Paramedic decision-making and the influence of bias: a case study

Abstract

Background: Prehospital clinical decision-making is a complex, evolving skill. Typically, there are multiple possible diagnoses and several potential treatment pathways to be considered, and usually prehospital clinicians have to base their decisions on imperfect information. Biases will inevitably compete to influence clinicians as they attempt to weigh the probabilities of diagnoses, degrees of certainty and permissible risks in their decision-making process. With experience, as intuition and tacit knowledge develop, paramedics will depend less on explicit knowledge and algorithm-based decision-making tools. Paramedics must strive to strike the right balance between the intuitive and analytical aspects of clinical decision-making, while maintaining an awareness of the human factors that will influence them in this process if optimal clinical decisions and therefore patient outcomes are to be achieved. This case study illustrates complex decision-making in the prehospital setting, with a focus on the influence of bias.