Between duty and discretion : paramedics and the implementation of emergency medical services policy with older persons in crisis in the community - a qualitative analysis
Date
1997
Authors
James, Pauline Marion
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
The study inquired, "how do paramedics implement Emergency Medical Services (EMS) policy with discretion, with older persons in crisis in the community?". The purpose of the study was to develop recommendations to reform EMS policy and practice during initiatives to regionalise health care in British Columbia. The method used was ethnography, and I rode the ambulance for ten months, in 1993. An ethical, investigative, participatory procedure was used to collect and analyse data. Sources included (a) field visits and notes, (b) interviews and focus groups, ( c) EMS legislation, regulations, policy and procedure manuals, reports, memoranda, and ( d) my personal journal. Findings confirmed that, in response to street-level dilemmas with older persons in crisis, paramedics implemented EMS policy with discretion. Seven discretionary decision-making processes were identified, and recommendations for EMS policy, planning, paramedic training and practice, including the implementation of guidelines and partnerships with community agencies, and future research, are discussed.