We also would like to extend our sincere gratitude to Biomedical editorial services for scientific editing of this manuscript.
Emergency Department (ED) overcrowding is an international phenomenon[1]. Overcrowding is associated with mortality[2], delay to time critical therapy[3,4], patient dissatisfaction[5] and ambulance ramping, where paramedics are unable to deliver patients to ED due to a lack of available beds. In

Australia, there are over 7 million hospital ED episodes of care per year with up to 25% of patients arriving in Inhibitors,research,lifescience,medical ED by ambulance[6]. Estimates of the proportion of these ED cases that are primary care patients vary according to the definition and scope of primary care[7], but a reasonable proportion of cases that present to ED by ambulance may be equally suited Inhibitors,research,lifescience,medical to care in the community by a primary care service. There are many reasons why people call an ambulance in addition to a medical emergency. There may be inability to access Selleck NVP-BGJ398 alternative health care; issues associated with

chronic illness and disability; requirements for advice and reassurance; and psychosocial reasons. Many patients access health care through the ambulance service without necessarily believing they need transport to hospital, yet paramedics in some jurisdictions are governed by the duty of care that requires them to render assistance and care for the patient until they handover to another health service. In practice Inhibitors,research,lifescience,medical this means that the patient may be transferred to ED even if the patient does not require emergency care. There is evidence from cluster and before-after studies that paramedics with extended Inhibitors,research,lifescience,medical skills can mange low-risk patients in the community without hospital transfer[8,9]. However other studies using paramedics as an assessment and referral service to divert cases away from Inhibitors,research,lifescience,medical ED have yielded conflicting results[10]. This trial has been designed to provide an alternative care path for patients that call an ambulance for minor injury and illness. The aim of the trial is to determine

whether paramedic referral to a rapid response primary care service in the patient’s own residence is clinically effective, safe and an efficient use of resources. Methods/Design Ethical considerations The study Phosphatidylinositol diacylglycerol-lyase has received human research ethical approval from Edith Cowan University (5249 SIM), the Department of Health Western Australia (#2010/45) and the Silver Chain Association of Western Australia (EC App 066). Study setting The study will commence in 2011 and be conducted in metropolitan Perth, Western Australia – a city with a population of over one million people serviced mainly by a single not-for-profit ambulance service (St John Ambulance Australia WA Inc) contracted by the government. The ambulance service transport adult patients to one of three tertiary or four district ED within the metropolitan area. Currently there are in excess of 100000 ambulance transfers to these ED annually.