Exploring Paramedics' Perspectives on Paediatric Head Injury in Prehospital Care: Qualitative Study

Area of Science:

• Emergency Medicine
• Paediatric Care
• Prehospital Care

Background:

• Paediatric head injury is a frequent cause for emergency calls, with a subset of patients experiencing rapid deterioration.
• Paramedics, as the initial clinical contact, encounter uncertainty due to a lack of paediatric-specific tools, limited experience, and high-pressure environments.
• Existing literature underrepresents paramedic perspectives on paediatric head injury assessment.

Purpose of the Study:

• To investigate paramedics' experiences and decision-making processes during prehospital assessment of children with suspected head injuries.
• To explore paramedics' perceptions of current hospital-based clinical decision rules and their applicability to out-of-hospital settings.

Main Methods:

• A qualitative study employing an interpretivist approach with 37 paramedics from the North West Ambulance Service NHS Trust.
• Semistructured virtual interviews were conducted to gather data on clinical assessment, decision-making, family communication, and views on guidelines.
• Inductive reflexive thematic analysis was used to analyze transcribed and anonymized interview data.

Main Results:

• Paramedics face challenges due to children's developmental differences, communication barriers, and subtle symptoms, requiring significant vigilance.
• Limited exposure, training gaps, and emotional pressures related to safeguarding contribute to paramedic uncertainty and frustration with adult-oriented tools and rigid guidelines.
• Clinical decision rules offer structure and defensibility but raise concerns regarding safeguarding, compensatory physiology, and relevance to non-conveyance decisions.

Conclusions:

• Prehospital paediatric head injury assessment is influenced by complex clinical, emotional, and systemic factors.
• Enhancing paediatric head injury care necessitates the development of paediatric-specific decision tools and integrated training.
• Systemic changes are needed to support, rather than override, paramedic professional judgment in managing paediatric head injuries.