Paramedic Recognition and Clinical Decision-Making in Suspected Malignant Hypercalcaemia, a systematic scoping review.

This systematic scoping review aims to map and synthesise the existing evidence on paramedic recognition and clinical decision-making for suspected malignant hypercalcaemia in the prehospital setting, and to identify gaps in the evidence base that warrant further primary research. The review is guided by the following research question: What is currently known about paramedic recognition and clinical decision-making for suspected malignant hypercalcaemia in the prehospital setting, and what are the gaps in the existing evidence base? The review will be conducted in accordance with the Arksey and O'Malley (2005) framework as updated by Levac et al. (2010) and the Joanna Briggs Institute Manual for Evidence Synthesis (Peters et al., 2024). Reporting will follow the PRISMA extension for Scoping Reviews (PRISMA-ScR; Tricco et al., 2018). The Population, Concept, and Context (PCC) framework will be used to guide the search strategy: Population: Adult patients (18+) presenting to prehospital emergency services with signs and/or symptoms consistent with suspected malignant hypercalcaemia, including those with a known or suspected underlying malignancy. Concept: Paramedic clinical recognition and decision-making, including assessment, diagnosis, triage, conveyance, and escalation decisions. Context: Prehospital emergency care setting including ambulance service response, community urgent care, and NHS 111 paramedic dispatch contexts within the United Kingdom and comparable international systems. Planned databases: MEDLINE, CINAHL, EMBASE, and Cochrane Library. Inclusion/exclusion criteria and full search strings will be added as an update prior to database searching commencing.