age groups. Recent legislation that makes it possible to document healthcare decisions has facilitated an era of choice in end-of-life care. EMS teams make time-sensitive decisions about care, resuscitation and hospital transport that influence how and where a seriously ill older adult will die and how his/her family will experience the death. Yet, EMS providers’ perspectives on urgent decision-making and how they work with families are unknown. The purpose of this study was to explore the decision-making process that occurs how EMS teams respond when someone is dying from a serious illness (vs. an injury). In-depth in-person interviews were conducted with 50 EMS providers (24 emergency medical technicians [EMTs] and 26 Paramedics) from four ambulance services. Participants’ ages ranged from 21-57 (M=37.9) and 70% were male. Qualitative data was coded using Atlas.ti software. Three themes illuminated participants’ experiences with end-of-life calls: (1) How legally binding documents (e.g. Do Not Resuscitate [DNR] orders, Medical Orders for Life Sustaining Treatment [MOLST]) inform care; (2) Decision-making about foregoing or halting resuscitation (e.g. no hospitalization, death at home); and (3) Family care, support and education. The results suggest that EMS providers have critically important roles in upholding the wishes of seriously ill older adults and helping caregiving families through the end-of-life transition. Implications: Discussions about the meaning of legally binding documents (e.g. DNR, MOLST) and EMS calls are important in advance care planning.

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