Introduction Ambulance services are facing increased demand to provide both urgent and emergency care. Details of a paramedic’s case load, patient mix and interventions delivered during patient encounters within contemporary practice are rarely described within the literature. This paper provides insight into the work of paramedics within an NHS ambulance service within the UK; the frequency of low, medium and high acuity clinical presentations, amongst patients they care for and the utilisation of clinical interventions in practice.

Methods A single site, retrospective service evaluation to describe the case load of 45 operational paramedics within a large regional English NHS ambulance service, over a full calendar year.

Results A combined caseload of 33649 patients were attended by 45 paramedics. Paramedics attend 748 patients per year (95% CI , 705 – 790), 91.6% are adults. Aetiology of clinical presentations of patients attended by paramedics are 76.2% medical and 23.8% traumatic. 34.8% of patients receive a clinical intervention or administration of a medicine during their clinical management. Conveyance to hospital occurs in 63% of face to face interactions. Most patient interactions by paramedics are for low acuity clinical presentations. National Early Warning Score calculations of 25678 clinical records demonstrate that 74.1% of patients are LOW RISK, 16.5% are MEDIUM RISK and only 9.4% of patients are categorised as HIGH RISK. The distribution of NEWS seems not to be affected by rurality of the paramedic’s operational base. Musculoskeletal injury is the most common clinical impression with 7.0% of attendances.

Conclusion Paramedics attend an extremely varied patient case mix; across the full life cycle. Most patients have low acuity clinical presentations. Patients with high acuity illness and in need of life saving critical interventions are seen infrequently, which may have implications for the education, exposure and skill retention in the management of this patient group.