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28 The difference between physician assistants and ambulance nurses as solo emergency care providers in EMS, a cross sectional study
  1. S Berben,
  2. A Bloemhoff1,
  3. L Schoonhoven2,
  4. A de Kreek3,
  5. P van Grunsven4,
  6. M Laurant5
  1. 1Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, the Netherlands
  2. 2Faculty of Health Sciences, University of Southampton, Southampton, UK
  3. 3Ambulance Emergency Medical Service Veiligheids en Gezondheidsregio Gelderland-Midden, Arnhem, the Netherlands
  4. 4Ambulance Emergency Medical Service Veiligheidsregio Gelderland-Zuid, Nijmegen, the Netherlands
  5. 5Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, Netherlands


Aim The aim of the study is to compare the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by the physician assistant (PA) and ambulance nurse (RN) in emergency medical services (EMS) in the Netherlands.

Methods In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n=493) and 23 RNs (n=498). Data were drawn from predefined and free text fields in the electronic patient records and analysed using descriptive statistics. We used χ2 and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of p<0.05.

Results In line with the medical education, PAs used a medical diagnostic approach (16%, n=77) and an exam of organ tract systems (31%, n=155). PAs consulted more often other medical specialists (33%) than RNs (17%) (χ2=35.5, p<0.0001). PAs referred less patients to the general practitioner (GP) or emergency department (ED) (50%) compared to RNs (73%) (χ2=52.9, p<0.0001). Patient follow up contact with the dispatch centre within 72 hour after completion of the emergency care on scene showed no variation between PAs (5%) and RNs (4%).

Conclusion PAs seemed to operate from a more general medical perspective. They referred significantly less patients to the ED.


  1. Bloemhoff, et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2016;24:86.

  2. Affiliation of presenting author is Eastern Regional Emergency Healthcare Network, Radboud University Medical Centre, Nijmegen, the Netherlands

Conflict of interest None declared.

Funding Ministery of Health Welfare and Sports, the Netherlands

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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