DIFFERENTIAL PREHOSPITAL BENEFIT FROM PARAMEDIC CARE

Study objectives: To determine whether prehospital outcome of patients who receive care from emergency medical technicians-paramedic (EMT-Ps ) differs from that of patients who receive care from emergency medica l technicians-defibrillation (EMT-Ds), as rated by the treating EMTs u sing standardized scales, and to determine whether the patient's serio usness of illness is relevant to any differential benefit of one level of care over the other. Design: Historical (retrospective) cohort. Se tting: An urban and semiurban region of southwest Ontario comprising a n area of 1,136 square kilometers (438 square miles) with a population of more than 445,000. Type of participants: Patients (1 0,291) who we re transported by the Hamilton-Wentworth EMS system between January 1, 1991, and December 31, 1991. Methods and measurements: EMTs rated the prehospital outcome of their own patients, using scales that had been tested in a previous study. Comparisons between EMT-P- and EMT-D-trea ted patients were made by chi2, chi2 by trend, and Fisher's exact test as appropriate. Results: More seriously ill or injured EMT-P-treated patients were rated as improved and fewer EMT-P-treated patients were rated as worsened compared with similar patients who were cared for an d rated by EMT-Ds. The differential benefit from EMT-P to EMT-D care r anged from 8% to 25% for patients rated as ''severe'' and from 27% to 49% for patients rated as ''life-threatened.'' Conclusion: According t o the ratings of prehospital care providers, patients classified as '' severe'' or ''life-threatened' had their conditions ''improve'' by the time they arrived at the hospital more often when care was provided b y an EMT-P team than when it was provided by an EMT-D team.