The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis
Objective To conduct a systematic review and meta-analysis to examine the impact of new pre hospital practitioners (NPPs), including emergency care practitioners (EmCPs), paramedic practitioners and extended care paramedics (ECPs), on ambulance transportation to the emergency department (ED).Methods...
| Main Authors: | , , , , |
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| Format: | Journal Article |
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BMJ Publishing Group
2013
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| Online Access: | http://hdl.handle.net/20.500.11937/34749 |
| _version_ | 1848754307939172352 |
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| author | Tohira, Hideo Williams, Teresa Jacobs, Ian Bremner, A. Finn, Judith |
| author_facet | Tohira, Hideo Williams, Teresa Jacobs, Ian Bremner, A. Finn, Judith |
| author_sort | Tohira, Hideo |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objective To conduct a systematic review and meta-analysis to examine the impact of new pre hospital practitioners (NPPs), including emergency care practitioners (EmCPs), paramedic practitioners and extended care paramedics (ECPs), on ambulance transportation to the emergency department (ED).Methods We searched MEDLINE, Embase, CINAHL and AUSTHealth databases, and hand searched emergency medicine journals and journal reference lists for relevant papers. To be included, studies were required to target one type of NPP and compare outcomes such as the frequencies of conveyance to the ED, discharge at scene, subsequent ED attendance and/ or appropriateness of care between NPPs and conventional ambulance crews. Three investigators independently selected relevant studies. The risk of bias in individual studies was assessed using a validated checklist. We conducted meta-analyses for comparisons which had acceptable heterogeneity (I2<75%) and reported pooled estimates of ORs with 95% CIs.Results 13 studies were identified from 16 584 citation reports. EmCPs were most frequently studied. The majority of studies (77%) did not fully report important potential confounders. NPPs were less likely to convey patients to the ED and more likely to discharge patient sat the scene than conventional ambulance crews. Pooled ORs for conveyance to the ED and discharge at the scene by ECPs were 0.09 (95% CI 0.04 to 0.18) and 10.5 (95% CI 5.8 to 19), respectively. The evidence for subsequent ED attendance and appropriateness of care was equivocal.Conclusions The NPP schemes reduced transport to the ED; however, the appropriateness of the decision of the NPPs and the safety of patients were not well supported by the reported studies. |
| first_indexed | 2025-11-14T08:38:20Z |
| format | Journal Article |
| id | curtin-20.500.11937-34749 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T08:38:20Z |
| publishDate | 2013 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-347492019-04-10T06:11:54Z The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis Tohira, Hideo Williams, Teresa Jacobs, Ian Bremner, A. Finn, Judith Objective To conduct a systematic review and meta-analysis to examine the impact of new pre hospital practitioners (NPPs), including emergency care practitioners (EmCPs), paramedic practitioners and extended care paramedics (ECPs), on ambulance transportation to the emergency department (ED).Methods We searched MEDLINE, Embase, CINAHL and AUSTHealth databases, and hand searched emergency medicine journals and journal reference lists for relevant papers. To be included, studies were required to target one type of NPP and compare outcomes such as the frequencies of conveyance to the ED, discharge at scene, subsequent ED attendance and/ or appropriateness of care between NPPs and conventional ambulance crews. Three investigators independently selected relevant studies. The risk of bias in individual studies was assessed using a validated checklist. We conducted meta-analyses for comparisons which had acceptable heterogeneity (I2<75%) and reported pooled estimates of ORs with 95% CIs.Results 13 studies were identified from 16 584 citation reports. EmCPs were most frequently studied. The majority of studies (77%) did not fully report important potential confounders. NPPs were less likely to convey patients to the ED and more likely to discharge patient sat the scene than conventional ambulance crews. Pooled ORs for conveyance to the ED and discharge at the scene by ECPs were 0.09 (95% CI 0.04 to 0.18) and 10.5 (95% CI 5.8 to 19), respectively. The evidence for subsequent ED attendance and appropriateness of care was equivocal.Conclusions The NPP schemes reduced transport to the ED; however, the appropriateness of the decision of the NPPs and the safety of patients were not well supported by the reported studies. 2013 Journal Article http://hdl.handle.net/20.500.11937/34749 10.1136/emermed-2013-202976 BMJ Publishing Group fulltext |
| spellingShingle | Tohira, Hideo Williams, Teresa Jacobs, Ian Bremner, A. Finn, Judith The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title_full | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title_fullStr | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title_full_unstemmed | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title_short | The impact of new prehospital practitioners on ambulance transportation to the emergency department: A systematic review and meta-analysis |
| title_sort | impact of new prehospital practitioners on ambulance transportation to the emergency department: a systematic review and meta-analysis |
| url | http://hdl.handle.net/20.500.11937/34749 |