factors affecting emergency medical technicians’ on-scene decision-making in emergency situations: a qualitative study

Introduction: to save lives and reduce the disability and death of the patients, emergency medical technicians (emts) must make timely decisions in complex and, sometimes, life-threatening situations. since the pre-hospital decision-making is a continuous and important process. objective: the present study aims to identify the factors affecting emts’ on-scene decision-making in emergency situations. methods: a qualitative approach using in-depth semi-structured interviews and field observations was employed to explore the factors influencing emts’ on-scene decision-making in emergency situations. purposeful sampling was performed with 19 participants including 12 emts, 3 dispatchers, 3 medical directions physicians and one ems manager as a policy maker. interviews were conducted from october 2018 to march 2018 and the data were analyzed using graneheim and lundman’s content analysis approach. results: eight categories and 18 sub-categories emerged to describe the factors effective in emergency medical technicians’ on-scene decision-making. they were cultural context (community’s culture and organizational culture), interactions (malingering, threat and violence and considerations), competencies (acquisitive and intrinsic); personal feeling (positive feeling and negative feeling), authority (structural and in processing), education (public and professional), special conditions (patient’s clinical situation, weather conditions, mission’s time and mission’s location), and organizational resource (facility and equipment, and human resources). conclusions: to facilitate emts’ on-scene decision-making, it is recommended to clarify the emts’ responsibilities, promote the community’s culture, modify people’s expectations, police monitoring and control and value the star of logo on emts' uniform. the emts’ on-scene decision-making process should also be explored.