This systematic review was undertaken by a team of researchers based in Canada who were interested in exploring the expanding scope of practice for paramedics working in the areas of unscheduled, urgent, low-acuity illness and injury. They termed this work as ‘community paramedicine’.
Here in the United Kingdom (UK) we might parallel this term with work undertaken by some paramedic practitioners (PP) and/or emergency care practitioners (ECP). However, we need to be cautious when using these terms as, even here in the UK, there is no consensus in our understanding of these roles and, it is likely that there is still a way to go before we will be able to confidently talk about these roles as being standardised in relation to scope of practice.
Using the Cochrane methodology, a systematic review was undertaken to examine the evidence for and/or against the development of ‘community paramedicine’. The research team searched Medline, Embase and CINAHL between the dates of 1 January 2000 until 30 September 2011, using a variety of search terms related to community health, paramedics and emergency medical services. In addition, other articles were identified through a manual search of bibliographies and by contacting a variety of experts in the field.
Overall, 3 089 papers were identified but ultimately through rigorous review processes only 11 papers met the final criteria for inclusion. Two investigators independently abstracted information from each paper about study design; population demographics; intervention; control; outcome data; type of emergency medical service provider; and the physical urgent care setting. Of these papers, only one was a randomised controlled trial while the other papers included case-control, economic, observational, and qualitative studies.
It is encouraging to note that nine of the papers were from the UK, demonstrating that the UK has had an interest in expanding scope of practice for paramedics in primary care settings for several years; of the two remaining papers one originated from Australia and the other from Canada.
The paper provides interesting information in a summary table about all of the 11 research projects, which is useful for the reader to get a feel for the content and focus of each study. However, with the differences in methodological approach, and with interventions and outcomes not uniformly being reported, it is very difficult to draw direct comparisons between the different studies. In addition, although it comes as no surprise, there was no standardised definition or understanding of the term ‘community paramedicine’.
The authors indicate that despite the lack of comparative data, there was a general trend from the reviewed papers that patient satisfaction, use of the emergency department, some health outcomes, and system performance appeared to improve slightly when utilising community paramedics.
Limitations of the study included the exclusion of non-English papers; use of only three databases (although these are very relevant databases); and the fact that the papers were so different that this meant that the researchers could not perform a meta-analysis of the data.
Clearly there is a need for further research to examine the impact of ‘community paramedicine’ but, as stated in this paper, the objectives for having this type of practitioner must be established first. Subsequently appropriate outcomes can be determined and research can be undertaken to see what, if any, difference these practitioners make within the healthcare system. These outcomes could include a variety of measures such as ED attendance; morbidity and mortality measures; quality of life indicators; patients’ experiences; safety outcomes; cost effectiveness etc.
The authors conclude by emphasising the importance of collaborative discussion between government agencies, emergency service providers, community health agencies, allied health professionals and medics in order to explore the full potential of extended scope of practice paramedics who are based in the community working with patients with low acuity illness and/or injury.