title: Decision-making by ambulance clinicians in London when managing patients with epilepsy: a qualitative study.
abstract: BACKGROUND
  In the UK, epilepsy is the neurological condition with the highest rate of accident and emergency department re-attendance, with most arriving by ambulance. Ambulance clinicians triage patients and assess their need for attendance. This study examined the decision-making process of ambulance clinicians in these situations.
  
  
  METHODS
  In-depth interviews with 15 ambulance clinicians working in South London.
  
  
  RESULTS
  Interviewees identified that epileptic seizures that self-resolve present a triage challenge. They reported insufficient training and guidance available for these situations and substantial reliance on experience to direct their practice. Fears of litigation in the event of complications, pressures of public expectation and limited on-scene access to relevant patient information or appropriate alternative care pathways were reported to be significant factors influencing decisions for care for epilepsy seizures.
  
  
  CONCLUSIONS
  Ambulance clinicians reported negotiating a balance between patient safety and patient choice, when deciding whether to transport a patient with epilepsy to hospital or not. Clinician fears and the pressures and limitations of practice may result in hospital conveyance being used as a safety precaution in some instances.
  
  
  CONCLUSIONS
  Decisions regarding conveyance of patients with epilepsy in this study were substantially guided by ambulance clinician experience rather than by robust training and guidelines. This study supports the need for improved guidance that addresses this common area of practice and the development of alternative care pathways that may be used by ambulance clinicians for patients with epilepsy.
authors.affiliation: Faculty of Health and Social Care, Kingston University and St George's University of London, London, UK. lisa.hollings@lond-amb.nhs.uk
authors.forename: Lisa
authors.initials: L
authors.lastname: Burrell
authors.forename: Adam
authors.initials: A
authors.lastname: Noble
authors.forename: Leone
authors.initials: L
authors.lastname: Ridsdale
mesh_terms: D000552:Ambulances; D003657:Decision Making; D004634:Emergency Medical Technicians / Q000523:psychology*; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D017408:Guidelines as Topic; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008131:London; D008297:Male; D011361:Professional Competence; D036301:Qualitative Research; D014218:Triage