Volume : 12, Issue : 10, October – 2025
Title:
THE IMPACT OF ADVANCED PARAMEDIC SKILLS ON PATIENT OUTCOMES IN TIME-CRITICAL EMERGENCIES: A SYSTEMATIC LITERATURE REVIEW
Authors :
Naser Ali Algharibi, Naif Abdullah Alotaibi, Mubarak Ayesh Al Mutairi, Meshal Salaf Al Otaibi, Aehd Sad Mhmad Algarfan, Matar Dibas Alotaibi, Saud Mohammed Alaqidi, Ali Saad Alshammari, Adel Hamad Almutairi, Yazeed Saud Alhamdan
Abstract :
Emergency Medical Services (EMS) are undergoing a profound transformation, driven by technological innovation. In time-critical emergencies, outcomes are heavily dependent on the speed and quality of prehospital care. However, traditional EMS systems face significant challenges, including prolonged response times, clinical uncertainty, and systemic inefficiencies. This systematic literature review aims to comprehensively analyze and synthesize current evidence on the role and efficacy of various technologies in enhancing EMS delivery across the entire prehospital care continuum. Following the PRISMA guidelines, a systematic search was conducted across four electronic databases (PubMed/MEDLINE, Scopus, IEEE Xplore, Cochrane Library) for literature published between 2010 and 2025. A total of 34 studies meeting the inclusion criteria were identified and analyzed. Data were extracted and synthesized narratively, with technologies categorized according to their primary point of impact in the EMS “Chain of Survival”: Activation and Dispatch, On-Scene Care, In-Transit Care, and System-Wide Integration. The findings reveal a technological revolution reshaping EMS into a connected, intelligent, and proactive system. Key innovations include Artificial Intelligence (AI) for dispatch triage and predictive analytics, telemedicine for remote specialist consultation, drones for delivering medical supplies, point-of-care diagnostics, and electronic patient care records. These technologies demonstrate significant potential to improve clinical outcomes (e.g., increased survival in cardiac arrest and stroke) and operational efficiency (e.g., reduced response and transport times). Critical barriers to implementation were identified, including high costs, lack of system interoperability, the digital divide, and training requirements. Technology is a transformative force in modern prehospital care, shifting the paradigm from a transport-centric to an intervention-centric model. To fully realize this potential, concerted efforts are needed from stakeholders to address financial, technical, and ethical challenges through strategic investment, standardized data protocols, and equitable, human-centered implementation.
Keywords: Emergency Medical S ervices; Prehospital Care; Digital Health; Artificial Intelligence; Telemedicine
Cite This Article:
Please cite this article in press Matar Dibas Alotaibi et al., The Impact Of Advanced Paramedic Skills On Patient Outcomes In Time-Critical Emergencies: A Systematic Literature Review, Indo Am. J. P. Sci, 2025; 12(10).
REFERENCES:
1. Abelsson, A., Rystedt, I., Suserud, B. O., & Lindwall, L. (2014). Mapping the use of simulation in prehospital care–a literature review. Scandinavian journal of trauma, resuscitation and emergency medicine, 22(1), 22.
2. Al Hashil, H. H., Almansour, M. H., Al-Mayouf, S. H. I., Balhareth, H. H. H., Al Hawkash, S. H., Alhashil, H. S. H., … & Almansour, H. Y. H. (2025). Paramedics As Life-Savers: A Systematic Review Of Pre-Hospital Interventions In Emergency Medical Services. The Review of Diabetic Studies, 218-228.
3. Albahrani, M. I., Abuizran, H. M., Alhadab, H. A., Al Habib, M. S., Albattat, M. A., Alzaid, M. A., … & Albaqshi, M. A. (2025). Critical Minutes In Traffic Accidents: A Review Of Paramedics’ Early Interventions And Patient Outcomes. The Review of Diabetic Studies, 207-217.
4. Alhur, A. (2024). The role of informatics in advancing emergency medicine: a comprehensive review. Cureus, 16(7). https://doi.org/10.7759/cureus.44871
5. Aljohani, M. S. M., Alharbi, Y. A. M., Alatawi, M. S., Almotarrafi, I. H., Zuayran, A. S., Fawal, A. M. H., … & Alahmadi, B. A. S. (2024). Ambulance Based Patient Care: A Depth Review Study, Advancements, Reward and Challenges. Azerbaijan Pharmaceutical and Pharmacotherapy Journal, 23, 41-51.
6. Bache, K. G., Hjortdahl, M., & Halvorsen, P. S. (2021). Prehospital telemedicine – A review of the literature. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), 94. https://doi.org/10.1186/s13049-021-00911-4
7. Black, J. J., & Davies, G. D. (2005). International EMS systems: United Kingdom. Resuscitation, 64(1), 21-29.
8. Bøtker, M. T., Jacobsen, L., Rudolph, S. S., & Knudsen, L. (2018). The role of point of care ultrasound in prehospital critical care: a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine, 26(1), 51.
9. Carne, B., Kennedy, M., & Gray, T. (2012). Crisis resource management in emergency medicine. Emergency Medicine Australasia, 24(1), 7-13.
10. Carnicelli, A., Williams, A. M. M., & Edwards, D. G. (2024, January). Paramedic education and training for the management of patients presenting with low-acuity clinical conditions: a scoping review. In Healthcare (Vol. 12, No. 2, p. 176). MDPI.
11. Carnicelli, A., Williams, A. M. M., & Edwards, D. G. (2024, January). Paramedic education and training for the management of patients presenting with low-acuity clinical conditions: a scoping review. In Healthcare (Vol. 12, No. 2, p. 176). MDPI.
12. Carr, B. G., Matthew Edwards, J., & Martinez, R. (2010). Regionalized care for time‐critical conditions: lessons learned from existing networks. Academic Emergency Medicine, 17(12), 1354-1358.
13. Elfahim, O., Edjinedja, K. L., Cossus, J., Youssfi, M., Barakat, O., & Desmettre, T. (2025). A Systematic Literature Review of Artificial Intelligence in Prehospital Emergency Care. Big Data and Cognitive Computing, 9(9), 219.
14. Fevang, E., Lockey, D., Thompson, J., Lossius, H. M., & Torpo Research Collaboration. (2011). The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration. Scandinavian journal of trauma, resuscitation and emergency medicine, 19(1), 57.
15. Flynn, D., Francis, R., Robalino, S., Lally, J., Snooks, H., Rodgers, H., … & Price, C. (2016). A review of enhanced paramedic roles during and after hospital handover of stroke, myocardial infarction and trauma patients. BMC emergency medicine, 17(1), 5.
16. Gunson, I. M., Barley, C., Rosser, A., Bullock, L., Gordon, A. L., Kingstone, T., & Bucknall, M. (2025). Ambulance responses to older adults who have fallen: a systematic review. Age and Ageing, 54(8), afaf228.
17. Hansen, P. M., Nielsen, M. S., Rehn, M., Lassen, A. T., Mikkelsen, S., Perner, A., & Brøchner, A. C. (2024). Ambulance and helicopter response time. Association with patient outcome and illness severity: Protocol of a systematic literature review and meta‐analysis. Acta Anaesthesiologica Scandinavica, 68(2), 287-296.
18. Jansson, J., Larsson, M., & Nilsson, J. (2021). Advanced paramedics and nurses can deliver safe and effective pre‐hospital and in‐hospital emergency care: An integrative review. Nursing Open, 8(5), 2385-2405.
19. Kelly, A. M., & Currell, A. (2002). Do ambulance crews with one advanced paramedic skills officer have longer scene times than crews with two?. Emergency medicine journal, 19(2), 152-154.
20. Kirolos, E. (2024). Time critical emergencies: a comprehensive review of rapid decision-making in emergency medicine. Journal de la Faculté de Médecine d’Oran, 8(2), 1063-1074.
21. Landman, A. B., Lee, C. H., Sasson, C., Van Gelder, C. M., & Curry, L. A. (2012). Prehospital electronic patient care report systems: Early experiences from emergency medical services agency leaders. PLoS ONE, 7(3), e32692. https://doi.org/10.1371/journal.pone.0032692
22. Liberman, M., Mulder, D., & Sampalis, J. (2000). Advanced or basic life support for trauma: meta-analysis and critical review of the literature. Journal of Trauma and Acute Care Surgery, 49(4), 584-599.
23. Myers, J. B., Slovis, C. M., Eckstein, M., Goodloe, J. M., Isaacs, S. M., Loflin, J. R., … & Pepe, P. E. (2008). Evidence-based performance measures for emergency medical services systems: a model for expanded EMS benchmarking: a statement developed by the 2007 consortium US metropolitan municipalities’ EMS medical directors. Prehospital Emergency Care, 12(2), 141-151.
24. Napi, N. M., Zaidan, A. A., Zaidan, B. B., Albahri, O. S., Alsalem, M. A., & Albahri, A. S. (2019). Medical emergency triage and patient prioritisation in a telemedicine environment: a systematic review. Health and Technology, 9(5), 679-700.
25. Nehme, Z., Andrew, E., & Smith, K. (2016). Factors influencing the timeliness of emergency medical service response to time critical emergencies. Prehospital emergency care, 20(6), 783-791.
26. Nurumal, M. S., Abd Talib, M. L., Hasan, M. K. C., Firdaus, M. K. Z. H., & Sutrisno, R. Y. (2022). Skill and knowledge of Prehospital Care Competency of Emergency and Trauma Department Personnel: a systematic review. International journal of care scholars, 5(3), 79-94.
27. O’Hara, R., Johnson, M., Siriwardena, A. N., Weyman, A., Turner, J., Shaw, D., … & Shewan, J. (2015). A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety. Journal of health services research & policy, 20(1_suppl), 45-53.
28. O’Hara, R., Sampson, F. C., Long, J., Coster, J., & Pilbery, R. (2025). What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments. Emergency Medicine Journal, 42(1), 21-27.
29. Reddy, S., Patel, M., & Weidman, L. (2021). A systematic review of the impact of traffic congestion on prehospital emergency medical services response and transport times. Journal of Emergency Medical Services, 46(7). https://www.jems.com/patient-care/a-systematic-review-of-the-impact-of-traffic-congestion-on-prehospital-emergency-medical-services-response-and-transport-times/
30. Sasson, C., Haukoos, J. S., Ben-Yehuda, E., et al. (2022). Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA, 327(9), 850–859. https://doi.org/10.1001/jama.2022.0989
31. Sofianopoulos, S., Williams, B., & Archer, F. (2012). Paramedics and the effects of shift work on sleep: a literature review. Emergency Medicine Journal, 29(2), 152-155.
32. Stipp, K., Schöne, G., & Hahnenkamp, K. (2023). The connected ambulance: A systematic review of the concept and technologies. Health and Technology, 13(2), 191-207. https://doi.org/10.1007/s12553-023-00737-3
33. Strandås, M., Vizcaya-Moreno, M. F., Ingstad, K., Sepp, J., Linnik, L., & Vaismoradi, M. (2024). An integrative systematic review of promoting patient safety within prehospital emergency medical services by paramedics: a role theory perspective. Journal of multidisciplinary healthcare, 1385-1400.
34. Thim, S., Henriksen, T. B., Laursen, H., Schram, A. L., Paltved, C., & Lindhard, M. S. (2022). Simulation-based emergency team training in pediatrics: a systematic review. Pediatrics, 149(4), e2021054305.
35. Titko, M., & Slemenský, M. (2025). Educational Aspects Affecting Paramedic Preparedness and Sustainability of Crisis Management: Insights from V4 Countries and the Role of Innovative Technologies. Sustainability, 17(5), 1944.
36. van der Weegen, K., van der Hoek, L., Groot, J., et al. (2019). The effect of prehospital time related factors on mortality in polytrauma patients: A systematic review. Injury, 50(12), 2047-2056. https://doi.org/10.1016/j.injury.2019.10.003
37. Weile, J., Nebsbjerg, M. A., Ovesen, S. H., Paltved, C., & Ingeman, M. L. (2021). Simulation-based team training in time-critical clinical presentations in emergency medicine and critical care: a review of the literature. Advances in Simulation, 6(1), 3.
38. Williams, T. A., Tohira, H., Finn, J., Perkins, G. D., & Ho, K. M. (2016). The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: a systematic review. Resuscitation, 102, 35-43.