Perceptions of paramedics and emergency staff about the care they provide to people who self-harm: Constructivist metasynthesis of the qualitative literature

Highlight
• Studies have explored care from emergency staff and paramedic care for self-harm within mental health context.
• Staff report feelings of frustration, futility and question legitimacy of care for self-harm.
• First contact following self-harm is important, and paramedics provide this care opportunity.
• Decision making involves balancing legislation, risk and autonomy

ObjectivePresentations of self-harm to paramedic and emergency staff are increasing, and despite being the first professionals encountered, patients who self-harm report the quality of care and attitudes from these staff are unsatisfactory. Understanding this care may provide opportunities to improve services. The aim of this study is to enhance knowledge building and theory generation in order to develop practice and policy through a metasynthesis of qualitative research relating to perceptions of paramedic and emergency care for people who self-harm.MethodsThe metasynthesis draws on Evolved Grounded Theory Methodology (EGTM). A search was undertaken of CINAHL®, MEDLINE®, OVID ® and Psych INFO®, and grey literature. Subject headings of ‘self-harm’ were used alongside key words ‘suicide’, ‘paramedic’ ‘emergency’, ‘overdose’, ‘pre-hospital’ mental health, ambulance, perceptions of care, emergency.ResultsA total of 1103 papers were retrieved; 12 were finally included. No papers investigated paramedic care for self-harm. The following metaphors emerged: (a) frustration, futility and legitimacy of care; (b) first contact in the pre-hospital environment: talking, immediate and lasting implications of the moral agent; (c) decision making in self-harm: balancing legislation, risk and autonomy; (d) paramedics' perceptions: harnessing professionalism and opportunities to contribute to the care of self-harm.ConclusionParamedics are often the first health professional contact following self-harm, yet limited qualitative literature has explored this encounter. Metaphors revealed in this paper highlight challenges in decision making and legislation, also opportunities to improve care through professionalization and tailored education.