Effectiveness of paramedic practitioners in attending 999 calls from elderly people in the community: cluster randomised controlled trial.

OBJECTIVE: To evaluate the benefits of paramedic practitioners assessing and, when possible, treating older people in the community after minor injury or illness. Paramedic practitioners have been trained with extended skills to assess, treat, and discharge older patients with minor acute conditions in the community. DESIGN: Cluster randomised controlled trial involving 56 clusters. Weeks were randomised to the paramedic practitioner service being active (intervention) or inactive (control) when the standard 999 service was available. SETTING: A large urban area in England. PARTICIPANTS: 3018 patients aged over 60 who called the emergency services (n=1549 intervention, n=1469 control). MAIN OUTCOME MEASURES: Emergency department attendance or hospital admission between 0 and 28 days; interval from time of call to time of discharge; patients' satisfaction with the service received. RESULTS: Overall, patients in the intervention group were less likely to attend an emergency department (relative risk 0.72, 95% confidence interval 0.68 to 0.75) or require hospital admission within 28 days (0.87, 0.81 to 0.94) and experienced a shorter total episode time (235 v 278 minutes, 95% confidence interval for difference -60 minutes to -25 minutes). Patients in the intervention group were more likely to report being highly satisfied with their healthcare episode (relative risk 1.16, 1.09 to 1.23). There was no significant difference in 28 day mortality (0.87, 0.63 to 1.21). CONCLUSIONS: Paramedics with extended skills can provide a clinically effective alternative to standard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions. TRIAL REGISTRATION: ISRCTN27796329 [controlled-trials.com].

Outcomes after injury: a comparison of workplace and nonworkplace injury.

BACKGROUND: Factors affecting recovery from injury are investigated comparing male emergency department patients involved in work-related and non-work-related accidents. METHODS: This was a prospective cohort study of 154 injured employed male emergency department patients recording demographic and accident details, return to work information, and involvement in litigation. Standardized questionnaires measured psychological, physical, and social responses. Evaluations were at admission, and at 6 weeks, 6 months, and 18 months after injury. RESULTS: Work-related injuries were less severe than non-work-related injuries (p = 0.006), and more patients became involved in litigation (p = 0.02) and suffered symptoms of posttraumatic stress disorder (p = 0.04). Psychosocial symptoms increased with nonreturn to work (p < 0.05). Factors predicting return to work include injury severity, blaming others, involvement in litigation, and subsequent physical and social functioning. CONCLUSION: Patients injured at work are more likely to commence litigation and develop symptoms consistent with posttraumatic stress disorder. Nonreturn to work is associated with higher psychosocial morbidity. Return to work is predicted from event and recovery period variables.