Paramedic-Led Prehospital Emergency Care Interventions and Their Impact on Patient Outcomes: A Systematic Review

Background: Paramedic-led prehospital emergency care is a central component of time-sensitive emergency systems, and the clinical value of advanced procedures and drug treatment varies by condition, training model, and endpoint. Objective: This systematic review evaluated the impact of paramedic-led prehospital interventions on survival, neurological recovery, physiological improvement, hospital use, and safety. Methods: A PRISMA-aligned systematic search plan covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Cochrane CENTRAL. Eligible studies enrolled emergency patients managed before hospital arrival by paramedics or ambulance clinicians and reported patient-level outcomes after a defined intervention. Randomized trials, cluster trials, controlled before–after studies, and large prospective clinical studies were prioritized. Results: Ten studies were selected for synthesis. Evidence showed context-specific benefit rather than universal benefit from prehospital care. Advanced life support improved outcomes in respiratory distress, while systemwide advanced life support did not improve survival after cardiac arrest or major trauma. Epinephrine improved 30-day survival after out-of-hospital cardiac arrest without an increase in favorable neurological recovery. Supraglottic airway approaches achieved easier ventilation, with mixed survival findings. Plasma improved 30-day survival in air-medical trauma patients, whereas tranexamic acid and combined red-cell/plasma resuscitation produced neutral primary results. Prehospital antibiotics for suspected sepsis shortened treatment time without mortality reduction. Conclusion: Paramedic-led interventions improve outcomes when matched to precise clinical phenotype, rapid protocol execution, and outcome-focused quality systems.