Clinical decision-making is a key aspect of the student paramedic journey. In particular, it is vital that students can understand the theories that underpin this vital facet of their practice. This article considers a case encountered in practice and the evidence that informs the decision process which was undertaken. The influence of biases, systems of thinking and an appreciation of probability are all considered in this call to a 55-year-old patient with chest pain. In addition, an appreciation of robust history taking is considered as part of this process. As ambulance clinicians can be limited in the tests and scoring systems appropriate to them, consideration is given to the value of traditional ‘in-hospital’ scoring systems and the advantages and limitations they present to the paramedic. These limitations can ultimately result in hospital attendance in many acute presentations such as chest pain incidents, and it may be that our practice is overdue a review of what can be done to address such limitations.

Philip Patenotte -

Iain Darby -