Managing Uncertainty in Paramedics’ Decision Making

The objective of this article is to improve the understanding of uncertainty in paramedics’ work and the strategies they employ to manage uncertainty, and to provide a resource for training novices. Managing uncertainty is an important part of paramedic decision making and may have a direct impact on patient’s health. Yet, uncertainty has not been sufficiently examined in the naturalistic decision-making paradigm. Therefore, in this study I looked at the uncertainty paramedics have to deal with in nonroutine situations and the strategies they use to manage it. I conducted critical decision method interviews with nine paramedics from paramedic-only ambulance crews. To study uncertainty and coping strategies, I used the RAWFS (reduction, assumption-based reasoning, weighing pros and cons, forestalling, and suppression) heuristic framework. As hypothesized, types of uncertainty were predicted by incident phase, and the coping strategies were predicted by both incident phase and type of uncertainty. The most prevalent type of uncertainty was inadequate understanding of the situation, and the strategy most used to manage uncertainty was reduction. I describe specific examples of cases of uncertainty and the strategies used by paramedics, with the aim of providing materials for training the novices.