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Paramedics play important roles in healthcare, yet little is known about their decision-making. There is evidence that thinking style is associated with individual preference for intuitive or deliberative decision-making.

Australian and New Zealand paramedics (n = 103; mean age: 38.7; mean 12 years’ experience; 44% female) and paramedic students (n = 101; mean age: 25.7; 59% female) completed a thinking style survey measuring active open-mindedness (AOT), close mindedness (CMT), preference for intuitive thinking (PIT) and preference for effortful thinking (PET). Participants also completed the 7-item Cognitive Reflection Test (CRT) to assess ability to override an attractive but incorrect intuition.

With prior exposure to the CRT controlled, regression analysis found increasing AOT and decreasing age predicted cognitive reflection across all participants (R2/R2 adjusted: 0.198/0.157; F(10, 192) = 4.752, p < 0.001). There were moderate correlations between CMT, age and paramedic experience. There was no difference between paramedics and student performance on the CRT, though more students reported prior exposure to the items (33.7 vs 16.5%; Chi-square (2) = 8.02, p = 0.02). Those who reported prior exposure to the CRT scored significantly higher than those who had not (5.08 [1.44] vs 3.87 [1.70]; F(2, 201) = 14.34, p < 0.001).

Self-reported AOT was associated with cognitive reflection and indicates a role for open-mindedness in paramedics to support decision-making.

Previous research has shown that paramedics form intuitive impressions based on limited “pre-arrival” dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied.

This was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years' experience (Range: 1–32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS) and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.

More participants exposed to the likely pre-arrival vignette recorded a final diagnosis of ACS, than those exposed to unlikely pre-arrival information (0.85 [95%CI: 0.78, 0.90] vs 0.74 [95%CI: 0.66, 0.81]; p = 0.03). This effect was greater in paramedics with more than 14 years' experience (0.94 [95%CI: 0.78, 0.99] vs 0.67 [95%CI: 0.48, 0.81]; p = 0.01). Answer fluency and confidence were associated with the impression, while the impression and confidence were associated with final diagnosis.

The authors have experimentally shown that pre-arrival information can affect subsequent diagnosis. The most experienced paramedics were more likely to be affected.

This is the first experimental study of diagnostic decision-making in paramedics and paramedic students.

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