Further definition of critical incidents in paramedics' work.
International emergency nursing · 2025-05-09 · Qualitative study
Abstract
INTRODUCTION: Paramedics operate in unpredictable, fast-paced, and high-risk environments, yet their profession is profoundly centered on human interaction. This study aimed to define, through a unifying analysis, the critical incidents in paramedic work. METHODS: This qualitative study utilized three previously published listings of critical incidents among paramedics from the United States, Germany, and Denmark and e-survey data of Finnish paramedics. A directed content analysis was applied. RESULTS: The previously identified critical incidents formed two main categories. The first, 'Challenging situations or circumstances faced during Emergency Medical Service (EMS) missions', had five categories: 'Accidents, threats, and violence targeting EMS personnel'; 'Mistakes'; 'EMS missions identified within one's own personal life'; 'Psychologically challenging interaction situations'; and 'Working conditions that involve experiences of failure or unreasonableness'. The second main category, 'Ethically burdensome and professionally demanding patient outcomes', also had five categories: 'Facing mutilated bodies and death'; 'Children and youth as victims of illness, severe accidents, or crimes'; 'Tragic patient outcomes involving injustice and misfortune'; 'Mass casualty incidents'; and 'Situations caused by intentional acts of others'. The unifying analysis proposed 34 critical incidents. The largest number of different critical incidents was identified in categories of 'Accidents, threats, and violence targeting EMS personnel' (7), 'Psychologically challenging interaction situations' (6), and 'Children and youth as victims of illness, severe accidents, or crimes' (6). CONCLUSIONS: The unified listing should be tested in various countries to assess its comprehensiveness and, if necessary, refine and supplement the critical incidents in paramedic work.