***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 r and omised controlled trial involving 56 clusters . Weeks were r and omised to the paramedic practitioner service being active ( intervention ) or inactive ( control ) when the st and ard 999 service was available . Setting A large urban area in Engl and . 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 clinical ly effective alternative to st and ard ambulance transfer and treatment in an emergency department for elderly patients with acute minor conditions . Trial registration IS RCT N27796329 Over a 2-week period a prospect i ve study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service .  Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective . The author 's finding that , of patients attending after a ‘ 999 ’ call , 49.8 % were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service . Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service , improving patient care in the pre-hospital setting Background : A scheme to train paramedics to undertake a greater role in the care of older people following a call for an emergency ambulance was developed in a large city in the UK . Objectives : To assess the cost effectiveness of the paramedic practitioner ( PP ) scheme compared with usual emergency care . Methods : A cluster r and omised controlled trial was undertaken of  PP  compared with usual care . Weeks were allocated to the study group at r and om to the PP scheme either being active ( intervention ) or inactive ( control ) . Re source use data were collected from routine sources , and from patient-completed question naires for events up to 28 days . EQ-5D data were also collected at 28 days . Results : Whereas the intervention group received more PP contact time , it reduced the proportion of emergency department ( ED ) attendances ( 53.3 % vs 84.0 % ) and time in the ED ( 126.6 vs 211.3 minutes ) . There was also some evidence of increased use of health services in the days following the incident for patients in the intervention group . Overall , total costs in the intervention group were £ 140 lower when routine data were considered ( p = 0.63 ) . When the costs and QALY were considered simultaneously , PP had a greater than 95 % chance of being cost effective at £ 20 000 per QALY . Conclusion : Several changes in re source use are associated with the use of PP . Given these economic results in t and em with the clinical , operational and patient-related benefits , the wider implementation and evaluation of similar schemes should be considered Introduction : The Department of Health document Reforming emergency care stated that new initiatives need to be developed to improve the care and assessment of patients .  The Audit Commission has suggested that ambulance services should be allowed to decide who should be sent to each type of emergency and treat some patients at home . Aims : This scheme explores a new way of providing clinical assessment of older patients in their homes or in care homes within Sheffield . It sets out to provide a very patient centred model of care by providing community based clinical assessment for patients presenting to the emergency services with minor acute conditions . Scope , development , and structure of scheme : The scheme trains paramedic practitioners in the assessment and treatment of minor conditions to emergency nurse practitioner level . It consists of a three week full time theory based course and a 45 day period of supervised clinical practice based in the emergency department , minor injury unit , care of the elderly falls clinic , and with community services . Subsequently , the competence of the practitioners is assessed . Service delivery : The service will be activated by a 999 call between 0800 to 2000 each day . It is anticipated that between 25 % to 50 % of patients eligible to receive the service will be assessed and treated within the home . This approach to providing emergency care is untested and the frequency of use , patient acceptability , safety , and cost effectiveness are unknown , therefore rigorous assessment is essential through a r and omised controlled trial To determine whether paramedics can safely treat and discharge  insulin-dependent diabetic patients experiencing uncomplicated hypoglycemic events , we conducted a prospect i ve , observational study with a convenience sample of diabetic patients whose hypoglycemia resolved after intravenous administration of dextrose and before they were transported by paramedics . On-line medical control was contacted to obtain approval and informed consent for participation from interested patients who met all eligibility criteria for the study . Participating patients were given instructions upon discharge from the study and were contacted by telephone 24 hours later to ascertain their medical outcomes and their opinions of the study protocol . We enrolled a total of 36 patients with 38 incidents of hypoglycemia . Of these , 91 % reported no complications after discharge . Two patients developed recurrent hypoglycemia but treated themselves and did not require further emergency care . One further patient was found unresponsive on the morning following discharge and was subsequently admitted to a long-term care facility with hypoglycemic encephalopathy . Of the study participants , 85 % were very satisfied with not being transported to an emergency department ( ED ) and 91 % were very satisfied with the care they had received . All ( 100 % ) of the patients surveyed favored a permanent protocol allowing discharge of hypoglycemic patients without admission to an ED . We conclude that paramedics successfully treated , without complication , most of the patients with uncomplicated hypoglycemic events who were examined in our study . These patients generally preferred discharge without transportation to an ED BACKGROUND The role of paramedics with extended skills is evolving , enabling them to assess and treat patients in the community . A United Kingdom service led by extended-role paramedic practitioners ( PPs ) is aim ed at managing minor acute illness and injury among older people in the home when appropriate , avoiding unnecessary transfer to the emergency department ( ED ) . OBJECTIVES The objectives were to evaluate the safety of clinical decisions made by PPs operating within the new service . METHODS As part of a cluster-r and omized controlled trial , patients aged > 60 years contacting the emergency medical services ( EMS ) with a minor injury or illness were included in the study . The safety of the new PP intervention was compared with st and ard practice of EMS transfer and ED treatment . Outcomes included unplanned ED attendance within 7 days of the index episode . Clinical records were rated independently by two senior ED clinicians to identify related episodes , avoidable subsequent episodes , and suboptimal care . RESULTS Of the 2,025 patients included in this analysis , 219 ( 10.9 % ) went on to have an unplanned ED attendance within 7 days . Of these , 162 ( 74.0 % ) re-presented with a condition related to their index episode . The independent raters agreed on suboptimal care 83.4 % of the time . There were 16 agreed upon episodes related to suboptimal care ( 0.80 % ) . No significant differences were found between intervention and control groups in relation to re-presentation at hospital within 7 days for a related condition or rates of assessed suboptimal care . CONCLUSIONS This study suggests that appropriately trained paramedics with extended skills treating older people with minor acute conditions in the community are as safe as st and ard EMS transfer and treatment within the ED Objective To evaluate the impact of emergency care practitioners ( ECPs )  on the patient care pathway for children presenting with minor conditions in unscheduled care setting s. Design A pragmatic quasi-experimental multi-site community intervention trial comparing ECPs with usual care providers . Setting Three pairs of emergency and urgent care services in the UK : minor injury unit ( MIU ) , urgent care centre ( UCC ) and general practitioner out of hours . Patients Paediatric acute episodes ( n=415 intervention and n=748 control ) in participating services presenting with minor conditions . Main outcome measures Percentage of patients discharged following care episode and percentage of patients referred to hospital and primary care services . Interventions ECPs operational in emergency and unscheduled care setting s. Results ECPs  discharged significantly fewer patients than usual care providers ( percentage difference 7.3 % , 95 % CI 13.6 % to 0.9 % ) . ECPs  discharged fewer patients within all three pairs of services ( out of hours percentage difference 6.33 % , 95 % CI 15.17 % to 2.51 % ; UCC percentage difference 8.73 % , 95 % CI 19.22 % to 1.76 % ; MIU percentage difference 6.80 % , 95 % CI 24.36 % to 10.75 % ) . ECPs also referred more patients to hospital ( percentage difference 4.6 % , 95 % CI –2.9 % to 12.0 % ) and primary care providers ( percentage difference 3.0 % , 95 % CI 3.7 % to 9.7 % ) . Conclusions ECPs are not as effective as usual health providers in discharging children after assessment of urgent healthcare problems . This has implication s for the workload of other paediatric providers such as the emergency department . ECPs may be better targeted to setting s and patients groups in which there is more evidence of their effectiveness in patient care pathways 
    Output:
    
Community paramedicine research to date is lacking , but programs in the United Kingdom , Australia , and Canada are perceived to be promising , and one RCT shows that paramedics can safely practice with an exp and ed scope and improve system performance and patient outcomes .