P040: Paramedic perception of their role in the emergency department

Abstract

Introduction: Inter-disciplinary interaction in the Emergency Department (ED) is critical for good patient care. The perception of paramedics’ experience in this interaction is not well described in the literature. This project gives voice to paramedics’ understanding of their role in the ED. Methods: Qualitative thematic framework analysis of digitally recorded, semi-structured, telephone interviews of 11 paramedics from one urban and one rural Paramedic Service in southwestern Ontario. Recordings and field notes were repeatedly reviewed and discussed by two researchers. A conceptual framework was constructed from themes emerging from the data. Results: Paramedics interviewed had 7-33 years of primary, advanced, or critical care experience. Three major themes emerged. (1) Patient advocate – Paramedics present the patient pre-hospital context and course of care information. They feel this information is essential and must be communicated. (2) Communication – Concerns raised that information is not listened to and valuable information is lost or ignored. A formal 30-second ‘pause’ for a structured paramedic to ED staff handover was seen as beneficial. Paramedics also want clinical feedback and outcome information from ED staff. No formal mechanism exists to obtain this. (3) Respect – When it exists, it is often based upon personal relationships between individuals. Paramedics feel when ED staff don't understand their scope of practice, their skills and abilities are ignored. In smaller EDs, paramedics also see themselves as a resource to help the ED staff with technical procedures. They need respect to do this. Conclusion: Paramedics’ perceive themselves as providing valuable information and advocacy for their patients in the Emergency Department. In order to present this information, they require uninterrupted time, as short as 30-seconds, for communication. Their relationship with the ED staff is further strengthened by mutual respect and understanding of each discipline's scope of practice and interdisciplinary teamwork. Paramedics would like more feedback on clinical outcomes and on their pre-hospital care. Some areas for practice change suggested by this study include: time for un-interrupted communication of pre-hospital information, formal feedback, and reflection on how to improve interdisciplinary interactions.