title: Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study.
abstract: BACKGROUND
  This study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medical services (EMS) in the Netherlands: the physician assistant (PA), educated in the medical domain, and the ambulance registered nurse (RN), educated in the nursing domain. The hypothesis of this study was that there is no difference in outcome of care between the patients of PAs and RNs.
  
  
  METHODS
  In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n = 493) and 23 RNs (n = 498). The inclusion period was October 2010-December 2012 for region 1 and January 2013-March 2014 for region 2. Emergency care data were drawn from predefined and free text fields in the electronic patient records. Data were analysed using descriptive statistics. We used χ (2) and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P <0.05.
  
  
  RESULTS
  Patients treated by PAs and RNs were similar with respect to patient characteristics. In general, diagnostic measurements according to the national EMS standard were applied by RNs and by PAs. In line with the medical education, PAs used a medical diagnostic approach (16 %, n = 77) and a systematic physical exam of organ tract systems (31 %, n = 155). PAs and RNs provided similar interventions. Additionally, PAs consulted more often other medical specialists (33 %) than RNs (17 %) (χ (2)  = 35.5, P <0.0001). PAs referred less patients to the general practitioner or emergency department (50 %) compared to RNs (73 %) (χ (2)  = 52.9, P <0.0001). Patient follow up contact with the dispatch centre within 72 h after completion of the emergency care on scene showed no variation between PAs (5 %) and RNs (4 %).
  
  
  CONCLUSIONS
  In line with their medical education, PAs seemed to operate from a more general medical perspective. They used a medical diagnostic approach, consulted more medical specialists, and referred significantly less patients to other health care professionals compared to RNs. While the patients of the PAs did not contact the dispatch centre more often afterwards.
authors.affiliation: Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, Netherlands. Anneke.Bloemhoff@radboudumc.nl.
authors.forename: Anneke
authors.identifier: http://orcid.org/0000-0002-0712-1484
authors.initials: A
authors.lastname: Bloemhoff
authors.affiliation: Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, Netherlands.|Faculty of Health Sciences, University of Southampton, Southampton, UK.|Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Ambulance Emergency Medical Service Veiligheids- en Gezondheidsregio Gelderland-Midden, Arnhem, Netherlands.
authors.forename: Arjan J L
authors.initials: AJ
authors.lastname: de Kreek
authors.affiliation: Ambulance Emergency Medical Service Veiligheidsregio Gelderland-Zuid, Nijmegen, Netherlands.
authors.forename: Pierre M
authors.initials: PM
authors.lastname: van Grunsven
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, Netherlands.|Department of Organisation of Health and Services, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, Netherlands.
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
authors.affiliation: Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, PO Box 9101, 6500, HB, Nijmegen, Netherlands.|Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, Netherlands.|Department of Emergency and Critical Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, Netherlands.
authors.forename: Sivera A A
authors.initials: SA
authors.lastname: Berben
mesh_terms: D000552:Ambulances; D003430:Cross-Sectional Studies; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D009726:Nurses / Q000592:standards*; D010823:Physician Assistants / Q000592:standards*
keywords: Ambulances; Emergency medical services; Netherlands; Nursing; Paramedical personnel; Physician assistants; Prehospital emergency care