The minor differences between the three EMCC areas with respect to doctors’ responses strengthen the representativeness of the 85 municipalities and 35 out-of-hours districts. In nearly 90% of all cases we retrieved records from car and air ambulances, casualty clinics and rGPs. Together with the complete set of AMIS

forms this yields a comprehensive material for analysis of the objectives of the study. Severity score (NACA) on patients was assessed retrospectively based on medical records and may therefore have lower accuracy. It is also a limitation of the study that we lack access to the patients’ medical records after hospitalisation. Inhibitors,research,lifescience,medical Analyse of the medical usefulness of having the primary care doctor at site was thus not possible. The pronounced differences between the EMCCs with respect to alerting primary care doctors on-call indicate that the opportunity to have a doctor on scene as part of the initial mTOR inhibitor examination and treatment varies among the inhabitants in different geographical areas. The government wants to Inhibitors,research,lifescience,medical have a decentralised pattern of settlement in Norway and obtaining equality in health care is a stated political goal [12]. By not alerting the doctors on-call an EMCC violates the regulation for pre-hospital emergency [3] and the Inhibitors,research,lifescience,medical inhabitants are not offered an equal level of medical

competency. The large majority of the patients are not in need of immediate treatment based on protocols, like cardiopulmonary resuscitation, and most patients are elderly with more complex medical symptoms and comorbidities [13]. Ambulance personnel’s formal education is two years in upper

secondary school and two years in apprenticeship [3]. However, a large group of ambulance personnel Inhibitors,research,lifescience,medical does not fulfil that educational level [14]. As patients in most cases of the emergency situations have complex medical problems Inhibitors,research,lifescience,medical [14,15] there is need of competence based on higher education and experience when examining the patients. Compared to ambulance personnel the doctors are superior when it comes to clinical judgement and deciding treatment and level of care when the patients have a serious illness. The professions provide supplementary contributions [15] and the professions should more frequently these appear together on site. More doctors on site could possibly contribute to a reduction of transports to both casualty clinics and hospitals, thus decreasing hospitalisations and use of the ambulances. Direct transports to hospitals by the ambulance services were doubled when doctors on-call were not alerted, compared to whit if they were (table ​(table2).2). This difference indicates the important gatekeeper function by the emergency primary healthcare services. Every patient treated by the primary care services will reduced costs because the patient is treated at a lower and less costly level of care.