Prehospital Clinical Decision-Making for Medication Administration for Behavioral Emergencies.

IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Annals of Family Medicine Pub Date : 2024-11-01 DOI:10.1370/afm.22.s1.4729
Samuel Ofei-Dodoo, Dustie Samuels, Lieu Nguyen Lowrie, Leah Duncan, Matthew Hoang
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Abstract

Introduction. Prehospital behavioral emergency protocols provide guidance on when a medication may be necessary; however, the final decision of which medication to administer to a patient is made independently by paramedics. This study sought to describe the clinical decision-making process of prehospital behavioral emergencies when paramedics consider chemical restraints, and determine the factors associated with choosing specific medications to administer. Methods. Paramedics from a Midwest County in the United States were surveyed in November of 2019. The survey consisted of two open-ended questions, measuring paramedics' clinical decision-making process and factors that they considered when selecting a medication. An immersion-crystallization approach was used to analyze the interviews. Results. There was a 53% (79/149) response rate. Six themes emerged regarding the paramedics' decisions to use medication for cases involving patients with behavioral emergencies: safety of the patients and paramedics; inability to use calming techniques; severity of the behavioral emergency; inability to assess the patient due to presentation; etiology of the behavioral episode; and other factors, such as age, size, and weight of the patient. Six themes emerged regarding factors paramedics considered when choosing which medication to use in behavioral emergencies: etiology of the behavioral emergency, patient presentation, the patient's history, the patient's age, desired effect and intended outcome of the medication, and other factors. Conclusion. This study suggests there are several factors, such as safety and the etiology of the behavioral emergency, that contributed to paramedics' decision-making. The results of this study could help Emergency Medical Services administrators in revising behavioral emergency protocols.

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行为紧急情况下的院前临床用药决策。
简介。院前行为急救协议为何时需要用药提供了指导;然而,对患者使用何种药物的最终决定是由护理人员独立做出的。本研究旨在描述院前行为紧急情况下护理人员考虑使用化学抑制剂的临床决策过程,并确定与选择特定药物治疗相关的因素。研究方法于 2019 年 11 月对美国中西部某县的护理人员进行了调查。调查由两个开放式问题组成,测量护理人员的临床决策过程以及他们在选择药物时考虑的因素。采用浸入-结晶法对访谈进行分析。结果。回复率为 53%(79/149)。医护人员在决定对行为紧急情况患者用药时出现了六个主题:患者和医护人员的安全;无法使用安抚技巧;行为紧急情况的严重程度;由于表现形式无法评估患者;行为发作的病因;以及其他因素,如患者的年龄、体型和体重。护理人员在选择对行为紧急情况使用哪种药物时考虑的因素有六个主题:行为紧急情况的病因、患者的表现、患者的病史、患者的年龄、药物的预期效果和预期结果以及其他因素。结论本研究表明,安全和行为紧急情况的病因等几个因素有助于辅助医务人员做出决策。本研究的结果可帮助急救医疗服务管理者修订行为急救协议。
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来源期刊
Annals of Family Medicine
Annals of Family Medicine 医学-医学:内科
CiteScore
3.70
自引率
4.50%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Annals of Family Medicine is a peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve.
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