title: A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients.
abstract: Ambulance paramedics play a critical role expediting patient access to emergency treatments. Standardised handover communication frameworks have led to improvements in accuracy and speed of information transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved by paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize and synthesise data from studies describing development/extension of the ambulance-based paramedic role during and after handover for time-critical conditions (trauma, stroke and myocardial infarction).
  
  
  
  We conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured strategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics, emergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i) generic or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii) paramedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in secondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.
  
  
  
  We did not identify any studies that evaluated the health impact of an emergency ambulance paramedic intervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage which reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced paramedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer location. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration of treatment) might supplement handover information; (ii) structured handover tools and feedback on handover performance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of paramedics after arrival at hospital was limited to 'direct transportation' of patients to imaging/specialist care facilities.
  
  
  
  There is insufficient published evidence to make a recommendation regarding condition-specific handovers or extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes. However, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced paramedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required.
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, United Kingdom. darren.flynn@ncl.ac.uk.
authors.forename: Darren
authors.identifier: 0000-0001-7390-632X
authors.initials: D
authors.lastname: Flynn
authors.affiliation: Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Francis
authors.affiliation: Research Design Service - North East, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Shannon
authors.initials: S
authors.lastname: Robalino
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lally
authors.affiliation: College of Medicine, Swansea University, Wales, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Snooks
authors.affiliation: Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Rodgers
authors.affiliation: North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: McClelland
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
authors.affiliation: Institute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Price
mesh_terms: D004634:Emergency Medical Technicians / Q000458:organization & administration / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D009203:Myocardial Infarction; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards*; D024382:Professional Role; D020521:Stroke; D014947:Wounds and Injuries
keywords: Acute myocardial infarction; Extended role; Paramedics; Stroke; Systematic review; Trauma