Moreover, only 5% of patients who had been managed in the community by an ECP had an acute ED presentation

within 7 days of that ECP attendance; although no comparison data were provided for conventional ambulance crews. In the Sydney West-Nepean catchment area, the ECP program commenced operations in December 2007. By October 2009, a total of 22 #no keyword# ECPs had responded to over 10,000 cases, with a non-transport rate of 38% – 45% depending on area [15]. The South Australian Ambulance Service (SAAS) introduced an ECP programme in the metropolitan area in December 2008 [16]. A conference abstract reported that in the first 7 months “ECPs attended 1123 patients, of those 555 interventions (49.4%) were considered to have prevented an ED presentation and 60 (5.3%), were considered to have prevented a hospital admission; and no adverse events were recorded”

[18]. ECPs provide alternative care pathways for patients who Inhibitors,research,lifescience,medical call for an ambulance and meet certain pre-defined criteria, such as the patient Inhibitors,research,lifescience,medical having a minor illness or injury, or only requiring basic medical advice or reassurance [15]. Through a ‘see and treat’ or a ‘see and refer’ strategy it is suggested that they can assist in reducing ambulance transport to hospital [16]. Whilst there is clear enthusiasm about the concept of ECPs as an alternative community-based model of emergency/primary health care, there is no good quality research data in Australia to support the efficacy, Inhibitors,research,lifescience,medical safety or cost-effectiveness of an ECP programme. It needs to be established that patients seen by ECPs do not end up presenting to ED within hours/days of the initial ECP attendance – possibly in a worse clinical condition than their initial presentation Inhibitors,research,lifescience,medical – or come to harm or die because of an unrecognised life-threatening condition. Our project will develop and test (through simulation) the feasibility and safety of empirically derived clinical protocols for an extended care paramedic (ECP) role for the Perth metropolitan area. We are aware of the fact

that paramedics do not have the same repertoire of clinical assessment skills as emergency physicians, nor do they have access to the same array of diagnostic tests. Of clearly concern to all clinicians is the risk of failing to identify potentially catastrophic Brefeldin_A events, such as sepsis, stroke or myocardial infarction. Thus, while we are interested in modelling the impact of the introduction of ECPs on ED demand and ED crowding, our primary concern will be patient safety. Methods/Design Setting Perth is located in the south-western corner of Australia. It is the capital city of WA and has a land area of 5,400km2[19]. The estimated population for the Perth Statistical Division in 2011 was 1,728,867 persons [20] of whom 49.6% were men and the median age was 36 years.