• Hideo Tohira, Teresa A Williams, Ian Jacobs, Alexandra Bremner, and Judith Finn.
• Prehospital, Resuscitation and Emergency Care Research Unit, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Crawley, Western Australia, Australia.
• Emerg Med J. 2014 Oct 1;31(e1):e88-94.

ObjectiveTo conduct a systematic review and meta-analysis to examine the impact of new prehospital practitioners (NPPs), including emergency care practitioners (EmCPs), paramedic practitioners and extended care paramedics (ECPs), on ambulance transportation to the emergency department (ED).MethodsWe searched MEDLINE, Embase, CINAHL and AUSTHealth databases, and hand searched emergency medicine journals and journal reference lists for relevant papers. To be included, studies were required to target one type of NPP and compare outcomes such as the frequencies of conveyance to the ED, discharge at scene, subsequent ED attendance and/or appropriateness of care between NPPs and conventional ambulance crews. Three investigators independently selected relevant studies. The risk of bias in individual studies was assessed using a validated checklist. We conducted meta-analyses for comparisons which had acceptable heterogeneity (I(2)<75%) and reported pooled estimates of ORs with 95% CIs.Results13 studies were identified from 16 584 citation reports. EmCPs were most frequently studied. The majority of studies (77%) did not fully report important potential confounders. NPPs were less likely to convey patients to the ED and more likely to discharge patients at the scene than conventional ambulance crews. Pooled ORs for conveyance to the ED and discharge at the scene by ECPs were 0.09 (95% CI 0.04 to 0.18) and 10.5 (95% CI 5.8 to 19), respectively. The evidence for subsequent ED attendance and appropriateness of care was equivocal.ConclusionsThe NPP schemes reduced transport to the ED; however, the appropriateness of the decision of the NPPs and the safety of patients were not well supported by the reported studies.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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