Table 2

Study characteristics

Authors (year) (setting)Aim of studyMethodology/qualityParticipants
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 careSystematic review. Quality: moderate. High risk of selection bias, out of dateInclusion 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 EMSEconomic evaluation of cluster RCT. Quality: moderate. Well-designed trial but substantial outcome data missing7 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 systemDescriptive report (case report) of education and service change intervention. Quality: moderate. Good descriptions of intervention, moderate risk of bias1 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 riskQuasi-experimental study of educational and service change intervention. Quality: good. Rigorous study, small risk of confounding130 paramedics. No control
 Knowles et al (2011) (UK urban)To understand impact of PP management of minor acute health episodes on carersOpportunistic cross-sectional survey during cluster RCT. Quality: good. Randomised, matched but no blinding. Risk of selection bias7 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 problemsDescriptive report (case report) of educational and procedural change intervention. Quality: poor. High risk of bias and confounding, reporting lacks detailStaff 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 gatheringsDescriptive report (case report) of training and service change intervention. Quality: good. Low risk of bias12 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 illnessCluster RCT of training and programme change intervention. Quality: good. Well-designed trial, low risk of bias. Intention to treat analysis7 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 careQualitative evaluation of pilot educational intervention. Quality: moderate. Inadequate detail about qualitative methodology8 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 promotionQuasi-experimental trial of training intervention, with control group. Quality: poor. High risk of biasStaff 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 elderlyQuasi-experimental trial of education and service change intervention with control group. Quality: moderate. Moderate risk of bias, poor follow-upEMS 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 hospitalDescriptive report (case report) of a training and service change intervention. Quality: moderate. Substantial risk of biasHighest 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 needsQuasi-experimental study of educational intervention with control group. Quality: moderate. Small risk of bias and confounding and small influence of chanceAll 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 admissionQuasi-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 capacityQuasi-experimental study with control group. Quality: poor. Appropriate design, adequate follow-up but significant risk of bias and confounding200 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 risksQuasi-experimental study of training and service change intervention. Quality: poor. High risk of biasParamedics. 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-effectivenessQuasi-experimental study of training and practice-change intervention. Quality: poor. High risk of bias2 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 traumaDescriptive report (case report) of group building intervention. Quality: poor. Strong influence of bias, lacks generalisability100 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 healthcareQualitative study with mixed data sources. Quality: moderate. appropriate methodology, poor reportingUp 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.