Objectives The UK ambulance service is expected to now manage more patients in the community and avoid unnecessary transportations to hospital emergency departments (ED). Most people it attends who have experienced seizures have established epilepsy, have experienced uncomplicated seizures and so do not require the full facilities of an ED. Despite this, most are transported there. To understand why, we explored paramedics’ experiences of managing seizures.
Design and setting Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed.
Participants A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics.
Results Participants’ confirmed how most seizure patients attended to do not clinically require an ED. They explained, however, that a number of factors influence their care decisions and create a momentum for these patients to still be taken. Of particular importance was the lack of access paramedics have to background medical information on patients. This, and the limited seizure training paramedics receive, meant paramedics often cannot interpret with confidence the normality of a seizure presentation and so transport patients out of precaution. The restricted time paramedics are expected to spend ‘on scene’ due to the way the ambulance services’ performance is measured and that are few alternative care pathways which can be used for seizure patients also made conveyance likely.
Conclusions Paramedics are working within a system that does not currently facilitate non-conveyance of seizure patients. Organisational, structural, professional and educational factors impact care decisions and means transportation to ED remains the default option. Improving paramedics access to medical histories, their seizure management training and developing performance measures for the service that incentivise care that is cost-effective for all of the health service might reduce unnecessary conveyances to ED.
- ACCIDENT & EMERGENCY MEDICINE
- EDUCATION & TRAINING (see Medical Education & Training)
- QUALITATIVE RESEARCH
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Contributors AJN conceived of the study and designed it together with DS, AM, SG, MJ and MP. DS, AJN and FCS planned and completed the analysis. AJN wrote the manuscript, with revisions being made by DS, FCS, AM, SG, MJ and MP. All authors read and approved the final manuscript.
Funding This project was funded by a University of Liverpool Knowledge Exchange and Impact Voucher (KE&I Noble).
Disclaimer The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the University of Liverpool.
Competing interests None declared.
Ethics approval The University of Liverpool's Institute of Psychology, Health and Society Research Ethics Committee approved the study (IPHS-1516-38).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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