A Modified Delphi Process to Develop Consensus Definitions of Time-Dependent Care by Paramedic Services Systems

Just as prospective differentiation between true emergencies and calls for subacute patients is critical to the delivery of prehospital care, retrospective differentiation is critical to research and quality improvement. Determining the acuity of patients based on the type of care they received could complement the vital-sign-based instruments currently popular, yet imperfect. The study aim was to create a consensus definition of time-dependent care and a list of time-dependent interventions in paramedicine.

The study was a Delphi approach consisting of four rounds of voting by a bi-provincial panel of 22 Canadian key informants representing medical first responders, paramedics, and physicians - first to agree on a definition of time-dependent care - then to categorize 29 clinical and 34 pharmacological interventions.

Based on the consensus definition of "A majority of patients who should receive the intervention, according to provincial protocols, would suffer a direct prejudice to their health or safety if the intervention, provided on its own, was not performed within eight minutes of the initial call," the panel reached consensus on 52 of 63 interventions (82.5%), of which 17 (32.7%) were voted time-dependent (11 clinical [64.7%] and six pharmacological [35.3%]). Clinical interventions included airway suction or de-obstruction, cricothyrotomy, positive pressure ventilation, chest decompression, cardiopulmonary resuscitation, defibrillation, cardioversion, pacing, and hemorrhage control. Pharmacological interventions included medication classed as sympathomimetics, caloric agents, antiarrhythmic agents, anticonvulsants, or tranquilizers.

The panel reached a consensus on a definition of time-dependent care and used this to identify prehospital interventions that could serve as an instrument to improve care and system performance.