title: 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: BACKGROUND
  Increasing 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.
  
  
  METHODS
  International 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.
  
  
  RESULTS
  8724 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Newcastle University Medical School, Newcastle Upon Tyne, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Evans
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: McGovern
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Birch
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
mesh_terms: D000488:Allied Health Personnel; D004635:Emergency Medicine / Q000592:standards*; D006301:Health Services Needs and Demand; D006801:Humans; D011361:Professional Competence; D006113:United Kingdom
keywords: emergency ambulance systems; extended roles; paramedics; prehospital care; training