Community paramedicine: cost-benefit analysis and safety evaluation in paramedical emergency services in rural areas - a scoping review.

OBJECTIVE: To examine the current knowledge and possibly identify gaps in the knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas. DESIGN: Scoping review. DATA SOURCES: MEDLINE via PubMed, CINAHL, Cochrane and Embase up to December 2020. STUDY SELECTION: All English studies involving community paramedicine in rural areas, which include cost-benefit analysis or safety evaluation. DATA EXTRACTION: This scoping review follows the methodology developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We systematically searched for all types of studies in the databases and the reference lists of key studies to identify studies for inclusion. The selection process was in two steps. First, two reviewers independently screened 2309 identified articles for title and abstracts and second performed a full-text review of 24 eligible studies for inclusion. RESULTS: Three articles met the inclusion criteria concerning cost-benefit analysis, two from Canada and one from USA. No articles met the inclusion criteria for safety evaluation. CONCLUSION: There are knowledge gaps concerning safety evaluation of community paramedicine in rural areas. Three articles were included in this scoping review concerning cost-benefit analysis, two of them showing positive cost-effectiveness with community paramedicine in rural areas.

A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest.

BACKGROUND: Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. METHODS: All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD's. RESULTS: Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. CONCLUSIONS: Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.

Community paramedicine-cost-benefit analysis and safety with paramedical emergency services in rural areas: scoping review protocol.

INTRODUCTION: Community paramedicine models have been developed around the world in response to demographic changes, healthcare system needs and reforms. The traditional role of the paramedic has primarily been to provide emergency medical response and transportation of patients to nearby medical facilities. As a response to healthcare service gaps in underserved communities and the growing professionalisation of the workforce, the role of community paramedicine has evolved as a new model of care. A community paramedicine model in one region might address other healthcare needs than a model in another region. Various terms are also in use for community paramedicine providers, with no consensus on the definition for community paramedics, although the definition used by the International Roundtable on Community Paramedicine has been widely accepted. We aimed to examine the current knowledge and possibly identify gaps in the research/knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas using a scoping review methodology. METHODS AND ANALYSIS: This scoping review will follow the methodology developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In October 2020, we will search electronic databases (MEDLINE via PubMed, CINAHL, Cochrane and Embase) and the reference lists of key studies to identify studies for inclusion. The selection process is in two steps. First, two reviewers will independently screen identified articles for title and abstracts and, second, perform a full-text review of eligible studies for inclusion. Studies focusing on community paramedicine in rural areas, which include cost-benefit analysis or safety evaluation, will be included. ETHICS AND DISSEMINATION: The data used are available from publicly secondary sources, therefore this study will not require ethical review. The results will be disseminated through peer-reviewed publication.