Prehospital Assessment Units - a Matched Cohort Study

The demand for healthcare is increasing, stressing the need for adaptive Emergency Medical Services (EMS). This development was also illustrated in a Danish cohort study from 2017. The authors reported an increase in the annual number of patients assessed by EMS by 67% between 2007 and 2014.Thus, the traditional role of paramedics is changing to establish a bridge between the community and the hospital by offering primary care services. Paramedic assessment units (PAU) were implemented in Region Zealand, Denmark in 2021 to accommodate the increased demand. The PAU should increase focus on a patient-centered approach with the capability to make advanced assessments of patients to reduce unnecessary transportation. Further, this paramedic assessment program could positively impact the healthcare system by reducing admissions to emergency departments.

While this approach is new in Denmark, variations of the approach have been implemented internationally for more than two decades.The PAU can be compared with the community paramedic units. Different community paramedic programs have arisen to address the regional requirements; different regional and national operation environments explain this regarding the population density and level of healthcare service. No exact definition is present, but these assessment programs generally focus on frail elderly and other high-needs patients.

The PAU is operated by paramedics who have additional education, and they do have point-of-care test facilities (POCT). The paramedics can monitor saturation, blood pressure and electrocardiogram, all of which are standard equipment of ambulances in Region Zealand. Further, the paramedic can measure C-reactive protein, analyse urine test strips (pH, glucose, acetoacetate, leucocytes, nitrite, protein and erythrocytes), blood glucose and analyse blood gas (pH, pO2, pCO2, lactate, sodium, potassium, calcium and creatinine).

The patients assessed by the PAU had four possible destinations: admittance to the E-Hospital, a unique regional arrangement in which the patient stays at home but is under virtual surveillance by physicians and nurses. Alternatively, the patient was admitted to the E-hospital at local acute community-based facilities. Third, the patient was admitted to the emergency department at the hospital and finally, the PAU examined the patient at home without further follow-up. The decision was made between the physicians at the E-Hospital and the paramedic on the scene.

While the evidence supporting PAU is promising, convincing data from well-designed studies focusing on the impact of PAU on health outcomes and patient safety are still being determined.

This retrospective cohort study was conducted to compare individuals treated by PAU with a control group of matched individuals not treated by PAU. Thus, the primary objective of this study was:

• To identify patients among cases who were admitted to the emergency department within 48 hours and 7 days after consultation with the PAU, respectively.
• Secondary, to identify patients admitted to the emergency department within 6 hours from the initial call to the medical emergency number.
• Finally, to identify 30-day survival.

Inclusion criteria

• expectations of undergoing an uncomplicated illness progression
• green or yellow level of triage based on the ABCDE approach (red, orange, yellow, green, blue levels of triage.

Exclusion criteria

• gynaecological disease