Implications of the changing role of the Ambulance Paramedic for the interpretation of inappropriate calls: a review of the literature

Objectives: This article is a review of the literature on the changing role of the ambulance paramedic in the light of recent changes in UK Government policy towards the ambulance service. Methods: A systematic review of the literature on the Ambulance Service in the UK was carried out with regard to the expanding role and skills of ambulance paramedics in assessing, treating and advising patients at the scene of an emergency call-out. This involved accessing papers on the impact of increasing call outs, debates about the appropriateness of emergency calls, the outcomes of changing patterns of ambulance service practices and the effects of the performance indicators appertaining. Results: The review identifies the differences in the interpretation of the appropriateness of call-outs between ambulance callers and professionals. It also establishes that the contrast in perspectives has increased in importance as the number of call-outs has risen and the role of the paramedic has been developed. The narrow performance measurement regime in place intensifies this dilemma. These developments have implications for assessing the impact of improved ambulance services in terms of efficiency and effectiveness. Conclusions: A more balanced set of performance indicators is required, which would clearly recognise the work done by ambulance paramedics on the ground. This should reflect the perceptions of professionals and users concerning appropriateness. In addition there were gaps identified in the literature, especially with regard to the managerial and policy implications of changes in the service.