In this week's BMJ, Mason and colleagues report a cluster randomised controlled trial examining the effects of a “paramedic practitioner” service in a UK urban setting.1 The trial focused on managing older patients without life threatening conditions who accessed the emergency ambulance service. It aimed to increase the proportion receiving care in the community and reduce admissions to the emergency department. It found that people in the intervention group were less likely to attend the emergency department (relative risk 0.72, 95% confidence interval 0.68 to 0.75) or need hospital admission within 28 days (0.87, 0.81 to 0.94). However, use of secondary care services after the initial episode increased (1.21, 1.06 to 1.38).

Paramedic practitioners undertook a three week theory course followed by 45 days of supervised clinical experience. Their scope of practice was restricted to common presentations considered unlikely to result in serious injury, including falls, lacerations, epistaxis, and minor burns. Skills acquired beyond those normally practised by UK paramedics included wound care and suturing; examination …