Article Text

Download PDFPDF
Community emergency medicine throughout the UK and Ireland: a comparison of current national activity
  1. Anthony Hanks1,
  2. Lisa Ramage2,
  3. Caroline Leech3
  4. PreHOspital Trainee Operated research Network (PHOTON) Research group collaborators
    1. 1 Grange Physician Response Unit, Aneurin Bevan Health Board, Newport, UK
    2. 2 Physician Response Unit, Barts Health NHS Trust, London, UK
    3. 3 Emergency Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
    1. Correspondence to Dr Lisa Ramage, Physician Response Unit, Royal London Hospital, Barts Health NHS Trust, London E11FR, UK; ramagelisa{at}


    Background Community emergency medicine (CEM) aims to bring highly skilled, expert medical care to the patient outside of the traditional ED setting. Currently, there are several different CEM models in existence within the UK and Ireland which confer multiple benefits including provision of a senior clinical decision-maker early in the patient’s journey, frontloading of time-critical interventions, easing pressure on busy EDs and reducing inpatient bed days. This is achieved through increased community-based management supplemented by utilisation of alternative care pathways. This study aimed to undertake a national comparison of CEM services currently in operation.

    Method A data collection tool was distributed to CEM services by the Pre-Hospital trainee Operated Research Network in October 2020 which aimed to establish current practice among services in the UK and Ireland. It focused on six key sections: service aims; staffing and training; job tasking and patient selection; funding and vehicles used; equipment and medication; data collection, governance and research activity.

    Results Seven services responded from across England, Wales and Ireland. Similarities were found with the aims of each service, staffing structures and operational times. There were large differences in equipment carried, categories of patient targeted and with governance and research activity.

    Conclusion While some national variations in services are explained by funding and geographical location, this review process revealed several differences in practice under the umbrella term of CEM. A national definition of CEM and its aim, with guidance on scope of practice and measurable outcomes, should be generated to ensure high standard and cost-effective emergency care is delivered in the community.

    • prehospital care
    • doctors in PHC
    • emergency ambulance systems
    • emergency care systems
    • paramedics

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplemental information.

    View Full Text


    • Handling editor Mary Dawood

    • Twitter @LisaRamage, @leechcaroline

    • Collaborators Pre-Hospital trainee Operated Research Network (PHOTON): David Cookson; Scott Knapp; Nicholas Moore; Andrew Patton; Varsha Rao; Syed Masud; Matthew Bowker.

    • Contributors AH was involved in study design, dissemination, data interpretation, write-up and revision of the manuscript. LR was involved in study concept, study design, data interpretation, write-up and revision of the manuscript. CL was involved in study design, write-up and revision of the manuscript. The PHOTON study investigators DC, SK, NM, AP, VR, SM and MB were involved in data collation and submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.