Interventions and measures of included studies
| Authors (year) | Intervention | Measures |
|---|---|---|
| Assessment and investigation of health and planning/preparation for and addressing of health requirements | ||
| Cooper and Grant (2009) | NA | NA |
| Dixon et al (2009) | PPs providing community-based assessment, treatment and referral of elderly patients with minor acute illnesses. Eligible patients aged ≥60, presenting complaint within PP scope of practice, Sheffield postcode. Training method: 3-week full-time theory-based course with lectures from specialists in emergency medicine or elderly care and 45 days supervised clinical practice | Routine clinical data (to estimate resource use), EQ-5D™ questionnaire to calculate Quality Adjusted Life Years (QALY). Cost of PPs, alternative responders and ED/social/community/inpatient care. £20 000/QALY threshold |
| Everden et al (2003) | ‘ACAPON’ service: paramedic part of primary care team providing routine assessment, minor injury clinics and treatment, making home visits and liaising with doctors. Paramedic continues to respond to local emergency calls. Training method: 8-month placement but no detail about training given | Treatments in the community, appropriate hospital admission pathways, ambulance usage, care costs |
| Gerson et al (1992) | Paramedics screen for and refer medical, mental health, social and environmental problems. Eligible patients aged >60s. Training method: 4-h monthly sessions with presentations from specialists, with progress review every subsequent session | ‘Usefulness’ of referral defined as a real problem amenable to intervention and help consequently received, or ‘usefulness’ to caregiver. ‘Real’ problem validated by geriatrician |
| Knowles et al (2011) | PPs trained to provide community-based assessment, treatment and referral of elderly patients with minor acute illnesses. Eligible patients aged ≥60 with a Sheffield postcode. Training method: 3-week full-time theory-based course with lectures from specialists and 45 days supervised clinical practice | Intervention and control carers sent questionnaire at 7 days about satisfaction and change in care burden. Reminder sent at 14 days |
| Krumperman et al (1993) | Paramedics identify individuals ‘at-risk’ and make referrals. Training method: teaching by volunteer staff to recognise risk factors for child abuse, sexual abuse, isolation, mental illness and those specific to elderly | ‘Accuracy’ of referral (no definition given) |
| Lukins et al (2004) | Paramedics screen, assess and intervene for heat-related injury in a purpose-built venue. Aiming to assess, treat and discharge in <120 min. Training method: 20 min session before shift started, written and verbal information about features and management of dehydration | Recorded outcomes were opening times, patient numbers, patient complaints, admission and discharge times and patient outcome |
| Mason et al (2007) | PPs providing community-based clinical assessment, treatment and referral of elderly patients with minor acute illness. Eligible patients aged ≥60, presenting complaint within PP scope of practice, Sheffield postcode. Training method: 3-week full-time theory-based course with lectures from specialists in emergency medicine or elderly care and 45 days supervised clinical practices | ED attendance, hospital admission (0–28 days), interval from call time to discharge (episode time), patient satisfaction, investigations and treatment, health status and mortality at 28 days. Data from hospital and ambulance records and patient questionnaire at 28 days |
| Ruston and Tavabie (2011) | (Pilot) education placements in General Practices. Training method: 2-month apprenticeship-type placement and one shorter ‘sign-off’ placement. Workplace-based teaching includes patient assessment, differential diagnosis, clinical management plans, consultation skills and teamwork | Placement acceptability, support received and how many patients assessed. Identification and address of learning needs. Fulfilment of specific competencies: communication, consultation, holistic care, data gathering and interpretation. Review of placement structure. Online survey and interviews (trainees and trainers) |
| Shah et al (2006) | EMS practitioners screened patients aged >65 for vaccine status and falls risk. Distributed educational documents and referred to GP if necessary. Eligible patients aged >65. Training methods: 90 min case-based discussion, instruction how to ask screening questions. Training ‘reinforced’ monthly | Screening ‘successful’ if status confirmed by primary care provider. Telephone survey at 2 weeks for ‘effect’ of intervention: vaccine uptake, recollection of education information |
| Shah et al (2010) | Paramedics screened patients aged >60 in the community for falls depression and medication management strategies. Offer Case Manager if appropriate. Eligible patients aged >60. Training method: Geriatric Education for EMS course including communication and assessment, abuse and neglect, emergencies, mental health. 1 day for BLS professionals, 1.5 day for Advanced Life Support | ‘Successful evaluation’ of unmet need=completed questionnaire. Patient satisfaction survey and completion of home visit. Follow-up at 2 weeks |
| Swain et al (2010) | Extended care paramedics sent to eligible patients (emergency calls triaged as suitable) and can clinically assess, refer to GPs of community health staff, use range of medication at patient's home, transfer to appropriate facility or revisit later to enhance care. Service operates 12 h/day, 7 days/week. Training method: 1 month's additional training from experienced staff and regular training days and service audits | Transfers to hospital, type and characteristic of patient, presenting problem, route of access, proportion of EMS workload |
| Planning/preparation for and addressing of health requirements (only) | ||
| Spaite et al (2001) | Paramedics manage patients aged <21 years with physical or mental condition affecting growth and development, requiring: ‘an assistive technology device; prolonged or frequent hospitalisation; a specialised approach to assessment or management’. Training method: self-study programme containing information about most common conditions including a manual, a video, practice manikins, quizzes and observed skills evaluations | Assessment and intervention as recorded on EMS paperwork deemed ‘appropriate’ by reviewer. Agreement between reviewers measured |
| Spaite et al (2001) | Paramedics with improved skills and knowledge to treat children with special healthcare needs (requiring: ‘an assistive technology device; prolonged or frequent hospitalisation; a specialised approach to assessment or management’) Training method: self-study programme containing information about common conditions including a manual, a video, practice manikins, quizzes and observed skills evaluations | Patient characteristics, diagnosis, level of care received, procedures performed, destination (type of facility), discharge status |
| Development and sharing of information and knowledge of health | ||
| Riley et al (2004) | EMTs improving documentation of patient decision-making capacity for transport refusal. All EMS patients eligible. Training method: 1.5 h module with case-based small group discussion led by physician. Includes importance and procedure of assessment and documentation | Reviewed convenience sample of ambulance call records (ACRs, N=75) from each group. Reviewed for presence of signature and capacity assessment procedure. Accuracy assessed by re-entry of ambulance call records data by blinded reviewer, sample N=15 |
| Safeguard and protect individuals | ||
| Hawkins et al (2007) | Paramedics undertaking paediatric home safety assessment and providing safety devices and advice. Families with children or expectant mothers were eligible and invited by mail to request visit. Training method: 1 day about injury, how to conduct safety inspections, use injury prevention survey and mitigate injury risk. Catch-up sessions for late entering paramedics | Paper survey measured: average visit time length, directly observed safety hazards, functioning safety devices, evacuation plans, hazardous practices, hazard mitigation by paramedics |
| Jaslow et al (2000) | EMTs to take CO measurements. Positive readings referred to fire department. Calls not requiring advanced life support management were eligible. Training method: 2 h inservice training session about signs/symptoms and causes of CO poisoning, use of metres and administration of questionnaire | Positive reading confirmed by fire department, detector present in home, patient knowledge about CO poisoning |
| Willis et al (1997) | Community groups created to improve road trauma management, local support and community networking. Rural communities eligible. Training method: four free facilitator-led sessional workshops (role play, group exercises, discussions) including knowledge about grief and coping awareness, disaster planning, community resources and referral pathways | Impact: (questionnaire): ‘most useful’ session, skills, knowledge and personal coping strategies gained. Outcome: (opportunistic focus group postroad trauma): application of knowledge, coping strategies, knowledge and application of support services |
| Stirling et al (2007) | Paramedics with ESP can enhance communities through health promotion, capacity building and community development. Training method: not clear, may vary between sites | Interviews with ‘key informants’, observations of ‘key processes and events’ and ‘review of documents that describe the paramedic role, available organisational and educational support’ |
ACAPON, appropriate care at point of need; CO, carbon monoxide; ED, Emergency Department; EMS, emergency medical services; ESP, Extended Scope of Practice; GP, General Practitioner; PP, Paramedic Practitioner.