title: New and emerging roles in out of hospital emergency care: a review of the international literature.
abstract: OBJECTIVE
  The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to describe their activity and impact.
  
  
  BACKGROUND
  Demographic changes, increased demands for health services, altered working practices, and health system economic pressures have led to the development of a disparate set of new health care roles.
  
  
  METHODS
  MEDLINE, EMBASE and CINAHL databases, and the two search engines Google and Google Scholar were searched for contemporary studies in the identified study area.
  
  
  METHODS
  All publications identified through the search were assessed for relevance. Those that discussed new roles were included (n=34) and empirical studies (n=14) analysed in detail.
  
  
  RESULTS
  Emergency care and paramedic practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data suggests savings of between pound31 (USD 55) and pound37 (USD 65) per case when ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and training levels, regulatory and role implementation issues.
  
  
  CONCLUSIONS
  Further work is required to fully understand the patient safety, clinical practice, professional role and financial implications of these new roles.
authors.affiliation: School of Nursing and Midwifery, Monash University, Gippsland Campus, Churchill, Vic 3842, Australia. Simon.cooper@med.monash.edu.au
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.forename: Julie
authors.initials: J
authors.lastname: Grant