Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature

Abstract

BackgroundIncreasing demand on the UK emergency services is creating interest in reviewing the structure and content of ambulance services. Only 10% of emergency calls have been seen to be life-threatening and, thus, paramedics, as many patients’ first contact with the health service, have the potential to use their skills to reduce the demand on Emergency Departments. This systematic literature review aimed to identify evidence of paramedics trained with extra skills and the impact of this on patient care and interrelating services such as General Practices or Emergency Departments.MethodsInternational literature from Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and grey literature from 1990 were included. Articles about any prehospital emergency care provider trained with extra skill(s) beyond their baseline competencies and evaluated in practice were included. Specific procedures for certain conditions and the extensively evaluated UK Emergency Care Practitioner role were excluded.Results8724 articles were identified, of which 19 met the inclusion criteria. 14 articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing and one health information. There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in prehospital emergency care.ConclusionsThis review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy. The findings should be used to guide future research, particularly into paramedic care for elderly people.

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

“…We have summarised the characteristics and findings of the seven systematic reviews [146][147][148][149][150][151]173 (Tables 10 and 11). Data on the 12 papers 174-185 not included in the systematic reviews were extracted in to summary tables (Tables 12-14).…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk 146 Cooper and Grant, 2009 147 Evans, 2014 148 Hill, 2014 149 Mikolaizak, 2013 150 Tohira, 2014 151 Adams, 2005 152 ✓ ✓ …”

“…Six of the systematic reviews [146][147][148]150,151,187 found evidence that prehospital professionals can successfully reduce the number of patients transported to EDs and provide autonomous care and appropriate referral in the community setting. The evidence is predominated by schemes to provide ambulance paramedics with extended and enhanced clinical skills.…”

“…167 Four of the UK studies 154,157,161,168 involved emergency care practitioners (ECPs), a role open to other health-care professionals such as nurses, although in reality dominated by ambulance paramedics, and practised in settings other than ambulance services. The review by Evans et al, 148 which was concerned only with paramedics with extended skills, excluded studies of ECPs. The title 'ECP' has created problems as the generic 'practitioner' part of the title proved confusing.…”

A Culture in Transition: Paramedic Experiences with Community Referral Programs

“…Evidence of this limited or incomplete integration of the CREMS program into paramedic practice may contribute to implementation challenges of community-based care experienced by the profession. However, a reframing of paramedic practice is under way worldwide 10 and likely to become increasingly present. Still, this study suggests that incongruent messages impacted how paramedics integrated this relatively new role into their professional identities, and ultimately their patient care.…”