Clinical Innovation in pre-hospital care: An introduction to Critical Care Paramedics in the United Kingdom

Abstract

The aim of the project was to evaluate the development of ‘Critical Care Paramedics’ (CCPs) at South East Coast Ambulance NHS Trust (SECAmb) in the UK. SECAmb has developed a new CCP role in response to numerous national reports critical of sub-standard pre-hospital care for seriously ill and injured patients, and the need to save more lives. There is an ongoing debate on the use of doctors and paramedics in pre-hospital care and the evidence is mixed whether one is more effective than the other in reducing mortality rates. There are examples in other countries of increasing the involvement of paramedic staff, and of improved survival and treatment rates. This evaluation study used a financial and qualitative methodology to unravel the cost effectiveness of CCPs. Using this methodology rather than just a randomised population study, helped uncover the rich processes underlying the new capabilities rather than simply reporting statistically significant differences. In any case, the small CCP sample at the start of this evaluation would have made any statistical comparisons meaningless. The study is based on an extensive literature analysis, 60 interviews with key stakeholders, observations of CCPs in the field, attendance at meetings including developmental activities, and review of internal documentation.