Paramedic-delivered teleconsultations: a grounded theory study

Richard Armour,John Tallon,Jennie Helmer

doi:10.1007/s43678-021-00224-6

Richard Armour, John Tallon + Show 1 more

Open Access

https://doi.org/10.1007/s43678-021-00224-6

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Abstract

ObjectiveProgression in Anglo-American models of out-of-hospital care has resulted in the development of alternative roles for paramedics, including advanced paramedics providing teleconsultations to frontline paramedics. Traditionally provided by physicians, little is known about how paramedics perceive peer-to-peer teleconsultations. This research aimed to explore paramedic perceptions of paramedic-delivered teleconsultations.MethodsThis investigation employed a constructivist grounded theory methodology. Six focus groups were conducted with purposive and theoretical sampling and data analyzed using open coding and continual comparative analysis.Results33 paramedics from across British Columbia, Canada, participated in the focus groups. Seven key themes emerged during the focus groups; the perceived roles and status of paramedic specialists and physicians in healthcare, the influence of relationships and culture on clinical consultations, practicalities of out-of-hospital care and the importance of lived experience, provision of appropriate clinical advice, professional trust and respect, mentorship in out-of-hospital care and clinical governance and education requirements. This led to the development of the grounded theory paramedics increasing ownership of their profession.ConclusionParamedics reported a number of areas in which paramedic-delivered teleconsultations provided benefits not seen with traditional physician-delivered teleconsultation model. Emergency health systems delivering an Anglo-American model of care should consider the possible benefits of paramedic-delivered teleconsultations.

Highlights

The out-of-hospital setting remains fraught with ambiguity, lacking diagnostic testing and imaging required to make definitive diagnoses
British Columbia Emergency Health Service (BCEHS) provides an Anglo-American model of out-of-hospital care, utilizing paramedics in the delivery of clinical care [12]
Primary care paramedic and advanced care paramedic staff within BCEHS most frequently engage with CliniCall and so members of staff holding these licenses with previous experience of both paramedic- and physician-delivered teleconsultations were purposively invited to participate

Summary

Introduction

The out-of-hospital setting remains fraught with ambiguity, lacking diagnostic testing and imaging required to make definitive diagnoses. Compounding this is the isolated nature of paramedic work, with limited access to specialist consultation or support in times of indecision or crisis. To mitigate this risk many paramedic services provide access to emergency teleconsultation services [1,2,3,4]. The majority of care is delivered by emergency medical responders and primary care paramedics, supported by advanced care paramedics and critical care paramedics in higher acuity and more complex cases [12]

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