James Thompson and Dr Claire Drummond
Journal of Paramedic Practice, Vol. 5, Iss. 6, 10 Jun 2013, pp 342 - 347

Objective: This study explored the topic of paramedic patient assessment, investigating how they informed clinical decisions, the challenges associated with performing assessments and the perceived effectiveness of current approaches.

Methods: Using a Delphi research method, expert participants were independently interviewed which encouraged them to share experiences and views. A thematic analysis approach was then used and the data coded and organised into a series of statements to represent the collective expert views. Statements were then returned to the expert participants for validation and comment.

Results: A process of paramedic care delivery was defined, whose activities were largely identified as representing areas of assessment. Protocols and guidelines which are designed to inform paramedic interventions influenced every stage of care delivery. The depth and breadth of a paramedic's patient assessment were found to be limited once indications for a treatment guideline have been satisfied and the main contraindications are excluded. Current formal assessment tools skills being utilised by paramedic staff (including protocols and practice guidelines) were considered only effective for encounters with critically ill patients, and were of limited benefit to the assessment of patients of a lower clinical acuity. There was a direct correlation between the increased paramedic confidence in their patient assessment skills and the more critical the patient's condition. Paramedics were the least familiar or confident with the assessment principles and skills linked with the lower acuity of patient illness.

Conclusion: When compared to both national and international ambulance case loads, it is significant that those groups of patient complaints representing the vast majority of ambulance work are the same patient cohorts for whom the paramedic has the least knowledge, preparation and confidence in relation to assessment. Findings relating to the defining of a paramedic's role and process of care distinctly features assessment skills to be both a major component of all pre-hospital activities and integral to the effectiveness of all interventions to follow. This should firmly place 'assessment' on the pre-hospital research agenda.

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