Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study

Abstract

Introduction: Children with head injury are commonly transported to the ED by ambulance. However, most of those conveyed are deemed non-serious and are discharged at triage. Research is needed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED, and to establish whether a clinical decision tool designed to support them would be beneficial.

Methods: A generic qualitative approach, comprising semistructured interviews with front-line ambulance paramedics working in the UK. Interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Interviews aimed to explore the factors that influence paramedics when deciding to convey children with minor head injury to the ED.

Results: A total of 20 paramedics from several ambulance services participated in interviews. Three overarching themes were identified: 'we just take them in'; 'there are too many hurdles'; 'creating the right tool'. These were further categorised into subthemes. Paramedics do not feel confident when assessing and managing children with head injury, and convey children to hospital due to fear of consequences, despite knowing there will be no intervention in the ED. Further education, a prehospital paediatric clinical decision tool and greater support from Ambulance Trusts would be welcomed by paramedics. Criteria such as: parental anxiety; time; wound closure; policy and non-accidental injury need to be considered in a clinical decision tool designed to support paramedics' management of children with head injury.

Conclusion: Paramedics generally feel a lack of confidence in assessing and managing children with head injury. A decision tool, coupled with training and useful feedback from EDs following conveyance, would be useful to help improve decision-making.

Keywords: admission avoidance; pediatric injury.