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Table 7 Inductive qualitative content analysis of free-text responses in a paramedic spine survey, with illustrative quotations

From: Paramedic attitudes towards prehospital spinal care: a cross-sectional survey

MAIN CATEGORY

TENSION BETWEEN SMR-AS-DIRECTED AND SMR-AS-APPLIED

Categories

Complications and solutions in the application of SMR

Conflicting influences on how to apply SMR

Sub-categories

SMR causes motion

Direction from protocols and guidelines

 

Adverse effects of SMR

Training in the procedure and higher education

Efforts to minimize patient movement

Past experience with difficult/unusual situations

Suggested improvements

Knowledge of recent research

 

Influence of workplace culture

Illustrative quotations

• Patient discomfort with the c-collar seems lead to many cases of patients readjusting, pulling at, attempting to remove c-collar, leading to increased manipulation of the neck [The] “no-neck” [smallest] size seems to help with patient comfort and reduce this

• [Past practice] led to a vast number of unnecessarily boarded patients. Change in protocol and more leeway in critical decision-making during assessment led to improvement in this area

• More experience means comfort in defending/rationalizing my choice for SMR….Less willingness to treat in a certain way because “it’s always been that way.”

 

• I’ve grown tired of fighting with people who are intoxicated, combative, etc., and … think I can make a case that not wrestling with someone and allowing them to not be immobilized is safer for them than wrestling with someone I suspect is truly injured

• More research done showing many adverse effects

• [There is now] less fear in the workplace around disciplinary action towards not utilizing SMR