The informants found that internal procedures provided a good reference, and that they were easily accessible, updated at all times and useful in the treatment of patients. Jewkes (29) supports the use of written internal procedures and maintains that in the face of limited access to sophisticated equipment and varying competence levels among staff, standards can be improved by good procedures.
Inadequate competence enhancement
The informants were concerned that they often worked independently, but clearly signalled that they needed to be flexible in order to be able to work well with their partner, the doctor, the emergency call service and the hospital. The study also showed that ambulance personnel should boost their professional and interactive competencies, particularly considering the fact that several local authorities have entered into inter-municipal partnerships with respect to their accident and emergency services and that timing conflicts may arise that require them to work without assistance from, for example, the air ambulance service.
It may be necessary to introduce competence-enhancing measures into the education programme. The informants demonstrated clear frustration over the paramedic foundation course, which does not include the testing of skills in paediatric airway management. This suggests that the responsibility for skills training in paediatric airway management may rest with the practice field.
Because specialty training and a postgraduate degree is not a requirement for joining the service, there will be individual differences with respect to professional background. One of the reasons for this discrepancy among ambulance personnel is that vacancies are often advertised without citing specialty or postgraduate education as a minimum requirement. It may be useful to introduce mandatory postgraduate education in this field. The ambulance service often employs nurses, as seen from the sample.
Reflections on methodology
The first author works in the prehospital service and is therefore familiar with the field and the topic of our study. The second and third authors are less familiar with the field. A range of different backgrounds may be a strength for the study because we were able to identify different nuances within the data material. A small sample taken from a single region does not demonstrate breadth of knowledge, so we cannot know with any degree of certainty how prehospital staff in other areas perceive paediatric airway management. Nevertheless, the informants showed engagement and an interest in the questions we asked, which enabled us to collect nuanced data.
The focus group interviews constituted a strength because they facilitated discussion and reflection on the topics, and we felt that the material was sufficiently broad, varied and rich. It may nevertheless have been a weakness that there was a doctor included in only one of the three focus groups, because doctors train to a higher standard and may have acquired better knowledge of the study area. It may have been a strength that the analysis was conducted by two of the authors because the data was examined by more than one person.
The study shows that the informants were apprehensive about the prehospital treatment of children with acute and critical respiratory problems. They were unsure how to use medical equipment, had few opportunities to practise in order to maintain their competence, and their training was inadequate. Children who present with respiratory problems can therefore be a challenge for the prehospital service.
Several informants intimated that professional and interactive competencies were not consistently optimal throughout the emergency medicine chain. They wanted the required training so they would be able to provide health services of a high professional standard and maintain patient safety in emergencies and critical situations. The informants were looking for more high-volume training, internships and simulations in order to maintain their skills and competencies.
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