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The role of paramedics in hospital triage or streaming models has not been adequately explored and is potentially a missed opportunity for enhanced patient flow. The aim of the present study was to assess the concordance between a streaming decision by paramedics with the decision by nurses after arrival to the ED. A prospective observational study was conducted. Paramedics were met at the entrance to the hospital and asked which destination they thought was appropriate (the index test). The ED nurse streaming decision was the reference st