Background In dynamic pre-hospital environments responders of varying skills, competence and experience must promptly form ad-hoc teams. Leadership has been identified as crucial for responder safety and patient outcomes. However, a universal approach to identifying the clinical leader at pre-hospital incidents is not apparent and pre-hospital literature appears sparse. Therefore, the project sought to identify who pre-hospital personnel perceive to be the clinical leader, factors contributing to these perceptions and if personnels’ perceptions varied based upon their clinical role.

Methods The project recruited pre-hospital personnel responding on behalf of Yorkshire Ambulance Service including non-registered ambulance personnel, paramedics, paramedics with specialist roles, and pre-hospital doctors. 40 participants completed an online questionnaire sharing who they identified as the clinical leader, their rationale and valuable leader attributes. In a second questionnaire, five participants read three evolving prehospital scenarios and shared factors which may change their leadership perceptions through open ended questions. Descriptive analysis and a ‘Codebook’ thematic analysis drew common themes from responses to present participants perspectives.

Results Communicating effectively was unanimously ranked the top clinical leader attribute. Contributing factors identified included interpersonal attributes, perceived seniority, clinical role, skill level, and task specific variables. Pre-hospital doctor participants placed a greater emphasis on experience in leader selection whereas non-doctor participants appeared to value clinical skill level to a greater extent. Non-doctor participants frequently commented that doctors should take over clinical lead upon their arrival.

Conclusion There was not a consensus on who pre-hospital personnel perceive to be the leader, or a universal approach to leader selection. Effective leader attributes were unanimous amongst personnel, however the attributes used to select a leader in practice appeared to vary based upon the personnel’s role, a new finding warranting further investigation.