title: Expanding paramedic scope of practice in the community: a systematic review of the literature.
abstract: BACKGROUND
  Paramedics are an important health human resource and are uniquely mobile in most communities across Canada. In the last dozen years, challenges in the delivery of health care have prompted governments from around the globe to consider expanding the role paramedics play in health systems. Utilizing paramedics for the management of urgent, low-acuity illnesses and injuries has been coined "community paramedicine," but the role, safety, and effectiveness of this concept are poorly understood.
  
  
  OBJECTIVE
  We undertook a systematic review of the international literature to describe existing community paramedic programs.
  
  
  METHODS
  We used the Cochrane methodology for systematic reviews. An international group of experts developed a search strategy and a health information specialist executed this search in Medline, Embase, and CINAHL starting January 1, 2000. We included all research articles in the English language that reported a research methodology. We excluded commentaries and letters to the editor. Two investigators independently screened citations in a hierarchical manner and abstracted data.
  
  
  RESULTS
  Of 3,089 titles, 10 articles were included in the systematic review and one additional paper was author-nominated. The nature of the 11 articles was heterogeneous, and only one randomized controlled trial (RCT) was found. This trial showed community paramedicine to be beneficial to patients and health systems. The other articles drew conclusions favoring community paramedicine.
  
  
  CONCLUSIONS
  Community paramedicine research to date is lacking, but programs in the United Kingdom, Australia, and Canada are perceived to be promising, and one RCT shows that paramedics can safely practice with an expanded scope and improve system performance and patient outcomes. Further research is required to fully understand how expanding paramedic roles affect patients, communities, and health systems.
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. blair.bigham@medportal.ca
authors.forename: Blair L
authors.initials: BL
authors.lastname: Bigham
authors.forename: Sioban M
authors.initials: SM
authors.lastname: Kennedy
authors.forename: Ian
authors.initials: I
authors.lastname: Drennan
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D000488:Allied Health Personnel; D003153:Community Health Services; D006801:Humans; D024382:Professional Role; D000078329:Workforce