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Introduction of an extended care paramedic model in New Zealand


  • Sarah Hoyle, MHSc, Executive Manager Clinical Services; Andrew H Swain, BSc, PhD, FRCS, FCEM, FACEM, Senior Lecturer in Emergency Medicine; Paul Fake, BHSc (Paramedic), Service Development Manager; Peter D Larsen, BSc (Hons), PhD, Associate Professor.

Correspondence: Associate Professor Peter D Larsen, Department of Surgery and Anaesthesia, University of Otago, PO Box 7343, Wellington 6242, New Zealand. Email:



The first extended care paramedic (ECP) model of care in New Zealand was introduced in the Kapiti region, north of Wellington in 2009. The ECP model aimed to increase the proportion of patients presenting to the ambulance service who could be treated in the community. This study evaluated the first 1000 patients seen by ECPs.


The first 1000 presentations attended by ECPs were examined to determine the proportions of patients transported to the ED and treated in the community. For patients treated in the community we determined the number presenting to the ED within 7 days of ECP attendance.


A total of 797 patients (mean age 62 years) had 1000 clinical presentations. In 59% the patient was treated either at home or in the local community, with 40% transported to the ED. Within the same region and time period 74% of patients attended by standard paramedics were transported to the ED. The rate of ECP transport to the ED differed significantly by clinical condition, with 71% of cardiac presentations versus 19% of patients with spinal problems taken to the ED. In 31 cases (5%) where the patient had been managed in the community there was an acute ED presentation within 7 days.


We observed that ECPs have significant potential to reduce hospital ED attendances by treating more patients in the community, and this is associated with a low rate of subsequent ED presentations. Prioritisation of dispatch of ECPs to particular types of patients might be useful in maximising this reduction.