Table 4

Findings from studies

Authors (year)Findings
Assessment and investigation of health and planning/preparation for and addressing of health requirements
 Cooper and Grant (2009)Results: 48 articles in total, and two (RCT and qualitative) describe the Paramedic Practitioner (PP). 1 paper (qualitative) refers to partnership working between paramedics and nurses. PPs are paramedics with ‘graduate level skills’ operating in normal ambulance service conditions and in one trial were given a 3-week course and 45 days supervised practice for advanced health assessment and skills for an elderly population. Findings about ECPs beyond scope of this review. PPs’ patients were less likely to attend ED after initial episode, more satisfied than control groups and experienced shorter episode times. They were more likely to use secondary services. Partnership service was perceived to increase confidence and improve care
 Dixon et al (2009)3081 consenting patient encounters. Response rate 34%–43%. Significant differences in resource use (p<0.05). Intervention groups: longer on scene time, more secondary care contacts within 28 days and more hospital time. Control group patients: more likely to go to the ED, be admitted to hospital and spend longer in ED or hospital. Similar patterns of primary and community care use in 28 days following. Overall PP costs £73 (95% CI 70 to 76), other responder £77 (95% CI 68 to 78). Overall PP £140 less but not statistically significant. 72.7%–73.7% data missing. PPs £680 less costly, 0.0003 fewer Quality Adjusted Life Years, PP >95% chance of being cost-effective
 Everden et al (2003)305 patients seen by ACAPON paramedic. 11 hospitalised, 5 transferred to ED. 125 Category A calls received. Of calls processed by ACAPON, ‘just under half’ remained in community, others admitted by ‘most appropriate pathway’. ‘Over half’ back-up ambulances were downgraded red-urgent or stood down completely. Number of calls responded to within time limit 55%–85%. Estimated total cost saving £28 729 per annum
 Gerson et al (1992)Paramedics assessed 197 patients: 37% had one problem, 31% two, 18% three, 13% four. Only 63% were subsequently assessed by geriatrician (11% refused). Paramedics screening had 98% positive predictive value. Programme ‘useful’ in 50% of cases and equal benefit to all problem types
 Knowles et al (2011)569 eligible carers. 71.5% response rate (n=401/561 carers). Care-recipient characteristics ‘similar’ between groups. Carers predominantly female, aged ∼60, family members and 75% provide ‘some form of care’ before episode. Intervention group carers were more likely to be family members, to be satisfied with their care, express a preference for care to be delivered at home and report less of an increased care burden postepisode
 Krumperman et al (1993)During the 19 months the trial ran, 50 referrals were made. Unknown how many patients seen. A high proportion of referrals were made for elderly patients: issues of abuse, isolation, loneliness and lack of services were identified
 Lukins et al (2004)143/450 000 attendees treated, 126 who would have been treated in main field hospital. 463 patients ineligible because non-heat related injury. Chief complaints: syncope, presyncope, dizziness. 75% patients discharged, 12% moved to main field hospital, 1% hospital off-site. 23% length of stay >120 min but did not need transfer (mean=94 min, missing n=25). Unit was safe and successful
 Mason et al (2007)3018 patients consented out of 4175 eligible. 65% questionnaire response rate. Intervention patients n=1549 (1090 received intended PP response), control n=1469 (adequate power). No difference in baseline patient demographics but carers 72.6% women, average age 82.6. Intervention patients were less likely to attend ED or be admitted and more likely to have shorter episode time and be highly satisfied. No difference in 28-day mortality
 Ruston and Tavabie (2011)8 paramedic trainees and 8 GP trainers participated and responded. All responses were positive regarding acquisition of skills, knowledge and understanding to work effectively in GP and avoid hospital admissions. High quality learning experience and enabled students to put skills into practice
 Shah et al (2006)669 patients were eligible and participated in intervention group, 272 in control group. Comparable characteristics. Screening ‘successful’ for pneumococcal vaccine status (79%), influenza vaccine (76%), falls history (91%), environmental hazards (87%). Statistically significantly greater pneumococcal vaccine rates in intervention group but no change in influenza vaccine or falls prevention measures. Paramedics could successfully identify those at risk but did not alter these proportions
 Shah et al (2010)1231/1444 eligible patients screened. Of those screened, 33% (n=240/728) positive for depression, 68% (n=552/814) at risk of falling, 90% (852/950) at risk for medication management problems. 73% refused further intervention. Case Manager intervention: 635 were offered home visit, 171 accepted, 153 completed, 130 followed up (at 2 weeks). 92% of these were satisfied with whole programme. 130 patients were followed up. 583 patients attended by extended care paramedics, 25%–30% EMS workload. 38% transported to hospital. 49% patients aged >75. 78% medical condition, 22% traumatic
583 patients attended by extended care paramedics, 25%–30% EMS workload. 38% transported to hospital. 49% patients aged >75. 78% medical condition, 22% traumatic
Planning/preparation for and addressing of health requirements (only)
 Spaite et al (2001)N=332 eligible calls, random sample of 74 reviewed. Overall appropriateness of paramedic care was significantly better for paramedics in trained group than non-trained (x2=6.33, p=0.01). Specific improvements were in initial and disability assessments. No significant difference in ‘appropriate’ review between professional groups
Development and sharing of information and knowledge of health
 Riley et al (2004)N=150 patients records reviewed at 1 month, N=504 measured at 12 months. Following the educational module: no difference in frequency of documentation, fewer refusals. Increase in total patient transports. Accuracy rate of documentation was 92.6%
Safeguard and protect individuals
 Hawkins et al (2007)262 inspections were made. Large proportion of households lacking safety devices or with hazardous practices. Between 25% and 100% received missing devices through programme. Paramedics can recognise common hazards and provide mitigating tools. No follow-up took place to measure impact on child safety
 Jaslow et al (2000)Responded to 2637 EMS calls in 2 months. 340 readings taken: nine were positive, one source and 0 life-threatening levels were found. 212 surveys completed, 68% heard of CO poisoning, 37% could name symptoms. No information about cases in which readings were not taken; therefore, no conclusions can be drawn
 Willis et al (1997)62% response rate to questionnaire (N=65). ‘Building community networks’ was most useful (66%), 85.7% increased their knowledge of community networks, 87% responded positively about increasing skills for responding to road trauma. All had increased understanding of many aspects and felt workshops had increased the ability to cope with road trauma. Professionals felt that they had not gained new skills but refreshed existing ones
 Stirling et al (2007)Paramedic ESPs promote rural community health by increasing community response capacity, linking communities closely to ambulance services and undertaking health promotion and illness prevention work. Communities report increased awareness and improved volunteer services (eg, following community first aid training)
  • ACAPON, appropriate care at point of need; CO, carbon monoxide; ECP, Emergency Care Practitioners; ED, Emergency Department; EMS, emergency medical services; ESP, Extended Scope of Practice; GP, General Practitioner; RCT, randomised controlled trial.