Background: Ambulance paramedics play a critical role expediting patient access to emergency treatments.\nStandardised handover communication frameworks have led to improvements in accuracy and speed of\ninformation transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved\nby paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize\nand synthesise data from studies describing development/extension of the ambulance-based paramedic role\nduring and after handover for time-critical conditions (trauma, stroke and myocardial infarction).\nMethods: We conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured\nstrategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics,\nemergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i)\ngeneric or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii)\nparamedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in\nsecondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.\nResults: We did not identify any studies that evaluated the health impact of an emergency ambulance paramedic\nintervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage\nwhich reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced\nparamedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer\nlocation. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration\nof treatment) might supplement handover information; (ii) structured handover tools and feedback on handover\nperformance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of\nparamedics after arrival at hospital was limited to ââ?¬Ë?direct transportationââ?¬â?¢ of patients to imaging/specialist care facilities.\nConclusions: There is insufficient published evidence to make a recommendation regarding condition-specific handovers\nor extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes.\nHowever, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced\nparamedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required
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