title: A medically wise approach to expanding the role of paramedics as physician extenders.
abstract: The authors examined a portion of the complex issue of the scope of practice of paramedics in light of the epidemiologic profile of emergency patients seen at two Baltimore hospitals. They suggest that the same approach could and should be used to help decide on the scope of work of prehospital personnel in any jurisdiction. The findings lead the authors to urge caution toward any potential changes to the work done by medics, because of the enormous breadth of presenting patient conditions. The authors suggest that the epidemiologic profile witnessed in Baltimore would require increased direct physician input on patient destination decisions for all medics who would be working under an expanded scope of functions, and the paper suggests a mechanism for accomplishing this goal. Finally, while there may be compelling economic reasons to change what medics do in the field, this article cautions health care managers to design changes, based on solid evidence, that will have a positive public health impact, and then work to evaluate the character of the impact after changes are implemented.
authors.affiliation: Department of Emergency Health Services, University of Maryland Baltimore County, Baltimore 21250, USA. bissell@umbc.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Bissell
authors.forename: K G
authors.initials: KG
authors.lastname: Seaman
authors.forename: R R
authors.initials: RR
authors.lastname: Bass
authors.forename: E
authors.initials: E
authors.lastname: Racht
authors.forename: C
authors.initials: C
authors.lastname: Gilbert
authors.forename: A F
authors.initials: AF
authors.lastname: Weltge
authors.forename: M
authors.initials: M
authors.lastname: Doctor
authors.forename: S
authors.initials: S
authors.lastname: Moriarity
authors.forename: D
authors.initials: D
authors.lastname: Eslinger
authors.forename: R
authors.initials: R
authors.lastname: Doherty
mesh_terms: D000465:Algorithms; D015142:Baltimore; D003663:Decision Trees; D004634:Emergency Medical Technicians / Q000193:education / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007587:Job Description; D020380:Needs Assessment; D010343:Patient Admission / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000193:education / Q000458:organization & administration*; D017009:Professional Autonomy; D014218:Triage / Q000379:methods*; D000078329:Workforce