Emergency care practitioners should not be compared with paramedics

I enjoyed the article by Cooper et al¹ and was delighted to see some evidence being published outlining the role of the emergency care practitioner (ECP). However, I have some concerns about the study. I was puzzled why the authors chose to compare the ECPs with paramedics. The roles are entirely different—ECPs are equipped with additional skills enabling them to undertake an indepth evaluation of a patient and treat them accordingly, leaving them at home where appropriate and without referral to another clinician. I am not aware that paramedics are trained to this level, and therefore I cannot understand how a comparison can be made.

Cooper et al also commented on the differences in the chief complaints that the ECPs attended, but surely this is the whole point of ECPs? They are specially trained to deal with minor illness and injury and therefore the response should be directed at these patients in order to ensure maximum benefit from the role. This paper would have been more relevant and interesting if the authors had compared the whole patient episode, rather than part of it. This may have allowed some conclusions to be drawn about the potential benefit an ECP might have for the patient in terms of time saved and appropriate clinical decisions made to avoid the emergency department.