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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Emergency Medicine 1/2014

Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

BMC Emergency Medicine > Ausgabe 1/2014
Deborah Shaw, Aloysius Niroshan Siriwardena
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-227X-14-18) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

DS and ANS conceived the original idea for the study. DS supported by ANS developed the study design. DS undertook the focus groups and analysis. DS wrote the first draft of the paper. All authors contributed to the discussion and final paper. DS is guarantor for the study. Both authors read and approved the final manuscript.



Acute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians’ adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence.


We conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data.


Seventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians’ and patients’ expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma.


This qualitative study provides insight into paramedics’ perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma.
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