Authors (year) (setting) | Aim of study | Methodology/quality | Participants |
---|---|---|---|
Assessment and investigation of health and planning/preparation for and addressing of health requirements | |||
Cooper and Grant (2009) (international) | To identify and describe the new roles in out of hospital emergency care | Systematic review. Quality: moderate. High risk of selection bias, out of date | Inclusion criteria: articles reporting significant development or change in face-to-face ambulance, nurse or medical prehospital care practice published between 1998 and 2008. Exclusion criteria: non-English language article or ‘minimal extensions’ of practice |
Dixon et al (2009) (UK urban) | To assess the safety and cost–benefit of a Paramedic Practitioner (PP) elderly care model in EMS | Economic evaluation of cluster RCT. Quality: moderate. Well-designed trial but substantial outcome data missing | 7 experienced PPs were trained. Weeks were the unit of randomisation: 54 weeks randomised with or without a trained PP on duty. Control: in weeks with no PP on duty, patients receive EMS care as normal. Patient details passed to PP in ED and followed up 28 days later |
Everden et al (2003) (UK semirural) | To describe the role and training of a Primary Care Paramedic and a new urgent care system | Descriptive report (case report) of education and service change intervention. Quality: moderate. Good descriptions of intervention, moderate risk of bias | 1 community paramedic in 1 General Practice (GP). Control: not specifically, but evaluation compared with routine service |
Gerson et al (1992) (USA urban) | To evaluate paramedics’ ability to identify and refer elderly at risk | Quasi-experimental study of educational and service change intervention. Quality: good. Rigorous study, small risk of confounding | 130 paramedics. No control |
Knowles et al (2011) (UK urban) | To understand impact of PP management of minor acute health episodes on carers | Opportunistic cross-sectional survey during cluster RCT. Quality: good. Randomised, matched but no blinding. Risk of selection bias | 7 experienced PPs were trained. 54 weeks randomised with or without a trained PP on duty. Carers defined as ‘provider of physical or emotional support to patient and present at time of episode’. Control: carers of eligible patients in control week (EMS care as normal) |
Krumperman et al (1993) (USA urban) | To give paramedics skills to recognise and intervene with social problems | Descriptive report (case report) of educational and procedural change intervention. Quality: poor. High risk of bias and confounding, reporting lacks detail | Staff in 1 ambulance group—number of individuals not given. No control |
Lukins et al (2004) (Canada urban) | To examine the feasibility of paramedic-staffed rehydration unit at mass gatherings | Descriptive report (case report) of training and service change intervention. Quality: good. Low risk of bias | 12 paramedic team members per shift, 1-day event. No control |
Mason et al (2007) (UK urban) | To evaluate the impact of a PP programme managing elderly patients with minor illness | Cluster RCT of training and programme change intervention. Quality: good. Well-designed trial, low risk of bias. Intention to treat analysis | 7 experienced PPs were trained. 54 weeks randomised with or without a trained PP on duty. Weeks with no PP on duty patients receive EMS care as normal. Patient details passed to PP in ED and followed up 28 days later |
Ruston and Tavabie (2011) (UK not known) | To enhance paramedics’ autonomous practice, knowledge and understanding of working in primary care | Qualitative evaluation of pilot educational intervention. Quality: moderate. Inadequate detail about qualitative methodology | 8 paramedic practitioner students. No control. Placements in accredited training practices |
Shah et al (2006) (USA rural) | To evaluate the feasibility of EMS-based screening and health promotion | Quasi-experimental trial of training intervention, with control group. Quality: poor. High risk of bias | Staff in 1 ambulance service—number of individuals not given. Control: patients treated by comparable ambulance service |
Shah et al (2010) (USA rural) | To describe and evaluate a health promotion programme for the rural elderly | Quasi-experimental trial of education and service change intervention with control group. Quality: moderate. Moderate risk of bias, poor follow-up | EMS staff in 1 ‘health partnership’ agency—number of individuals not given. No control |
Swain et al (2010) (New Zealand rural) | To describe a service to treat patients in their own communities, improve their experience and reduce conveyance to hospital | Descriptive report (case report) of a training and service change intervention. Quality: moderate. Substantial risk of bias | Highest grade paramedics eligible for training (later, intermediate grades also accepted)—number of individuals not given. No control |
Planning/preparation for and addressing of health requirements (only) | |||
Spaite et al (2001) (USA urban) | To improve EMS care, transport status or hospital admission of children with special healthcare needs | Quasi-experimental study of educational intervention with control group. Quality: moderate. Small risk of bias and confounding and small influence of chance | All paramedics in district fire brigade: 68% uptake (n=52/89). Control: 73/325 comparable pretraining responses |
Spaite et al (2001) (USA urban) | To determine effect of education programme on EMS care, transport status or hospital admission | Quasi-experimental study of educational intervention with control group. Quality: moderate. Risk of confounding and small sample size (low uptake) | All paramedics in district fire brigade: 68% uptake (n=52/89). Control: 53 eligible patients treated post-training by untrained paramedics |
Development and sharing of information and knowledge of health | |||
Riley et al (2004) (Canada urban) | To determine whether an educational intervention affected paramedic documentation of patient decision-making capacity | Quasi-experimental study with control group. Quality: poor. Appropriate design, adequate follow-up but significant risk of bias and confounding | 200 Emergency Medicine Technicians (EMT) -Intermediates and EMT-Basics. Control: 698 sample records taken preintervention |
Safeguard and protect individuals | |||
Hawkins et al (2007) (USA urban) | To document paramedic assessment of and intervention to mitigate home-safety risks | Quasi-experimental study of training and service change intervention. Quality: poor. High risk of bias | Paramedics. 77% of 262 inspections made by paramedics—number of individuals not given. No control |
Jaslow et al (2000) (USA urban) | To determine whether EMTs can incorporate CO screening into 911 responses and the cost-effectiveness | Quasi-experimental study of training and practice-change intervention. Quality: poor. High risk of bias | 2 Basic Life Support (BLS) ambulances were trained—number of individuals not given. No control |
Willis et al (1997) (Australia rural) | To create groups with the knowledge and skills to support the community in case of road trauma | Descriptive report (case report) of group building intervention. Quality: poor. Strong influence of bias, lacks generalisability | 100 people in 6 communities, including ‘some ambulance officers’. No control |
Stirling et al (2007) (Australia rural) | To explore how ‘community engagement’ aspects of paramedic Extended Scope of Practice (ESP) contribute to primary and emergency healthcare | Qualitative study with mixed data sources. Quality: moderate. appropriate methodology, poor reporting | Up to 17 ‘informants’ at each of four purposively sampled sites with ESP. No control |
CO, carbon monoxide; ED, Emergency Department; EMS, emergency medical services; RCT, randomised controlled trial.