Prehospital team composition and mortality: a scoping review

Emergency Medical Services (EMS) operate with heterogeneous team configurations, yet the impact of prehospital staffing models on patient mortality remains uncertain. Existing evidence suggests that survival differences may reflect system-level factors rather than the intrinsic superiority of specific professional roles. The aim of the present study was to map and synthesize the available evidence on the association between EMS team composition and mortality outcomes in prehospital care. A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, CINAHL, Web of Science, ProQuest, and Scopus were searched through July 2025. Peer-reviewed studies published from 2000 onwards that reported mortality outcomes in relation to defined prehospital team configurations were included. Two reviewers independently screened studies and extracted data, with disagreements resolved by a third reviewer. Twenty-five studies were included, encompassing diverse EMS systems across Asia, Europe, the Americas, and Oceania. Mortality outcomes varied substantially according to clinical severity, system maturity, dispatch accuracy, and prehospital time intervals. Physician-staffed teams demonstrated selective mortality benefits in high-acuity trauma and traumatic out-of-hospital cardiac arrest. Nurse–paramedic and advanced paramedic teams frequently achieved comparable survival outcomes in mixed emergencies and medical conditions when supported by robust training and standardized protocols. Across all models, emergency nurses contributed substantially to early assessment, physiological stabilization, clinical decision-making, and safety processes. System heterogeneity emerged as a dominant determinant of observed outcomes. No single EMS staffing model consistently outperforms others across all clinical contexts. Mortality outcomes appear to be shaped by the interaction between team competence and system organization rather than by professional composition alone. Future research should prioritize standardized quality indicators, intermediate outcomes, and comparative designs to support evidence-informed EMS workforce planning.

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