***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 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 OBJECTIVES To evaluate paramedics ' ability to identify elderly at risk and refer them for assessment and service . DESIGN A prospect i ve nonr and omized open trial . SETTING Akron , Ohio , a midsize city with a well-developed advanced life support emergency medical services system . TYPE OF PARTICIPANTS One hundred thirty firefighter paramedics evaluated 6,000 elderly patients .  Assessment s were performed by trained geriatric assessors . INTERVENTION Regardless of the reason for the call , paramedics screened all emergency medical services users age 60 and older for medical , mental health , social , and environmental problems . Identified cases were referred to the Area Agency on Aging for assessment and follow-up . MAIN RESULTS Paramedics identified 197 people with possible problems , 124 of whom received an assessment . The remainder could not be assessed due to death , moving , referral , or transfer to a long-term care facility . Assessors confirmed the presence of a problem in 121 of 124 assessed cases , a positive predictive value of 98 % . The program was useful for 94 people , 48 % of those identified and assessed . CONCLUSION Paramedics can serve as case finders for at-risk elderly , and effective linkage to service agencies can occur UNLABELLED Residential carbon monoxide ( CO ) poisoning represents a significant cause of unintentional morbidity and mortality in the United States . Screening by fire departments and utility companies is usually limited to instances in which there are symptoms of CO poisoning or there is activation of a home CO detector . OBJECTIVES To determine whether emergency medical services ( EMS ) personnel can perform routine CO screening during 911 calls . METHODS A prospect i ve observational study was conducted in an urban EMS system using emergency medical technicians ( EMTs ) to screen for elevated CO levels during emergency responses . The EMTs carried h and -held CO meters that detect as little as one part per million of CO . Readings were taken at the patient 's side during indoor patient contacts . If time allowed , a brief question naire was then administered to patients or by-st and ers concerning knowledge about CO poisoning , type of household heating system , and presence of home CO detectors . RESULTS In a three-month convenience sample of emergency responses , there were 264 residential CO readings obtained . There were nine ( 3.4 % ) positive residential readings , all with chief complaints believed to be unrelated to CO toxicity . Two hundred twelve surveys were completed during these emergency responses , with 145 of 212 ( 68 % ) participants familiar with the term " carbon monoxide poisoning . " Only 54 of 145 ( 37 % ) participants could name any signs or symptoms of CO poisoning . Of those surveyed , 133 of 212 ( 63 % ) participants reported an oil- or gas-powered heating system in their residence . Carbon monoxide detectors were absent in 185 of 212 ( 87 % ) residences , including all domiciles in which a positive CO reading was obtained . CONCLUSIONS Emergency medical services personnel can perform routine CO screening and detect occult elevations in CO levels during 911 responses . Public knowledge of CO poisoning is limited and the use of home CO detectors is rare in this study population INTRODUCTION This study evaluates whether a continuing education program for paramedics  , focusing on Children with Special Health Care Needs , improved paramedics ' assessment and management . METHODS Emergency Medical Services responses for children , 21 years of age or younger , with a congenital or acquired condition or a chronic physical or mental illness , were identified . The responses before and after the specialized education program were review ed by a multidisciplinary team to evaluate assessment and management of the children . Inter review er agreement between the nurses on the team and between the physicians on the team was assessed . We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program . RESULTS Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program . Review ers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training . Agreement on whether assessment and treatment was appropriate for all five review ers varied considerably , ranging from 32 % to 93 % . Overall there was a high percentage of agreement ( > 70 % ) between the nurses and between the physicians on most items . However , kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items . CONCLUSION Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs . Nevertheless , the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education The aim of this study was to carry out a critical appraisal to detect the occurrence of publication bias , specifically positive- outcome bias , in Brazilian dental journals . A convenience sample of twenty-eight dental journals published in Brazil between 1994 and 2003 was selected ( 564 issues containing 5,453 articles ) . Each article was classified according to method ological design ; 1,064 were classified as case reports . A simple r and om sample of 435 articles comprised the final study sample and was su bmi tted to a critical appraisal by previously trained raters . Although a great part of case reports achieve proper structural aspects , most authors did not consider important aspects that could help the decision making process , such as discussion of alternative approaches , limitation of the performed procedures , lack of long-term clinical follow-up , possible variations in treatment outcome , and failure to discuss limitations of study design . In addition , unanimous reports of successful outcomes of clinical interventions strongly suggest that publication of case reports was influenced by positive outcome bias , which may influence readers ' clinical decision making process 
    Output:
    
There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers .
This review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy .