Background National guidance suggests that adult survivors of medical out-of-hospital cardiac arrest (OHCA) should be considered for direct transport to a specialist centre. Much of the research that informs this recommendation originates from urban environments where patients achieve rapid access to hospital. Little evidence could be found describing the decision-making profile and experiences of paramedics caring for OHCA patients and how conveyance destinations are currently selected.

Methods Qualitative inquiry was used to describe the experiences of paramedics caring for OHCA patients and to determine the factors which constrain or facilitate the direct conveyance to a specialist centre. Data was gathered from two socially distanced focus groups lead by a facilitator using a pre-determined topic guide. Nine paramedics took part in this service evaluation from a single regional UK ambulance service. Focus group conversations were recorded, transcribed, and coded using thematic analysis.

Results Factors considered by participants could be broadly categorised under five primary themes; available guidance, hospital features, non-technical factors (e.g. dealing with conflict), patient condition and clinical skills. Factors including proximity to hospital, access to specialist services and the availability of pre-hospital enhanced care were identified which resonated with existing literature. Additional issues including managing resistance from other healthcare professionals, decision making based on experience and a reliance on local guidance emerged from the project and were felt to be unexpected.

Conclusion Paramedics consider a range of factors when selecting a conveyance destination for survivors of medical OHCA, including the hospital’s distance from scene and access to specialist services. The patient’s stability and availability of enhanced care, in particular to manage agitation are also considered. Paramedics predominantly use local Trust guidance, rely on familiarity, or previous experience to help support their decision making and may need to overcome conflict from hospital colleagues to select an appropriate conveyance destination.