ParaMED Home: A protocol for a randomised controlled trial of paramedic assessment and referral to access medical care at home

A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to ED via ambulance transfer or referral to a rapid response service that will assess and treat the patient in their own residence. The primary outcome measure is requirement for unplanned medical attention (in or out of hospital) in the first 48 hours. Secondary outcomes will include a number of other clinical endpoints. A cost effectiveness analysis will be conducted.If this trial demonstrates clinical non-inferiority and cost savings associated with the primary assessment service, it will provide one means to safely address ED overcrowding.Australian and New Zealand Clinical Trials Registry Number 12610001064099Emergency Department (ED) overcrowding is an international phenomenon[1]. Overcrowding is associated with mortality[2], delay to time critical therapy[3,4], patient dissatisfaction[5] and ambulance ramping, where paramedics are unable to deliver patients to ED due to a lack of available beds.In Australia, there are over 7 million hospital ED episodes of care per year with up to 25% of patients arriving in ED by ambulance[6]. Estimates of the proportion of these ED cases that are primary care patients vary according to the definition and scope of primary care[7], but a reasonable proportion of cases that present to ED by ambulance may be equally suited to care in the community by a primary care service.There are many reasons why people call an ambulance in addition to a medical emergency. There may be inability to access alternative health care; issues associated with chronic illness and disability; requirements for advice and reassurance; and psychosocial reasons. Many patients access health care through the ambulance service without necessarily believing they need transport to hospital, yet paramedics in some jurisdictions are governed by the duty of care that requires them to