General practitioner roles in emergency medical services: a systematic mapping review and narrative synthesis

BackgroundA significant proportion of Emergency Medical Services (EMS) work is for problems which may be amenable to timely primary care management and could benefit from general practitioner (GP) input. Utilising GPs in EMSs may reduce avoidable emergency department (ED) conveyance, releasing emergency ambulances for higher acuity care, and meeting patient needs earlier in the evolution of an emergency call.AimTo collate and summarise evidence on how GPs are utilised in EMS.Design & settingSystematic mapping review and narrative synthesis.MethodA systematic literature search was conducted using search terms for general practice and emergency care. Primary research articles investigating the utilisation of GPs in non-critical EMS were included. An inductive framework was used to structure the results alongside a narrative synthesis.Results21 papers were included. GPs were embedded in EMS for urgent management of high acuity patients or used as an intervention to avoid unnecessary ED conveyance in selected lower acuity patients. The importance of interprofessional relationships and training for GPs involved in EMS was highlighted. No studies explored patient-reported outcomes. Outcomes measured were predominantly ED non-conveyance and admission avoidance, with GP services as an intervention reducing the likelihood of these.ConclusionEmbedding GPs in EMS might service different purposes depending upon context. There is some evidence that GP EMS services may reduce the likelihood of ED conveyance and hospital admission in selected cases – it is unclear whether this is due to case selection or GP involvement. Future research should incorporate patients’ views and experiences.