Extended Care Paramedics

Chief Investigator:

Professor Ian Jacobs

Principal Investigators:

Professor Judith Finn, Associate Professor Glenn Arendts, Professor Daniel Fatovich, Associate Professor David Mountain, Dr Teresa Williams, Professor Peter Sprivulis and Winthrop Professor Tony Celenza

Associate Investigators:

Mr Tony Ahern, Assistant Professor Alexandra Bremner, Mr Joe Cuthbertson and Professor Peter Cameron

Data Analyst:

Hideo Tohira

Year Commenced: 2012

Year Completed: 2015

Funding: $370,000

Ethics Approval: Approved and expired

Duration: 2.5 years


As demand for Emergency Department (ED) services continues to exceed any increase that can be explained by population growth, strategies to reduce demand and/or increase supply are being explored. The concept of ambulance paramedics providing an alternative model of care to the current ‘see and transport to ED’ has intuitive appeal and a small number of so-called ‘extended care paramedics’ (ECPs) have been introduced in New South Wales and South Australia.

The premise is that for certain non-critically ill patients, the ECP can either ‘see and treat’ or see and refer’ to another primary or community care practitioner. However, there has not been any rigorous investigation of which patients can be safely managed in their home, nor has there been any rigorous evaluation of the impact on ED demand and ED over-crowding.

Our project will develop and test empirically derived clinical protocols for an extended care paramedic role for the Perth metropolitan area. In addition, we will model the impact of the introduction of ECPs on ED demand and investigate the potential for ameliorating the problem of ED over-crowding in Perth.

As recently reported by the AIHW, between 2009-10 and 2010-11, ED presentations increased in all states and territories, but the greatest increase occurred in Western Australia (8.1%). Moreover St John Ambulance has reported a 23% increase in cases attended in metropolitan Perth over the last 5 years, which is recognized as a key driver for ED demand. Our goal is to develop and test (through simulation) an empirically validated protocol for the introduction of ECPs in Perth. The goal is to reduce the number of patients transported by ambulance to Perth EDs, without compromising patient safety. We recognise that the success of such a strategy depends on the building of collaborative working relationships between the ambulance paramedics, ED clinicians, GPs and other primary/community care providers.

Status: Completed in 2015

Contact Person: Professor Judith Finn – email: judith.finn@curtin.edu.au

Tohira H, Fatovich D, Williams TA, Bremner AP, Arendts G, Rogers IR, et al. Is it Appropriate for Patients to be Discharged at the Scene by Paramedics? Prehospital Emergency Care. 2016;20(9):539-49.

Tohira H, Fatovich D, Williams TA, Bremner A, Arendts G, Rogers IR, et al. Which patients should be transported to the emergency department? A perpetual prehospital dilemma. Emerg Med Australas. 2016;28(6):647-53.

Tohira H, Fatovich D, Williams TA, Bremner A, Arendts G, Rogers IR, et al. Paramedic Checklists do not Accurately Identify Post-ictal or Hypoglycaemic Patients Suitable for Discharge at the Scene. Prehospital Disaster Med. 2016;31(3):282-93.

Tohira H, Williams TA, Jacobs I, Bremner A, Finn J. The impact of new prehospital practitioners on ambulance transportation to the emergency department: a systematic review and meta-analysis. Emerg Med J. 2014;31(e1):e88-e94.

Finn JC, Fatovich DM, Arendts G, Mountain D, Tohira H, Williams TA, et al. Evidence-based paramedic models of care to reduce unnecessary emergency department attendance — feasibility and safety. BMC Emergency Medicine. 2013;13(1):13.

Tohira H, Fatovich DM, Williams TA, Bremner A, Arendts G, Rogers I, et al., editors. Risk of representation or death in patients discharged at the scene by paramedics. The 16 the International Conference on Emergency Medicine 2016; 2016 18-21 May 2016; Convention and Exhibition Centre, Cape Town, South Africa.

Tohira H, Fatovich D, Williams TA, Bremner A, Arendts G, Rogers I, et al., editors. Risk of representation of death in patients discharged at the scene by paramedics. Paramedics Australasia 2015 Conference; 2015 2-3 Oct 2015; Adelaide, South Australia, Australia.

Tohira H, Jacobs I, Finn JC, Williams TA, Fatovich DM, editors. Outcome of patients seen but not transported by paramedics in the Perth metropolitan area. The 15th International Conference on Emergency Medicine 2014; 2014 11-14 June 2014; Hong Kong Convention and Exhibition Centre, Hong Kong.

Tohira H, editor The impact of new prehospital practitioners on Emergency Department services: A systematic review and meta-analysis. The 7th Asian Conference on Emergency Medicine; 2013; Tokyo, Japan.