New and emerging roles in out of hospital emergency care: a review of the international literature

Int Emerg Nurs. 2009 Apr;17(2):90-8. doi: 10.1016/j.ienj.2008.11.004.


Aims: The aim of the literature review was to identify new and emerging out of hospital emergency care roles and to describe their activity and impact.

Background: Demographic changes, increased demands for health services, altered working practices, and health system economic pressures have led to the development of a disparate set of new health care roles.

Data sources: MEDLINE, EMBASE and CINAHL databases, and the two search engines Google and Google Scholar were searched for contemporary studies in the identified study area.

Review methods: All publications identified through the search were assessed for relevance. Those that discussed new roles were included (n=34) and empirical studies (n=14) analysed in detail.

Results: Emergency care and paramedic practitioner roles (ECP & PP) are having an impact on patient care, including an average 25% reduction in the conveyance rate to hospital, improved inter-professional working, immediacy of treatment and referral, and high patient satisfaction. Limited economic data suggests savings of between pound31 (USD 55) and pound37 (USD 65) per case when ECPs replace standard ambulance responders. Concerns have been expressed about patient safety, recruitment and training levels, regulatory and role implementation issues.

Conclusion: Further work is required to fully understand the patient safety, clinical practice, professional role and financial implications of these new roles.

Publication types

  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Emergency Medical Services / economics
  • Emergency Medical Services / trends*
  • Emergency Medical Technicians*
  • Humans
  • Patient Satisfaction
  • Professional Role*
  • Quality Indicators, Health Care
  • Task Performance and Analysis
  • Workforce