Acute trauma alarms in Norway - a qualitative study of factors influencing primary care doctors’ decision to call out

Abstract Background In Norway, primary care doctors (PCDs) participate in prehospital trauma care. PCDs must decide whether to call out based on limited information shortly after a trauma incident. The Emergency Medical Communication Centre (EMCC) sends a short primary voice message containing the most important information. Although this information is often limited, it is one of several important factors influencing the decision to call out. Experienced PCDs may identify cues in the available information to help them decide. Methods This was a qualitative interview study exploring factors that influence PCDs’ decision-making on whether to call out to acute trauma incidents. Twenty PCDs who had received acute trauma alarms from the EMCC were included. Data from the interviews were analysed using systematic text condensation. The results were discussed in light of Klein’s Recognition-Primed Decision model and Kahneman and Tversky’s Heuristics-and-Biases Framework. Results We identified five main themes through which PCDs’ reflections provided insights into their decision to call out to a specific acute trauma incident: (1) Limited but sufficient information; (2) The dilemma of severity versus distance; (3) Managing the risk of concurrent conflicts; (4) Professional responsibility made the difference; and (5) Competence and collaboration among emergency primary care personnel. Conclusions In spite of limited information in the primary voice messages the PCDs stated that the message were an important factor deciding whether to call out. Experienced doctors reported using cues for guidance, consistent with Klein’s Recognition-Primed Decision model. However, decisions may at times be influenced by heuristic-based intuition. PCDs should be aware of cognitive biases. The PCDs reported several factors influencing their decision to call out, such as the patient’s vital signs, type of trauma, and mechanism of injury. However, these considerations were often overshadowed by time constraints. Not surprisingly, long distances, uncertainty about the time required at the incident scene, and concurrent conflicts were important reasons for not calling out. Despite these challenges, the PCDs emphasised a strong professional commitment to call out when needed as part of the prehospital trauma care team.