title: Can advanced paramedics in the field diagnose patients and predict hospital admission?
abstract: BACKGROUND
  Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training.
  
  
  OBJECTIVE
  The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission.
  
  
  METHODS
  A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records.
  
  
  RESULTS
  A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525/748) for all cases of AP diagnosis, and is mirrored with 70% (604/859) correct hospital admission predictions.
  
  
  CONCLUSIONS
  AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as 'treat and refer'.
authors: Centre for Prehospital Research, Graduate Entry Medical School, University of Limerick, , Limerick, Ireland.
authors: Niamh Maria
authors: NM
authors: Cummins
authors: Mark
authors: M
authors: Dixon
authors: Carrie
authors: C
authors: Garavan
authors: Eric
authors: E
authors: Landymore
authors: Noel
authors: N
authors: Mulligan
authors: Cathal
authors: C
authors: O'Donnell
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D007494:Ireland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014218:Triage / Q000592:standards*
keywords: diagnosis; emergency ambulance systems; hospitalisations; paramedics; prehospital care, advanced practitioner