TITLE : The impact of new prehospital practitioners on ambulance transportation to

Study Objective: To conduct a systematic review and meta-analysis that examined the impact of new prehospital practitioners, including Emergency Care Practitioners (EmCPs), Paramedic Practitioners and Extended Care Paramedics (ECPs) on Emergency Department (ED) services. Methods: We searched MEDLINE, Embase, CINAHL and AUSTHealth databases and handsearched the relevant journal and references in potentially relevant articles. To be included, studies were required to target one type of new prehospital practitioner and compare outcomes such as the frequencies of conveyances to ED, discharges at scene, subsequent ED attendances and/or appropriateness of care between new prehospital practitioners and conventional ambulance crews. Three investigators independently selected relevant studies. The risk of bias in individual studies was assessed using a check list developed and validated by Downs and Black. We conducted metaanalyses for comparisons which had an acceptable level of heterogeneity and reported pooled estimates of the odds ratio (OR) with 95% confidence intervals (CIs). Results: Thirteen relevant studies were identified from 16,584 citation reports. There were one experimental study, two quasi-experimental and 10 observational studies. EmCPs were most frequently studied. The majority of studies did not fully report potential confounding factors or adjust outcome measures for these. New prehospital practitioners were less likely to convey patients to ED and more likely to discharge patients at scene than conventional ambulance crews. Pooled ORs for conveyance to ED and discharge at scene by ECPs were 0.09 (95% CI 0.04-0.18) and 10.5 (95% CI 5.8-19), respectively. The evidence for subsequent ED attendance and appropriateness of care was equivocal.