The traditional principles of the ambulance service have served to underpin developments in pre‐hospital care, which together with increasing skills of paramedics and technology have both raised the profile of the service and arguably contributed to improvements in patient care. However despite these advances patients are still transferred to hospital following treatments from paramedic responses to ‘999’ emergencies. Evidence from the on‐scene treatment of diabetics suggests that certain patient groups can be appropriately managed in the community without recourse to either secondary or primary care through increasing paramedic judgement skills. Although this alone may not be enough to encourage support from health care professionals, the development of pre‐hospital care pathways with strict clinical and non‐clinical criteria may provide the answer. Increasing demands on all disciplines of the health service are to some extent determining the pace at which professionals work in finding solutions to more clinically effective care. The following paper offers a hypothesis that could potentially integrate paramedics more fully into the health care system.
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