A Simulation-Based, Qualitative Assessment of Decision Making Among Critical Care Transport Crews

Objective: The breadth and complexity of care in the out-of-hospital environment are increasing. The clinical decision-making process of emergency medical services clinicians is not well understood. Methods: This study aimed to analyze the process of critical care transport clinicians using simulated scenarios with structured debriefing. Members of a critical care transport team completed a simulation session during which they cared for a medical or trauma patient with airway management concerns. A standardized debriefing exploring their decision-making process was performed after the simulation session, recorded, and transcribed. Thematic analysis was performed to uncover themes related to the clinical decision making that took place. Results: A total of 8 subjects (5 nurses and 3 paramedics) completed simulation sessions including 5 medical and 3 trauma scenarios. The median years of experience in critical care transport was 15. The following 3 themes emerged from the quantitative analysis: (1) participants felt that the scenarios were realistic and applicable to their daily practice, (2) participants felt that the scenarios required them to think critically, and (3) participants relied on established protocols combined with experience for their clinical decision making. Conclusion: During the simulated care of complex patients with airway management concerns, critical care transport clinicians made complex decisions by using a combination of standing protocols, experience, and foundational knowledge.