Skilled Paramedics May Offer Effective Alternative To Standard Ambulance Service

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Main Category: Seniors / Aging
Also Included In: Public Health
Article Date: 05 Oct 2007 - 0:00 PDT

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Paramedics can be educated to handle some conditions for elderly people in the community, says an article in the British Medical Journal (BMJ). Approximately one fifth of all hospital emergency department visits involve older people.

The authors explain that current evidence regarding the effectiveness, safety and costs to support these changes in practice is insufficient. Researchers from South Yorkshire decided to do a randomized trial to find out how effective an alternative approach to managing older patients with minor problems might be.

Seven paramedics who had completed the Paramedic Practitioner In Older People's Support (PPSPS) training course were selected for the study. The course focuses on delivering patient centered care to elderly patients who call emergency services with conditions not considered to be immediately life-threatening.

The trial involved 3,018 patients aged at least 60 years, and took place from September 2003 to September 2004, in Sheffield, England. The patients had called emergency services between 8am and 8pm with a problem that was within the range of practice of the paramedic practitioners, such as nosebleeds, falls, minor burns and lacerations.

Each week, a paramedic practitioner who was based in the ambulance control room identified eligible phone calls and notified either a paramedic practitioner in the community (intervention weeks) or in the emergency department for the standard 999 service (control weeks).

(999 is the number you ring in the United Kingdom when you want to call the emergency services - like 911 in the USA)

The researchers recorded emergency department attendances or hospital admissions between 0 and 28 days, as well as intervals from time of call to moment of discharge. Two postal questionnaires were used to gauge patient satisfaction with the service - one was sent on the third day after the incident and the other one 28 days after the incident.

Patients in the intervention group had a 25% lower probability of attending the emergency department or need hospital admission within four weeks - their total episode time was about 42 minutes shorter than those in the other group. Their level of satisfaction, expressed in the questionnaires, was higher than in the control group. Mortality rates and health outcomes 28 days after the incident were the same in both groups.

The authors conclude that this service offers significant benefits for both patients and The National Health Service (NHS) - overall emergency department and hospital attendances were reduced, episode times were shorter, and levels of patient satisfaction were higher. As mortality and health outcomes were the same for both groups, the new service appears to be safe.

"Paramedic Practitioner Older People's Support Trial (PPOPS): cluster randomised controlled trial"
Suzanne Mason, Emma Knowles, Brigitte Colwell, Simon Dixon, Jim Wardrope, Robert Gorringe, Helen Snooks, Julie Perrin, Jon Nicholl
BMJ Online First - doi:10.1136/bmj.39343.649097.55
http://www.bmj.com

Written by: Christian Nordqvist
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