Coming out of England, (the land of the overburdened Public Health Service), they are trialing the new status of "Emergency Care Provider." Basically there are paramedics that receive additional training and can decide what type of care is appropriate for the patient - i.e. a full-blown emergency department, a walk-in clinic, their GP or even refuse to transport those who call with non-emergent conditions. While I personally would love this, the training/oversight would have to be rather stringent. While I personally feel comfortable making decisions about the urgetness of a patient's condition (and I did such as the Triage "RN" at an Emergency Department), there are some providers in the field that lack this decision-making capability. (Dare I say it… Firefighters….) Anyways, what do you all think? Is this a prudent way to control inappropriate ED visits, ED overcrowding, and reduce ED wait-times for those with true emergencies; or is it placing too much decision-making capability in those not qualified, and a disaster waiting to happen?

Medical Researchers Urge Policy Makers to Test Trials of Paramedics Pruning of Emergency Admissions

University of Warwick Medical School researchers are concerned that the health service could fail to learn important lessons from a crucial series of ambulance and emergency trials that increase the skills of paramedics and help reduce unnecessary emergency hospital admissions.

Dr Matthew Cooke, Head of the Emergency Care & Rehabilitation research group at the University of Warwick’s Medical School in England, will outline his concern at the “Emergency Care Conference”, at the University of Warwick on 2nd September 2004.

Dr Cooke is set to praise the general idea behind the trial schemes that seek to give paramedics and nurses additional training, allowing them to make more detailed and varied medical assessments of the patients they come across than ever before.

This additional training creates a new class of “Emergency Care Practitioners”, which allows them to identify patients that do not need to be transferred to an A&E department. In the past almost all patients who requested an ambulance by 999 were simply transferred to hospital by ambulance no matter what, with paramedics only taking decisions and making medical interventions in the cases of life threatening or other extremely serious injury. In future, they will undertake assessment and treatment that allows them to choose other alternatives, such as taking them to a GP surgery or deciding if they are fit to stay at home.

Dr Cooke is pleased with the potential benefits this will bring in decreasing the number of unnecessary admissions to hospitals, which means real emergency cases will be dealt with even faster than before. However, he is very concerned that this wave of innovative trial schemes with enhanced paramedic roles is being carried out without any investment in serious research or monitoring of how these trial schemes are working.

Dr Cooke will state at the forthcoming conference: “Many of these crucial schemes have been running for over six months yet all we seem to be hearing from them is mere anecdote – we are squandering a unique opportunity to learn real lessons on paramedic and nurse training, ambulance use, and A&E admissions that could be used to benefit patients and staff across the whole health service. It’s ironic that we have some great new ideas being tested on the evaluation of potential emergency patients, but no serious evaluation of those great new ideas.”

The current trials have created 216 Emergency Care practitioners in schemes in Greater Manchester, Hampshire, London, Bedfordshire, Hertfordshire, Coventry, Warwickshire, Hereford, Worcester, Kent, Surrey, Sussex, Norfolk, Suffolk, Cambridgeshire, Teesside, East and North Yorkshire, County Durham, Darlington, South Yorkshire, Devon and Cornwall.