title: Qualitative study of paramedics' experiences of managing seizures: a national perspective from England.
abstract: The UK ambulance service is expected to now manage more patients in the community and avoid unnecessary transportations to hospital emergency departments (ED). Most people it attends who have experienced seizures have established epilepsy, have experienced uncomplicated seizures and so do not require the full facilities of an ED. Despite this, most are transported there. To understand why, we explored paramedics' experiences of managing seizures.
  
  
  
  Semistructured interviews were conducted with a purposive sample of paramedics from the English ambulance service. Interviews were transcribed and thematically analysed.
  
  
  
  A diverse sample of 19 professionals was recruited from 5 different ambulance NHS trusts and the College of Paramedics.
  
  
  
  Participants' confirmed how most seizure patients attended to do not clinically require an ED. They explained, however, that a number of factors influence their care decisions and create a momentum for these patients to still be taken. Of particular importance was the lack of access paramedics have to background medical information on patients. This, and the limited seizure training paramedics receive, meant paramedics often cannot interpret with confidence the normality of a seizure presentation and so transport patients out of precaution. The restricted time paramedics are expected to spend 'on scene' due to the way the ambulance services' performance is measured and that are few alternative care pathways which can be used for seizure patients also made conveyance likely.
  
  
  
  Paramedics are working within a system that does not currently facilitate non-conveyance of seizure patients. Organisational, structural, professional and educational factors impact care decisions and means transportation to ED remains the default option. Improving paramedics access to medical histories, their seizure management training and developing performance measures for the service that incentivise care that is cost-effective for all of the health service might reduce unnecessary conveyances to ED.
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Noble
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: Darlene
authors.initials: D
authors.lastname: Snape
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Goodacre
authors.affiliation: North West Ambulance Service NHS Trust, Bolton, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
authors.forename: Frances C
authors.initials: FC
authors.lastname: Sherratt
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Clinical Sciences Centre, Liverpool, UK.|Aintree Health Outcomes Partnership, University of Liverpool, Clinical Sciences Centre, Liverpool, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Pearson
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Clinical Sciences Centre, Liverpool, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Marson
mesh_terms: D000552:Ambulances; D001291:Attitude of Health Personnel; D004632:Emergency Medical Services / Q000458:organization & administration; D004634:Emergency Medical Technicians / Q000193:education*; D004739:England; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D000069342:Medical Overuse; D036301:Qualitative Research; D012640:Seizures / Q000628:therapy*
keywords: ACCIDENT & EMERGENCY MEDICINE; EDUCATION & TRAINING (see Medical Education & Training); QUALITATIVE RESEARCH