Clinical presentations and practitioner levels appropriate for the introduction of ‘Treat and Referral’ into the Irish Emergency Medical Service: a survey of consultants in emergency medicine.

Brian Power, John Ryan, Gerard Bury



Objectives: Overcrowding in emergency departments (EDs) is an international issue and ambulance bypass is seen as one element of the solution to a complex problem. Irish EDs are not immune to this healthcare crisis, which, together with increased off-load delays for ambulances, is one catalyst for the introduction of Treat and Referral (paramedic non-ED disposition decision).  The confidence of consultants in emergency medicine in paramedics and advanced paramedics offering Treat and Referral to patients presenting with hypoglycaemia or seizure was explored.  Other specific clinical presentations were also investigated for suitability for Treat and Referral and a consensus was sought on an upper age limit for such patients.   


Methods: Public-sector consultants in emergency medicine in Ireland at the time of the study, were invited to complete an online survey.  A 62% response was received from the targeted population.


Results: Confidence was expressed in advanced paramedics offering Treat and Referral to patients with hypoglycaemia or seizure by the majority (78%) of respondents. However, confidence was reduced for paramedics (53%). Six of the twelve specific clinical presentations received clear support as suitable for Treat and Referral, with the remaining receiving reducing support and ‘falls in the elderly (without injury)’ was opposed.  There was no consensus on an upper age limit for patients being offered Treat and Referral.


Conclusions: Support for the highest level of EMS practitioner in Ireland, advanced paramedic, to expand their scope of practice to include Treat and Referral was identified.  Clinical presentations have been identified that would be conducive to a Treat and Referral clinical care pathway.  A trial implementation period may be essential to build confidence in the programme before a universal roll out.


Paramedic; emergency department; admission avoidance; pre-hospital emergency care; treat and referral

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