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Operations & systems
IMPACC paramedic model cuts ED transport
Redesigning 9-1-1 Paramedic Pathways: Evaluation of the IMPACC Model of Care
Prehospital Emergency Care · Added 22 September 2026
Evaluation of 7,382 encounters under Toronto's IMPACC model, which lets specially trained paramedics redirect lower-acuity 911 callers — activated encounters had transport rates of 36% vs 82% for others (still 43% vs 79% after matching) but added roughly 24 minutes on scene, with 4% re-contact at 72 hours
- Study type
- Cohort
- Design
- Retrospective observational cohort implementation evaluation with exact-matched comparison
- Participants
- 7,382 9-1-1 encounters attended by IMPACC-trained paramedics
- Main finding
- IMPACC activated in 9.9% of encounters; activated encounters had lower transport rates than non-activated (36.4% vs 81.7%) and than matched controls (42.9% vs 79.2%); time on task longer (90.0 vs 66.5 min); 72-hour repeat contact 4.0%
- Caveat
- Observational Canadian 9-1-1 system; marked paramedic-level heterogeneity (ICC 0.33) and declining activation over time
- Bottom line
- Hypothesis-generating
Why it matters in Australia (Medium relevance). transferability — treat-and-refer isn't in ACTAS's extracted model — but if the ACT ever debates widening paramedic-led pathways for low-acuity triple-zero callers, this is the strongest implementation evidence yet, warts and all
Learning goal
Understand how alternative paramedic pathways can safely reduce emergency department transport for lower-acuity callers.
More
- Topic: Operations & systems
- Daily scan: 22 September 2026
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