Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial.
OBJECTIVE
To evaluate the benefits of paramedic practitioners assessing and, when possible, treating older people in the community after minor injury or illness. Paramedic practitioners have been trained with extended skills to assess, treat, and discharge older patients with minor acute conditions in the community.


METHODS
Cluster randomised controlled trial involving 56 clusters. Weeks were randomised to the paramedic practitioner service being active (intervention) or inactive (control) when the standard 999 service was available.


METHODS
A large urban area in England.


METHODS
3018 patients aged over 60 who called the emergency services (n=1549 intervention, n=1469 control).


METHODS
Emergency department attendance or hospital admission between 0 and 28 days; interval from time of call to time of discharge; patients' satisfaction with the service received.


RESULTS
Overall, patients in the intervention group were less likely to attend an emergency department (relative risk 0.72, 95% confidence interval 0.68 to 0.75) or require hospital admission within 28 days (0.87, 0.81 to 0.94) and experienced a shorter total episode time (235 v 278 minutes, 95% confidence interval for difference -60 minutes to -25 minutes). Patients in the intervention group were more likely to report being highly satisfied with their healthcare episode (relative risk 1.16, 1.09 to 1.23). There was no significant difference in 28 day mortality (0.87, 0.63 to 1.21).


CONCLUSIONS
Paramedics with extended skills can provide a clinically effective alternative to standard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions.


BACKGROUND
ISRCTN27796329 [controlled-trials.com].
Mason
Suzanne
S
Health Services Research, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA. s.mason@sheffield.ac.uk
Knowles
Emma
E
Colwell
Brigitte
B
Dixon
Simon
S
Wardrope
Jim
J
Gorringe
Robert
R
Snooks
Helen
H
Perrin
Julie
J
Nicholl
Jon
J
D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D016000:Cluster Analysis; D003153:Community Health Services / Q000592:standards*; D003695:Delivery of Health Care / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013997:Time Factors; D016896:Treatment Outcome