Patients dialling 999 can be treated in the community by paramedics rather than be rushed to hospital for care, trial findings suggest.
A pilot in South Yorkshire found experienced paramedics were able to manage non-life-threatening emergencies safely and effectively.
The elderly patients treated reported great satisfaction with the service, reports the British Medical Journal.
Government wants to reform emergency care to cope with increasing demand.
Community care
Calls for emergency ambulances have been rising persistently by as much as 8% each year, yet half of patients taken to emergency departments by ambulance are discharged without being treated or transferred.
The government's emergency care tsar, Professor Sir George Alberti, has said encouraging health communities to deliver appropriate care closer to home is one way to streamline the system.
The Sheffield University team carried out the first randomised trial to evaluate the effectiveness of a paramedics assessing and, when possible, treating older people in the community with minor acute problems, compared with usual emergency department care.
"This study shows the real value that such extended roles and services can bring for patients"
Running between September 2003 and September 2004, the pilot included 3,018 patients aged 60 years and above calling the emergency services between 0800 and 2000 with a complaint such as a fall, laceration, nosebleed or minor burn.
Patients cared for in the community by a paramedic experienced a shorter treatment time, by around 42 minutes, yet with comparable health outcomes.
And they were almost 25% less likely to attend the emergency department or require hospital admission within 28 days, as well as being more satisfied with the care they received.
About a quarter of the "paramedic care" patients could not be treated in the community and had to be transferred to hospital.
The researchers, Suzanne Mason and colleagues, said: "The service conveyed considerable benefits for patients and the NHS in terms of reduced overall attendances at an A&E department and hospital, shorter episode times, and higher levels of satisfaction among patients."
As pressure increases within the NHS to extend this type of approach, this trial will help to inform practice in this fast developing area, they added.
Malcolm Woollard, professor in prehospital and emergency care at Coventry University, cautioned: "Evidence suggests a positive effect, but future programmes need rigorous assessment before expanding."
A Department of Health spokesperson said: "Our recent Ambulance Review, Taking Healthcare to the Patient, set a very clear vision for the way in which ambulance services and staff can play an increasing role in all aspects of healthcare to help patients get more care, closer to home.
"Lord Darzi's interim report on the 'Our NHS, Our Future' review continues this.
"This study shows the real value that such extended roles and services can bring for patients."
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