Ambulance professionals' adaptations in prehospital services: a critical incident study

The working environment for ambulance professionals in prehospital services is complex, dynamic, and associated with a high degree of unpredictability. It is therefore essential that ambulance professionals adapt to provide high-quality and safe care, yet the research literature on how they successfully adapt in their everyday work remains sparse. The aim of this study is to address this knowledge gap by exploring adaptations in the context of prehospital services, through ambulance professionals' descriptions of successful missions.

A qualitative descriptive study was conducted using the Critical Incident Technique methodology for data collection and analysis, the latter through the processes of re-storying and cross-incident analysis. Twenty semi-structured individual interviews were conducted between October 2023 and May 2024 with ambulance professionals, including licensed ambulance medical technicians and paramedics with dual licensing or other additional medical licenses across four ambulance stations in Norway with contrasting geographical locations.

A wide range of successful adaptations were described by the ambulance professionals and grouped into seven core themes: (1) Adaptations in mission planning; (2) Practical adaptations; (3) Time-critical adaptations; (4) Personal adaptations; (5) Task-focused adaptations; (6) Adaptations in stakeholder coordination; (7) Adapting to patients and informal caregivers.

This study provides insight and new knowledge about successful adaptations in prehospital services and illuminates the variety of adaptations ambulance professionals make in different contexts. Trust is an underlying feature for successful adaptations, while communication is the overall predominant feature, especially vital in stakeholder coordination and decision-making processes impacting team efforts and mission efficiency. Further research should provide insight into cross-occupational and cross-stakeholder collaborative processes.