Clinical decision making in paramedic practice

In the prehospital environment, paramedics are required to make daily clinical decisions, often rapidly, to ensure the provision of appropriate treatment and care. Decisions made by paramedics have a major impact on the lives, clinical outcomes, safety, health and wellbeing of their patients. This renders clinical decision-making capabilities an integral part of paramedic practice.

Paramedics must recognise that decision making is not the same as problem solving; however, the two are interchangeable in that one complements the other. Decision making is defined by Dowie (1993) as the assessment of the alternative and argues that such decisions are based on assessments of the future, with ethical and legal considerations. Problem solving on the other hand is a systematic process that focuses on analysing a difficult process, after which a decision will be reached (Cork, 2012).

The subject of how paramedics make decisions is being covered more frequently in the literature; however, it is still largely unexplored when compared with other health professions. Decision making in a clinical context has however been heavily studied by many authors over the last 50 years, and each seems to offer different terminology to describe the same concept. What was described as clinical reasoning by Carnevelli et al (1984) was described as clinical decision making by Field (1987) and clinical judgment by Thompson and Dowding (2009).