title: Unplanned, urgent and emergency care: what are the roles that EMS plays in providing for older people with dementia? An integrative review of policy, professional recommendations and evidence.
abstract: OBJECTIVE
  To synthesise the existing literature on the roles that emergency medical services (EMS) play in unplanned, urgent and emergency care for older people with dementia (OPWD), to define these roles, understand the strength of current research and to identify where the focus of future research should lie.
  
  
  METHODS
  An integrative review of the synthesised reports, briefings, professional recommendations and evidence. English-language articles were included if they made any reference to the role of EMS in the urgent or emergency care of OPWD. Preparatory scoping and qualitative work with frontline ambulance and primary care staff and carers of OPWD informed our review question and subsequent synthesis.
  
  
  RESULTS
  Seventeen literature sources were included. Over half were from the grey literature. There was no research that directly addressed the review question. There was evidence in reports, briefings and professional recommendations of EMS addressing some of the issues they face in caring for OPWD. Three roles of EMS could be drawn out of the literature: emergency transport, assess and manage and a 'last resort' or safety net role.
  
  
  CONCLUSIONS
  The use of EMS by OPWD is not well understood, although the literature reviewed demonstrated a concern for this group and awareness that services are not optimum. Research in dementia care should consider the role that EMS plays, particularly if considering crises, urgent care responses and transitions between care settings. EMS research into new ways of working, training or extended paramedical roles should consider specific needs and challenges of responding to people with dementia.
authors.affiliation: NIHR CLAHRC-EoE, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Marina
authors.initials: M
authors.lastname: Buswell
authors.affiliation: East of England Ambulance Service (EEAS), Cambridge, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Lumbard
authors.affiliation: EEAS, Ely, UK.
authors.forename: Larissa
authors.initials: L
authors.lastname: Prothero
authors.affiliation: NIHR CLAHRC-EoE, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lee
authors.affiliation: NIHR CLAHRC-EoE, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Martin
authors.affiliation: NIHR CLAHRC-EoE, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Fleming
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000592:standards; D003704:Dementia / Q000628:therapy*; D004632:Emergency Medical Services / Q000592:standards*; D004739:England; D006297:Health Services Accessibility / Q000592:standards; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans
keywords: aged; emergency care systems, admission avoidance; extended roles; prehospital care; psychiatry