• Colin A Graham, Manickam Kumaravel, and James Stevenson.
• Department of Accident and Emergency Medicine, Crosshouse Hospital, Kilmarnock, Scotland, UK. cagraham@rcsed.ac.uk
• Eur J Emerg Med. 2003 Dec 1; 10 (4): 279-82.

BackgroundAmbulance paramedics have been practising in North Ayrshire for some time. The aim of this study was to determine the range and number of procedures that are undertaken by paramedics, and whether they are performed in accordance with standard operating procedures.MethodsA five-year prospective observational study of patients attended by paramedics in a mixed urban/rural area of south-west Scotland. Data were collected on all procedures undertaken in the prehospital arena. A single investigator decided whether each procedure was performed in accordance with standard operating procedures in the light of available information.ResultsData on 6600 patients were available, a mean of 42 patients per paramedic per year. Oxygen administration increased significantly and the number of occasions when excess time was spent on scene decreased significantly during the study. Paramedics treated significantly fewer patients requiring intravenous cannulation, intubation, defibrillation and cardiopulmonary resuscitation in year 5 compared with year 1. Paramedics administered drugs in accordance with standard operating procedures in almost all cases.ConclusionParamedic exposure to extended skills is low in this region, leading to concerns about advanced skills retention. Paramedics can administer drugs appropriately according to protocol. Increasing paramedic experience, possibly augmented by feedback via audit, may be influencing paramedic decision making.

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