Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study

Participants in this multi-round survey study will be paramedic leaders and emergency medical services medical directors/physicians from across Canada. In the first round, participants will identify instances of clinical decision making they feel are important for patient outcome and safety. On the second round, the panel will rank each instance of clinical decision making in terms of its importance. On the third and potentially fourth round, participants will have the opportunity to revise the ranking they assigned to each instance of clinical decision making. Consensus will be considered achieved for the most important instances if 80% of the panel ranks it as important or extremely important. The most important instances of clinical decision making will be plotted on a process analysis map.The process analysis map that results from this Delphi study will enable the gaps in research, knowledge and practice to be identified.Clinical Decision Making (CDM) (also known as clinical reasoning, clinical judgment) has been defined and studied in medicine over the last few decades [1]. Other health professions have also investigated how practitioners made decisions, such as nursing [2,3]. However, to date, very little research on CDM has been conducted in the paramedic population. Presumably, weak abilities in CDM lead to clinical errors, which are prevalent in healthcare [4] and are often the causes of lapses in patient safety. Therefore, CDM is an essential component of the body of research on patient safety, as it relates to emergency medical services (EMS).The care that patients receive in the out-of-hospital setting likely has important repercussions on clinical outcome and patient safety. Patient assessment and treatment can vary substantially, from simple ambulance runs to calls that require expedient decision making and action by paramedical personnel. There are many factors that can influence outcome, including the acuity of the patient's injury or illness, the lo