Should emergency medical technicians be considered for the role of the emergency care practitioner?

We enjoyed a recent discussion in this journal about the evaluation of the role of the emergency care practitioner (ECP).¹,² In the UK, 77% of ECPs are paramedics and most of the remainder are nurses,² although studies report them as a homogeneous group. We also find differences within ECPs interesting, particularly as ECPs in London have also been recruited from emergency medical technicians (EMTs).

In the London pilot, 11 EMTs undertook the same ECP diploma‐level education as paramedic recruits, with EMTs also needing to complete paramedic training before qualifying as ECPs. We examined their performance in the period when they were practising autonomously as ECPs, but before their paramedic training.

Educational performance of EMTs was similar to that of a group of paramedic ECPs matched by operating area and length of time as ECPs—physical assessment average marks 59.8% v 57.3% and clinical decision making average marks by Objective Structured Clinical Examination 59.9% v 60.6% (EMTs v paramedics, respectively).

Practice data for 1086 EMT‐ECP and 973 paramedic‐ECP‐attended patients showed differences in care pathway use, defined as treat and leave (30.8% v 22.5%), treated and referred (11.1% v 12.3%), conveyed, not emergency department (3.5% v 5.8%) and conveyed to the emergency department (54.6% v 59.4%); χ² = 21.42, df = 3, p = 0.001. Without outcome data, the interpretation of findings is limited and the higher treat and leave rate among EMT‐ECPs needs further investigation. However, the clinical educational results offer some reassurance about the similarity of competence of EMT‐ECPs and paramedic ECPs.

These data raise two issues:

• differences in performance within the ECP group may be important to consider in future studies;

• recruitment from a variety of staff is promoted in the national ambulance review.³ As long as professional registration is embedded in the educational programme, and clinical governance is robust, the possibility of access to the ECP role for EMTs, and potentially for others, is open.