Background Only 10% of 999 calls are for people with life-threatening emergencies; up to 1/3 callers have needs that could be met by community based care. CCDS supports paramedics to assess patients and make decisions about onward care, aligning with policies to standardise patient care, promote community based care pathways, enhance paramedic decision making skills, reduce emergency admissions to hospital, and improve quality of care. CCDS has been shown to improve processes of care in other settings however there is little evidence in the emergency care setting. The aim of this research was to study the adoption of CCDS by paramedics and its impact on their role and practice.

Methods This qualitative study was conducted alongside a cluster randomised trial of the costs and effects of CCDS in two ambulance services (AS). We invited all intervention group paramedics to participate in interviews or focus groups to explore their use of CCDS and their views on its impact on role and practice. We used the ‘Framework’ approach to data analysis, underpinned by Strong Structuration Theory, a theoretical framework for studying innovation based on the relationship between what people do and their context.

Results 20/22 (17 male and 5 female) paramedics participated, with an average age of 39, and paramedic experience of 3 to 20 years. Paramedics reported low CCDS usage, particularly at one AS where problems with implementation persisted. Higher usage was reported at the AS where systems existed to support technology implementation. Use of CCDS was influenced by policy context (e.g. time-based performance pressures), organisational context (e.g. technological readiness), the paramedics’ own skills and attitudes (e.g. towards non-conveyance/use of technology) and the technology itself (e.g. usability). Paramedics reported that CCDS generally supported their decision making, provided documented evidence of their patient assessment, prompted them to do all the necessary checks and honed their skills with this patient group. However, they raised doubts about its usefulness and the time required to use it. In principle there was support for the potential of CCDS, it was not seen as a threat to paramedic autonomy but as another tool in the kit bag.

Conclusion Although paramedics felt that CCDS could support their decision making role in the future, across a range of patient conditions, in this trial usage was low. Organisational readiness and support for implementation is critical.