The impact of community paramedicine service on prehospital time intervals in rural Norway: a quasi-experimental study

Background Community paramedicine service (CPS) may improve prehospital healthcare delivery in rural regions. As CPS does not provide patient transport, its introduction could prolong prehospital time intervals. Thus, we aimed to evaluate whether CPS implementation influenced prehospital time intervals for acute patients admitted to hospital. Methods In this quasi-experimental study, we compared prehospital time intervals for acute missions resulting in hospital admission in two rural Norwegian municipalities with similar characteristics. Data were collected over four years before and two years after CPS implementation in one municipality (CPS REGION ). The second municipality served as a control (CONTROL REGION ). Results Of 1,872 missions, 362 acute missions with hospital admission were included, of which 228 occurred in the CPS REGION and 134 in the CONTROL REGION . After CPS implementation, the median response interval was reduced from 19 to 11 min ( p < 0.001), whereas no statistically significant changes were observed for the other prehospital time intervals in the CPS REGION or for any prehospital time intervals in the CONTROL REGION (all p > 0.12). Difference-in-differences analyses showed no statistically significant difference for total prehospital interval (-2 min, p = 0.850), while there were significantly shorter response- (-7 min, p < 0.001) and emergency medical service (EMS) on-scene intervals (-6 min, p = 0.003). Higher age was associated with longer total prehospital interval ( p = 0.018). Conclusions CPS implementation was not associated with changes of the total prehospital interval but was linked to shorter response interval and EMS on-scene intervals, which may indicate earlier arrival of prehospital personnel without evidence of delayed start of transport. However, given the observational design and the absence of clinical outcome data, the overall impact on patient safety and system performance remains uncertain.