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A Paramedic’s job revolves around making informed decisions to deliver the most effective care for patients. The prehospital environments are called to have unpredictable and dynamic features which require paramedics to use a flexible and creative approach to decision-making. (Reay, 2018) . The paramedic role is also a forever changing and evolving one to adapt to the new and growing pressures put on the NHS. This progression in their role brings about an increased need for Paramedics to have exceptional decision-making skills. Responsibilities such as independent prescribing, while carrying out a response to an emergency call, is a perfect example of the need to be able to make judgments, while taking into account several factors, including published standards and regulations set by professional bodies such as the Health and Care Professional Council (HCPC), ethical considerations and patient-focused principles (Collen, 2017). This essay aims to explore and assess these factors and how they influence a paramedic in practice.
Protocols and guidelines are designed to inform paramedic interventions that influence every stage of care delivery. (Thompson, 2013) The HCPC provides Paramedics with regulations to assure the public of a level of competence from individual clinicians (Eaton, 2019). They have published standards that give vital information about the requirements of healthcare professionals. This includes standards of proficiency, conduct, performance, and continuing professional development. (HCPC)These regulations are there, not to be approached with fear of the regulator but instead, the published standards should be used to guide you alongside your values, morals, and standards. This factors directly into a paramedic’s decision-making process as they use this as a baseline and work up from here. It also ensures standardization in practice from different ambulance services across the country. Care provided is done so, directly and indirectly, in line with published standards, ethical considerations, laws and legislation, best practice guidance, and patient-focused principles. (Collen, 2017) The nature of a paramedic’s job is constantly changing, meaning the HCPC has molded its Standards of Proficiency around this. Section 3.3 states a paramedic must keep your knowledge and skills up to date and relevant to your scope of practice through continuing professional development (CPD) (Health and Care Professional Council, 2016). CPD allows confidence in practice to grow over time but also diminishes risks of poor outcomes as reflection is carried out, so the same mistake isn’t made twice. (Collen, 2017) Reflection involves a conscious process in response to a negative feeling. Reflexivity can influence the process of decision-making. (Bellot, 2006). This is mirrored in the ‘novice to expert’ model which shows the progression from a novice in healthcare practice, through certain levels of competence and eventually being an expert in that field (Appendix A). Dreyfus and Dreyfus concluded that reflection and deliberation should certainly be sought whenever there is time and serious consequences are involved therefore emphasising reflection and CPD allows for the aforementioned advancement in practice. (Stuart E. Dreyfus and Hubert L. Dreyfus)
Human error can lead to catastrophic consequences. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provides a pocketbook resource that can be used to back up decision-making in practice. For example, stressful situations can cause judgment to be clouded and human errors to be made. The use of the JRCALC pocketbook allows a clear, direct path to dosage as it includes an extensive medicines formulary and Page for Age tables, which make medicines administration safer (Amazon). This allows factors that can impact decision-making, such as stress and panic to be avoided, and effective treatment plans to be made in crises, lowering the risk of mistakes.
A paramedic responds to an emergency as part of a larger group of healthcare and emergency responders. There is a level of teamwork required in these situations which allows effective decisions to be made for the whole thing to run as smoothly as possible as it reduces uncertainty and anxiety surrounding work demand (Lemieux-Charles et al, 2002). In the NHS practitioners are told to follow the core values, which include ‘working together for patients’ (NHS, 2021). This allows all healthcare professionals to have the same baseline morals and ethics, allowing decision-making to be made easier as they have shared values. However, there can be certain barriers that are encountered in practice that make clinical decision-making difficult. These barriers include time, incomplete facts, stress, or seniority barriers. (JRCALC, 2019) Working in a team allows for these barriers and challenges to be overcome, for example, stress can be decreased when working together as a team as tasks can be delegated and questions can be asked to allow for the most effective treatment plan to be formed. Error can also be avoided if double checking of each other’s work occurs. During the issuing of drugs, a good practice is to pass the intended drug to a team member and get them to check. There is insufficient evidence that double versus single checking of medication administration is associated with reduced harm (Koyama, Alain K et.al ). This can therefore avoid errors such as wrong dosage.
As well as working as a team, Paramedics work with other healthcare professionals, such as doctors, to provide the best level of care they can. South Central Ambulance Service supports the call that if you decide that a patient with a non-life threatening presentation requires further medical level interventions or diagnostics, then consulting with a GP or OOH provider, before the conveyance decision is made, can help to determine where the most appropriate patient care is delivered and by who (SCAS)
Knowing ethical principles and legal concepts helps clinicians to decide which path is the better option during a difficult decision. Understanding how to navigate such concepts and principles is key to personal and professional development, as well as the continued growth of the paramedic profession as a whole. (Eaton, 2019) Across medical disciplines, professionals are expected to put the needs of their service users first, even if it involves self-sacrifice. (Downie, 1988) This aligns with beneficence, which is the principle that focuses on medical professionals doing good for their patients. Non-maleficence is another principle that influences the ethics of a paramedic’s decision-making, with the focus that a medical practitioner must do no harm or allow harm to be caused to a patient through neglect. (The Medical Portal) Having these key principles at the forefront of a paramedic’s thinking allows them to make informed decisions while being confident in their judgments.
Being ethical means that a paramedic must be able to respond and adapt to conflicting values. Difficult situations can arise when a patient’s wishes do not align with a paramedic’s judgment. If a patient refuses treatment, the decision must be respected, even if it’s thought that this refusal could result in serious harm. (NHS) The paramedic must respect and adapt, bearing in mind the concept of consent and person-centered values to act in the patient’s best interests.
Communication is a vital part of a paramedic’s role. The process in which a person can convey their ailment relies on how effective the actual communication is. If it’s poor the treatment could be wrong for the patient, ending in a bad outcome.
To summarise a paramedic comes in contact with many challenges that can affect and cause their decision-making judgements to be altered. They are provided with skills, knowledge, and resources that allow them to overcome these challenges and enable them to respond in an appropriate and worthwhile manner.
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