Expanding Paramedic Scope of Practice in the Community: A Systematic Review of the Literature

From Prehospital Emergency Care:

Background. Paramedics are an important health human resource and are uniquely mobile in most communities across Canada. In the last dozen years, challenges in the delivery of health care have prompted governments from around the globe to consider expanding the role paramedics play in health systems. Utilizing paramedics for the management of urgent, low-acuity illnesses and injuries has been coined “community paramedicine,“ but the role, safety, and effectiveness of this concept are poorly understood.

Objective. We undertook a systematic review of the international literature to describe existing community paramedic programs.

Method. We used the Cochrane methodology for systematic reviews. An international group of experts developed a search strategy and a health information specialist executed this search in Medline, Embase, and CINAHL starting January 1, 2000. We included all research articles in the English language that reported a research methodology. We excluded commentaries and letters to the editor. Two investigators independently screened citations in a hierarchical manner and abstracted data.

Results. Of 3,089 titles, 10 articles were included in the systematic review and one additional paper was author-nominated. The nature of the 11 articles was heterogeneous, and only one randomized controlled trial (RCT) was found. This trial showed community paramedicine to be beneficial to patients and health systems. The other articles drew conclusions favoring community paramedicine.

Conclusion. Community paramedicine research to date is lacking, but programs in the United Kingdom, Australia, and Canada are perceived to be promising, and one RCT shows that paramedics can safely practice with an expanded scope and improve system performance and patient outcomes. Further research is required to fully understand how expanding paramedic roles affect patients, communities, and health systems.

FDNY EMTs Wrestle Gun Away from Patient and Treat Injured Officer

From JEMS:

Although he was handcuffed behind his back, he was able to remove one of the police officers’ guns and fired the weapon twice, according to police. He struck Officer Gomez one time on his left foot.

EMT Hernandez was turning off the ambulance and removing the key when he looked in the vehicle’s rear view mirror and police struggling with the man. He said he then heard popping sounds.

“I ran over, froze for a second, then just grabbed the gun,” EMT Hernandez said. Then, without any firearm experience, he figured out how to clear the gun’s chamber and emptied the magazine.