‘Send everyone, it’s my son’ – Combined Glaserian grounded theory and thematic analysis of paramedics attending their own families

Abstract

Introduction: Medical clinicians treating relatives is ethically complex; in paramedicine, the time-critical nature of pathologies often precludes alternative treatment without risking morbidity or mortality. Aims: This project had three aims: firstly, to retrieve baseline data for thematic analysis on the experiences of paramedics who have attended their own families; secondly, to generate explanatory grounded theory; and finally, to translate these findings into recommendations for practice. Methods: Glaserian grounded theory and thematic analysis methods were both undertaken using a realist perspective. Acquiescence, wording, and habituation heuristics were mitigated in the interview design. There were 44 responses (n = 93 instances of treating family), with 21 participants (n = 34) from three countries interviewed. Saturation was determined using both Guest et al.'s and Thorne's criterion. Semantic and latent themes were generated inductively via a five-step process, with grounded theory generated simultaneously via a three-step Glaserian process. Cohen's kappa ranged from 0.82 to 0.93. Results: Incidents were both traumatic (hangings, stabbings, traumatic arrests) and medical (paediatric arrests, cardiac arrests, overdoses). The core concept-category was ‘conflict between the roles of clinician and relative’. Paramedics reported a sympathetic hyperarousal response that they quickly suppressed, a rapid transition into ‘work mode’, and difficulty obtaining their normal state of flow, balancing dual roles as clinician and relative, transitioning out of work mode and into becoming a carer, and simultaneously processing the event. Organisational responses were frequently described as inadequate. Paramedics reported short-term experiences consistent with an acute stress response, and a large proportion suffered long-term, life-altering consequences. It is theorised that this phenomenon disrupts professional detachment, increases outcome self-expectations, interrupts normal routines, and promotes overmedicalisation. Conclusion: This research provides baseline data and theory on the experiences of paramedics attending their own families. Five themes and 24 subthemes were identified, an explanatory theorem proposed, and a preliminary set of eight recommendations for translation into practice provided.