Table 5 Refined CMO configurations

Context 1: The prehospital work is accomplished a long distance from medical support; the personnel handle many different symptoms and conditions in changing environments and they have different levels of education and experience.

Mechanism1: The guidelines are developed in a process in which people with in-depth context knowledge are excluded.

Outcome 1: Guidelines with a format poorly adjusted to the context.

Outcome 2: Guidelines with limited explicit use.

Outcome 3: Development of homemade guidelines.

Outcome 4: Lack of organizational control.

Outcome 5. Explicit use of guidelines in file format creates a sense of unprofessionalism.

Mechanism 2: Structured implementation strategy of the guidelines at local level.

Outcome 1: The personnel are well informed of the guidelines and their content.

Outcome 2: The personnel take a positive view of the guidelines.

Outcome 3: Both inexperienced and experienced personnel use them.

Outcome 4: Improved team function.

Mechanism 3. Difficulty developing guidelines which cover every possible situation.

Outcome 1: Deliberate deviation from guidelines.

Outcome 2: Ethical conflicts.

Mechanism 4: The ambulance mission is divided into 5 separate phases.

Outcome 1: Different need for support in the different phases.

Outcome 2: Request for a system which covers all phases.