Paramedic Clinical Judgement and Decision-Making of Mental Illness in the Pre-Hospital Emergency Care Setting: A Case Study of Accounts of Practice

Thumbnail Image
File version
Primary Supervisor

Wyatt-Smith, Claire

Other Supervisors

Cumming, Joy

File type(s)

The introduction of legislation governing the management of mental illness in Queensland led to complaints from paramedics and their industrial association to the Commissioner of the Queensland Ambulance Service regarding the inadequacy of education and training to fulfil their new practice obligations. The industrial association asserted that their members were ill-prepared, insufficiently skilled, and unsupported professionally to make clinical judgements and decisions about mental illness in the pre-hospital emergency care setting. Furthermore, they raised concerns that their members were at significant risk of harm from patients with mental illness, and that they were vulnerable to litigation for actions of negligence and breaches of duty of care that were a direct result of the inadequacy of their education and training. These concerns, coupled with a lack of published literature that might address them, highlighted the need for a deeper understanding of how paramedics accomplish clinical judgement and decision-making of mental illness in the field, and the factors that influence this aspect of their work. Integral to the concerns were questions about the relationship between the formal expectations of paramedic practice—in the form of legislation and clinical policy—and their actual judgement practice in the field. At issue in this study was the preparedness of paramedics to recognise, assess, and manage mental illness in everyday practice and the sufficiency of education and training programs, clinical standards, policy, and legislation for ensuring quality practice and accountability in the field. To understand how paramedics accomplish clinical judgement and decision-making of mental illness in the Queensland pre-hospital emergency care setting and the factors that influence this aspect of their work, this thesis adopted a descriptive theoretical framework of judgement and decision-making (Bell, Raiffa, & Tversky, 1988a) and undertook an interpretive, naturalistic case study according to Stake (1995). In this study, the cases were paramedics, the context was the Queensland pre-hospital emergency care setting, and the issue was how they accomplished clinical judgement and decision-making of mental illness. The study of paramedic clinical judgement and decision-making of mental illness was conducted in two iterative and recursive phases.

Journal Title
Conference Title
Book Title
Thesis Type

Thesis (PhD Doctorate)

Degree Program

Doctor of Philosophy (PhD)


School of Education and Professional Studies

Publisher link
Patent number
Grant identifier(s)
Rights Statement
Rights Statement

The author owns the copyright in this thesis, unless stated otherwise.

Item Access Status



Appendices 1 to 6 have not been published for copyright conditions.

Access the data
Related item(s)

Queensland Ambulance Service

Paramedics training

Pre-hospital emergency care

Mental illness clinical assessment

Persistent link to this record