Introduction Alternative pre-hospital pathways (APPs) are a relatively new model of healthcare delivery. The Cork APP Team was founded in November 2019 and consists of a Registrar and Emergency Medical Technician. The Team responds to low acuity 999/112 calls or Paramedic referrals, responding to life-threatening calls only when absolutely necessary. There is a lack of research on the service’s impact on patients aged over 75 and interventions delivered. This strengthens understanding of service delivery and allows us to identify areas for upskilling of paramedics.

Methods A retrospective analysis of 197 charts, consisting of all patients aged 75 and above (n=123) during a 12 week period (4th July 2022 – 28th September 2022) and all patients during the first 5 weeks of this same period. For patient records that matched the inclusion criteria, data was manually added to a spreadsheet and analysed in SPSS 28.0 and Stata 17.0. Statistical analysis included descriptive analysis and evaluation of associations between variables.

Results For patients aged 75 and above, 20.4% of callouts were for ‘elderly fall’, most calls (74.7%) were classified as non-life threatening, most callouts (58%) were requested by Ambulance Control, and nursing homes represented 6.5% of callouts. The only intervention delivered to 50.5% of patients in this cohort was a history and clinical examination by the Doctor, followed by the prescription of analgesia (22.8%). The majority (69.1%) were diverted away from immediate transfer to the emergency department.

Conclusion The APP Team provides a valuable service by diverting elderly adults away from busy Emergency Departments. The main skills provided by the service depend on having a Doctor on board, however this study highlights some areas for Paramedic upskilling including providing them with more options for analgesia.