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Petschack S, Lasslett R, Ross L. The paramedic-general practitioner relationship: a scoping review. Aust J Prim Health 2023; 29:547-557. [PMID: 37574261 DOI: 10.1071/py23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Health services internationally are implementing programs that increase working ties between paramedics and general practitioners (GPs) to reduce unnecessary transport to emergency departments (EDs) and improve access to primary health care. As paramedic involvement in primary health care develops, there is increasing focus on the GP-paramedic collaborative relationship. Resulting issues regarding professional boundaries may occur, as paramedics practice in fields that were previously solely in the GP scope. An effective paramedic-GP working relationship will be an essential foundation to the success of future strategies. METHODS A search of three electronic databases was completed (Ovid MEDLINE, Embase Classic+ Embase and CINAHL Plus). Eligibility for inclusion required analysis of the relationship between paramedics and GPs. All processes were completed by two independent reviewers. RESULTS After removal of duplicates, 4995 titles were screened by title and/or abstract. After full-text review, 15 studies were included. Five themes were identified that contribute significantly to the strengths and weaknesses of the relationship - the importance of communication, understanding scope of practice, leadership roles, responsibility for patient care and interdisciplinary training. Issues identified included significant variation in the structure of different emergency medical services and varying standards of education requirements for paramedics worldwide. CONCLUSIONS There were no published Australian studies that had the primary aim of examining the paramedic-GP relationship. The depth of research on this topic is lacking, despite increased interest over the past decade. The relevance of the international literature to the Australian setting is questionable.
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Affiliation(s)
- Sarah Petschack
- Department of Paramedicine, Monash University, Frankston, Vic. 3199, Australia
| | - Robert Lasslett
- Department of Paramedicine, Monash University, Frankston, Vic. 3199, Australia
| | - Linda Ross
- Department of Paramedicine, Monash University, Frankston, Vic. 3199, Australia
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Nystøyl DS, Røislien J, Østerås Ø, Hunskaar S, Breidablik HJ, Zakariassen E. Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway. BMC Emerg Med 2020; 20:88. [PMID: 33138780 PMCID: PMC7607704 DOI: 10.1186/s12873-020-00377-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Organizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district. Methods All primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable. Results We included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001). Conclusion After relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.
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Affiliation(s)
- Dag Ståle Nystøyl
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.
| | - Jo Røislien
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Steinar Hunskaar
- Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Erik Zakariassen
- Health Services Research Group, Department of Global Public Health and Primary Care, University of Bergen, PBox 7810, 5020, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Zakariassen E, Østerås Ø, Nystøyl DS, Breidablik HJ, Solheim E, Brattebø G, Ellensen VS, Hoff JM, Hordnes K, Aksnes A, Heltne JK, Hunskaar S, Hotvedt R. Loss of life years due to unavailable helicopter emergency medical service: a single base study from a rural area of Norway. Scand J Prim Health Care 2019; 37:233-241. [PMID: 31033360 PMCID: PMC6566894 DOI: 10.1080/02813432.2019.1608056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the patients are treated by a GP and ambulance staff only. We aimed to estimate the potential loss of life years for patients in these situations. Method: We included all HEMS requests in the period 2010-2013 from Sogn and Fjordane County that were medically indicated but subsequently cancelled. This provided a selection of patients, with the purpose of studying cancellations independently of the patient's medical status A multidisciplinary expert panel retrospectively assessed each patient's potential loss of life years due to the lack of helicopter transport and intervention by a HEMS physician. Results: The study included 184 patients from 176 missions. Because of unavailable HEMS, seven patients (4%) were anticipated to have lost a total of 18 life years. Three patients suffered from myocardial infarction, three from stroke and one from abdominal haemorrhage. The main contribution from HEMS care in these seven cases might have been rapid transport to definitive care. The probability of a patient losing life years when in need of HEMS evacuation was found to be 0.2%. Conclusion: During the four years period seven patients lost 18 life years. Lack of rapid transport seems to be the primary cause of lost life years in this specific geographical area. Key Points Knowledge about to what extent HEMS contributes to an increased survival and a better outcome for patients is limited. Compared to similar studies on life years gained the estimated loss of life years was minor when HEMS evacuation was unavailable in this rural area. The findings indicates that lack of rapid HEMS transport was the primary cause of the estimated loss of life years.
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Affiliation(s)
- Erik Zakariassen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- National Centre for Emergency Primary Health Care, Uni Research, Bergen, Norway;
- CONTACT Erik Zakariassen Department of Global Public Health and Primary Care, University of Bergen, Box 7810, 5020Bergen, Norway
| | - Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway;
- Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Dag Ståle Nystøyl
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway;
| | - Hans Johan Breidablik
- Department of Research and Development, District General Hospital of Førde, Førde, Norway;
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;
| | - Guttorm Brattebø
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway;
- Department of Clinical Medicine, University of Bergen, Bergen, Norway;
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway;
| | - Vegard S. Ellensen
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway;
| | | | - Knut Hordnes
- Center for Day Surgery, Hospitalet Betanien, Bergen, Norway;
| | - Arne Aksnes
- The Emergency and Primary Health Care Services, Kvam, Norway;
| | - Jon-Kenneth Heltne
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway;
- Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- National Centre for Emergency Primary Health Care, Uni Research, Bergen, Norway;
| | - Ragnar Hotvedt
- Institute of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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