Ambulance Staff Research Articles

Performance Assessment of Sri Lankan Pre-Hospital Ambulance Service

Ischemic heart disease is the leading cause of mortality that raised the demand for pre-hospital emergency care in Sri Lanka. Understanding the performance of Sri Lanka's 1990 Suwa Seriya ambulance service is essential to improve its quality and to reduce morbidity and mortality associated with the disease. This study aims to describe socio-demographic characteristics and evaluate the clinical assessment and management process of patients presenting with acute chest pain of cardiac in origin. A descriptive study was conducted in Gampaha District of the Western Province of Sri Lanka. A total of 154 records of patients with acute chest pain who rang the 1990 call centre over a 3-month period were selected. Composite values for treatment and examinations as a percentage were plotted on run charts to assess the performance and its variations over the study period. About 47.4% of the study group were in 35–65 age group, 53.2% were males, and 81.8% had a typical presentation. The median for composite value for examination as a percentage was 89.5%, indicating substantial control and alignment with the reference package with normal cause variation. The median composite value for treatment as a percentage was 9.96%, a low value with normal cause variation. A good control of the processes of clinical examination and treatment is apparent. A higher median for composite value for examination as a percentage attributed to the formal training process of the ambulance staff. Although a low median was obtained for the composite value for treatment as a percentage, it was stable and pointed room for improvement.

Work–family enrichment of firefighters: “satellite family members”, risk, trauma and family functioning

PurposeTraditionally, research exploring the work–family interface has focussed on two perspectives: the organisation and the employee. The third perspective of the family has been largely neglected. This has also been the case with emergency responders. Arguably, the social support that emergency responders receive from their families maintains the health and well-being of the emergency responders. There has been more literature focussing on family members of police and ambulance staff, but less is known about the experiences of the families of firefighters. This study, therefore, aims to explore the occupation-related consequences for families of firefighters to establish what could be done to preserve this important source of social support.Design/methodology/approachA qualitative approach was needed to understand the perspective of relatives of firefighters. Grounded theory was used to analyse interviews of family members of firefighters.FindingsImportant concepts to families of firefighters include the management of emotional contagion from their firefighter, their sophisticated perceptions of physical and emotional risk, their ability to make things work around a satellite family member, detail of the sacrifices they make and the social support from other firefighters' families.Research limitations/implicationsThe findings highlight the rich understanding and benefits offered when fire and rescue services and researchers consider the family perspective of the work–family interface within this context to develop a rich supportive dynamic between the organisation, the employee and their family.Practical implicationsFindings from this study are considered to inform the development of a positive resource ecology within fire and rescue services. Where work-family enrichment positively informs the interventions and practical approaches organisations can use to enhance the wellbeing of their employees, by acknowledging other life domains.Originality/valueThe contribution to theoretical perspectives on the work–family interface, as well as the informed understanding of occupational consequences of the firefighting occupation on relatives, offers a unique contribution to the literature.

Development of V-FAST: a vision screening tool for ambulance staff

Background: About two-thirds of stroke survivors experience visual problems and most patients who have a stroke limited to the occipital lobe will have visual impairments only. Aim: The V-FAST screening tool, which assesses visual symptoms, eye movements, visual field and visual extinction, and a training package to improve diagnostic accuracy of identifying visual impairment in hyperacute strokes were developed and evaluated. Methods: The educational package was developed through focus groups. The pilot study screened patients with suspected strokes in prehospital settings; the V-FAST tool was used with 43 of these patients. Each participant was also assessed in hospital using the National Institutes of Health Stroke Scale (NIHSS) and the score compared to V-FAST screening results to determine sensitivity and specificity. Results: The education package includes detailed instructions with video. In the pilot study, V-FAST detected visual impairment in 75.9% of FAST-positive and 80% of FAST-negative strokes. Sensitivity and specificity compared to NIHSS were 85.7% and 42.1% respectively. Conclusion: V-FAST has good sensitivity to detect vision impairment when screening for possible strokes. The added education package facilitates greater knowledge and understanding of potential visual problems caused by stroke.

Sleep quality and adaptation to shift-work among ambulance staff in the Basque Country

To explore the extent to which the shift-workers of emergency ambulances maintain an adequate sleep quality and adaptation to shift-work, and its relationship to personal, circadian rhythm, and work-related factors. A cross-sectional study was performed on a sample of 180 technicians and nurses from the Emergency Medical Service of the Basque Country (18-60 years old) who were surveyed. The Pittsburgh Sleep Quality Index (PSQI), the Adaptation to Shift-Work Scale (ASW), the Circadian Type Questionnaire (CTQ) and the Composite Scale of Morningness (CSM) for evaluating chronotype, were administered. Fifty-two percent of the staff presented an intermediate adaptation and 30% reported a good adaptation. A progressive deterioration of sleep quality across the shifts (52% were bad sleepers during days-off, 63% after day-shifts and 90% after night-shifts) was related to a poorer level of adaptation to shift-work. A predictive model of adaptability was obtained based on the baseline level of sleep quality during the days-off and the V factor. The R factor moderated this interaction positively or negatively depending on sleep quality. There is a high presence of sleep disorders among the technicians and nurses of emergency ambulances as the main symptom of maladjustment to shift-work. Sleeping habits can cushion the impact of difficulties in resting and favor a better adaptation to shifts, introducing key-factors at the level of formation, prevention and intervention.

WORK RELATED INJURIES AND EXPOSURES AMONG EMERGENCY MEDICAL SERVICE PERSONNEL DUE TO INTERIOR DESIGN OF AMBULANCE

The aim of this study is to investigate work-related injuries, exposures and their reasons that 112 Emergency Medical Services (EMS) personnel encounter during the treatment and care of the patient, depending on the ergonomics of the interior design of an ambulance. A questionnaire is designated to identify the challenges faced by 112 EMS personnel. A pilot study is conducted to determine the convenience of the questionnaire. After confirming the questionnaire, it is applied to a total of 90 voluntary participants in 13 stations of EMS in Eskişehir between June and July 2017. Data are analyzed by using SPSS 24 packet program. According to the findings, the participants were exposed to; problems due to hit on sharp corners (87%), problems due to slamming of the door (83%), exposures in treatment on the stretcher (69%), stuck during stretcher movement (%64), unable to reach the patient (at sitting position) during intervention in the ambulance (59%) and waste box problem (59%). Of the exposures faced, 83% are due to interior design framework, 82% are because of narrowness of the cabin and 81.1% are due to the fact that the layout of interior compartment was not ergonomic. According to the results of analysis obtained by the questionnaire data, it is essential to make some improvements in terms of ergonomics in the ambulance interior design in order to make working conditions of ambulance staff of 112 EMS more eligible.

Patient views on use of emergency and alternative care services for adult epilepsy: A qualitative study

PurposeEmergency Department (ED) visits are costly to the health service and alternative care pathways may address this whilst improving outcomes. We aimed to describe decision-making and preferences of people with epilepsy (PWE) during emergency service use, and views of ED alternatives, including use of an Urgent Treatment Centre and telephone-based support from an epilepsy nurse specialist. MethodsWe conducted a community-based interview study in South East England, informed by a qualitative framework approach. 25 adults with epilepsy and 5 of their carers took part. ResultsParticipants’ choice to attend ED generally corresponded with guidelines, including continuing seizures and injury. Nevertheless, over half reported unwanted or unnecessary ED attendance, mainly due to lack of access to individual patient history, a carer, or seizures occurring in a public place. Participants used proactive strategies to communicate their care needs to others, including 24 -h alarm devices and care plans. Some suggested preventative strategies including referral after ED. Participants highlighted the importance of ambulance staff in providing fast and efficient care that gives reassurance. ConclusionImproving communication and access to preventative, proactive services may facilitate better outcomes within existing care pathways. PWE felt ED alternatives were helpful in some circumstances, but Urgent Treatment Centres or epilepsy nurse specialists were not viewed as an ED replacement.

'We're the First Port of Call' - Perspectives of Ambulance Staff on Responding to Deaths by Suicide: A Qualitative Study.

IntroductionExposure to suicide is a known risk factor for suicide. Ambulance staff are exposed to work-related stressors including attending suicides, which may elevate their risk for mental health problems/suicide. Little is known about ambulance staff’s perspectives on how they experience these events and whether they feel equipped to respond to bereaved families at the scene of death. This study explores the perspectives of ambulance staff about responding to deaths by suicide.Materials and MethodsA convenience sample of ambulance staff recruited from one ambulance service in England. In-depth, qualitative, semi-structured face-to-face interviews conducted with nine ambulance staff (six male, three female) to explore experiences of responding to suicide. Data analyzed using thematic analysis.ResultsParticipants reported the experience of job-related strain including exposure to the suicide/suicidal ideation of colleagues; they described suppressing their distress despite significant emotional impact. All participants had been personally bereaved by suicide and responding to suicide was a common part of their job. They were often the first professionals at the scene, and undertook varied and often conflicting roles: negotiating with patients in crisis; informing individuals of the death of a loved one; preserving the body/potential crime scene; dealing with the intense emotional reactions of bereaved individuals. Participants reported long-term, salient memories of these events; however, there was a reported lack of acknowledgment in the workplace that suicides may be traumatic and no guidance for staff on how to cope. Opportunities to debrief were reportedly rare, and there was reluctance to access work-based liaison services. Training in how to respond to individuals bereaved by suicide was also lacking.DiscussionThe study is the first to reveal the complex challenges faced by ambulance staff in responding to suicide without adequate training and support. It demonstrates the potential impact that responding to suicide can have personally and professionally on staff, and emphasizes the need for employers to support staff wellbeing in better ways. Training and postvention support could enable better coping among staff, more effective support for bereaved individuals and reduce the risk of death by suicide both in those bereaved by suicide and in ambulance staff.

The paramedic profession: disruptive innovation and barriers to further progress

The paramedic profession in the UK evolved from a small number of pilot programmes in the early 1970s that focused on training selected NHS ambulance crews in advanced resuscitation techniques. Similar initiatives occurred almost simultaneously in the United States, Australia, New Zealand and Canada. This case study focuses primarily on the UK, and England in particular. The purpose of the initiatives described was to address the unmet needs of patients with serious injury and illness. Over the following decades, paramedics developed a clear identity and became fully professionally recognised and regulated as allied health professionals, becoming an example of the phenomenon termed ‘disruptive Innovation’; this is something that creates a new market and value network while disrupting existing ones. The steep developmental trajectory of paramedics has not been mirrored by a comparable pace of reform and modernisation in NHS ambulance services which, in comparison, have lagged behind and also failed to adapt to significant changes in the pattern, quantity and epidemiological characteristics of patient demand. This has led to a mismatch between the capabilities offered by paramedics and the professional opportunities available to them in ambulance services, and hampered these practitioners' ability to make full use of their skills. The consequence of this has often manifested as low levels of paramedic and other ambulance staff satisfaction, resulting in high rates of staff turnover. Parallel developments in medical personnel deployment have increased the quantity of medical labour available to patients with serious or life-threatening injuries, with medical staff added to helicopter emergency medical crews. While many patients with urgent conditions would have benefited from general practitioners being available out of hours, proportionally fewer doctors are available to fulfil this role today and those that are attracted to working with the ambulance service often prefer to respond to cases involving major injury. For these reasons and given the reality that the ambulance service is morphing into primarily an urgent care organisation, de-emphasising the transport aspect of the service, changes are needed to its model of operation and to staff management and support.

Pervasiveness of ambulance etiquette and knowledge in general population: a perspective from Pakistan

Background: Ambulance ethics refers to the principles of moral conduct that make the journey of an ambulance safe, convenient whereby ensuring provision of effective pre-hospital care to the patient. It concerns three sets of population: the paramedical staff, the patient and family and also the general population.Methods: Cross-sectional comparative study, conducted from February to May 2018. A questionnaire consisting of 25 questions was filled by 412 participants who were older than 15 years of age and their responses were collected via a 5-point likert scale. Chi-square analysis was done to compare the responses of medical and non-medical participants.Results: Vast majority of individuals agreed that they should give way to ambulances by switching their lanes or by breaking the signal. Half of the individuals were of the idea that ambulances should maintain their speed limit while some favored disregarding the speed limit if it meant saving someone’s life, while others remained neutral. A large percentage of participants agreed that a vehicle must meet certain standards in order for it to act as an ambulance. A number of participants agreed that an ambulance should have basic life support (BLS), the ambulance staff should be skilled enough to give cardiopulmonary resuscitation (CPR) en route to the hospital.Conclusions: The general population supports the idea that ambulances should have a hassle-free route to transport the patient to the hospital and to hasten the treatment even if that means breaking signals, switching lanes and exceeding speed limit.

Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry.

Out‑of‑hospital cardiac arrest (OHCA) is a severe medical condition. Prehospital care plays an essential role in patient survival. First, the study aimed to evaluate cases of OHCA managed by cardiopulmonary resuscitation (CPR) attempts in Poland in 2018, including their frequency and patient outcomes in terms of survival until hospital admission or transport to the hospital by helicopter emergency medical service (HEMS). Second, the study was performed to identify the predictors of patient survival until hospital admission or transport by HEMS. It was a case‑control study based on medical records. In 2018, 3 400 000 emergency visits were registered. Patients who were treated by emergency medical service (EMS) ambulance staff using defibrillation and / or administering at least 1 dose of 1 mg of epinephrine were considered to have OHCA managed by CPR attempts. A total of 26 783 CPR attempts were reported by EMS in Poland in 2018. The incidence of OHCA with CPR attempts in 2018 was 69.7 per 100 000 inhabitants and it varied from 58.9 per 100 000 to 84.5 per 100 000 inhabitants in 16 Polish provinces. The mean survival rate until hospital admission or transport by HEMS was 36.3% and it ranged from 34.5% to 38.3%. Patient survival until hospital admission or transport by HEMS was related to age, sex, emergency site, defibrillation during CPR, the first recorded rhythm, and procedures performed by the EMS personnel. The rate of OHCA with CPR attempts was similar to that reported in other European countries. Patient survival until hospital admission or transport by HEMS was associated with many well‑‑known, identified nonmodifiable and modifiable factors.

First initiatives in prehospital care-Basing assessments on incomplete preliminary information

Rationale and aim: Ambulance staff, i.e. registered nurses and assistant nurses, receive assignments from emergency dispatch centres including information on level of priority, address and patient’s care requirements. One problem is that the preliminary information the dispatcher gives to the ambulance staff may be incomplete. The purpose of this study was to determine how ambulance staff base their assessments on incomplete preliminary information when assessing care requirements.Methods: Fifteen ambulance staff working at seven ambulance stations were interviewed for this study. Interviews were transcribed and analysed using content analysis.Results: Incomplete preliminary information means that ambulance staff may be misdirected. This means that if the preliminary information from the dispatcher is incomplete, the ambulance staff need to reassess, and this is perceived to be difficult. Ambulance staff tend to stick to the first initiative that is taken after they receive an alert from the dispatcher.Conclusions: When ambulance staff receive incomplete preliminary information, they need to consider the possibility of conducting a reassessment. Based on the results, there is a need for new procedures to improve preparedness to conduct a reassessment after receiving incomplete preliminary information.

Suicide among ambulance service staff: a review of coroner and employment records.

Background:There is growing evidence to suggest that ambulance service staff may be at increased risk for suicide; however, few studies have explored risk factors within this occupational group.Aim:To investigate factors commonly associated with ambulance staff suicides.Method:Eleven ambulance service trusts across the United Kingdom were asked to return details of staff suicides occurring between January 2014 and December 2015. Coroners were then contacted to request permission to review the records of the deceased.Results:Fifteen suicides were identified (73% male, mean age 42 years). Inquest data were available on 12 deaths. The most common method used was hanging. Possible risk factors identified included recent return to work following a period of sickness absence, poor mental health, relationship and debt problems, history of self-harm and the loss of a driving licence/change in job role.Conclusion:Identifying characteristics of suicide among this high-risk group is important to inform the development of suicide prevention initiatives. Additional research is needed with an adequate control group to further explore the risk factors identified in this study.

Improving pressure ulcer risk identification: a pilot project by ambulance staff

Background: A quality improvement initiative was designed to identify patients at risk of compromised tissue viability before they were admitted to hospital. Paramedics were educated to better identify patients with pressure ulcers or pressure damage, or those at risk of compromised tissue viability, and these patients were fitted with a pressure ulcer alert bracelet so that emergency department staff could identify them. Aims: The aims of the current initiative were to educate paramedics to better identify patients with pressure ulcers or those at risk of compromised tissue viability to emergency department staff, and fit them with a pressure ulcer alert bracelet to highlight them to emergency department staff so they would receive prompt intervention. Methods: A plan, do, study, act improvement methodology was used, and data from a 3-month period were retrospectively analysed. Patients identified as being at risk of compromised tissue viability were flagged as requiring assessment via a pressure ulcer risk assessment tool to enable prevention. Results: Paramedics identified 130 at-risk patients (aged 23–100 years), and data from 127 patients were analysed. Most at-risk patients fitted with pressure ulcer alert bracelets were aged 70 years or over, and there was an even female/male division. More than half (53%) of patients were found to have a pressure ulcer and alerted to emergency department staff. More than one in four (27%) patients who were identified as being at risk of pressure ulcers lived in nursing or residential homes, and 43% lived alone or in warden-controlled accommodation. Conclusions: Paramedics effectively identified potential risk factors for pressure ulcer development, indicating a need for immediate intervention. This study gives insight into how pressure ulcer risk assessment using an alert bracelet may be used in paramedic practice in emergency department handovers. Success depends on hospital staff acting upon paramedic recommendation.

ICU nurses and ecpr

Introduction: Mortality from refractory cardiac arrest is greater than 90%. Survival may be significantly improved with Extracorporeal Membrane Oxygenation Cardio Pulmonary Resuscitation (ECPR). Objectives: To enable ICU nurses to participate in the ECPR team by preparing the ECPR trolley and/or console. Additional goals: maintain 66% ECPR accreditation following May 2016; plan ECPR nursing training at approximately 2 per month; and maintain ECPR outcomes comparable to reported rates. Methods: Training for nurses commenced May 2015. There were 10 planned sessions employing didactic explanations and simulated demonstrations. From 2016 to 2019 there were approximately two sessions per month booked. Additional hig- fidelity multidisciplinary simulations were provided by the Simulation Coordinator involving ED, Ambulance and Interventional Cardiology staff. Audits of ECMO outcomes were conducted biannually with comparisons made to international registries and literature. Results: By May 2016 greater than 66% of ECMO nurses had been accredited for ECPR. This rate was maintained and is currently 69/84 (82%). Of the planned education sessions from 2015 to 2018; the following were respectively documented as achieved 4/10, 13/23, 10/18 and 13/21. ECPR outcome from 2015-2018 was 39% survival to hospital discharge. Accredited ICU ECPR nurses were assigned every day to the ECPR team and attend ECPR emergency calls as they occurred. Conclusion: It is feasible for ICU nurses to participate as valuable members of the ECPR team. Whilst the potential numbers of patients in NSW who may require ECPR per year for refractory cardiac arrest may remain relatively low (i.e approximately 130/yr) it appears that the possible improvement in survival outcome for this group may be significantly increased from dismal to around 30%. The ICU ECMO ECPR nurse's role in assisting with this survival benefit for the patient is an important part of the function of the team.

A Series of Three Aircraft Emergency Public Health Alerts at an International Airport Over a Six Week Period due to Suspected Contaminated Cabin Air

Air travel is a safe, common mode of transport for both work and leisure activities. It can be associated with health risks, with exposure to toxic compounds or fumes in the aircraft cabin resulting in a variety of clinical symptoms. We report on three aircraft incidents which resulted in passenger and crew illness and necessitated emergency landings at Dublin International Airport. We obtained details on the three incidents from the National Ambulance Service Operations Centre dispatch system and staff, regional public health specialists and the National Air Accident Investigation Unit (AAIU). We conducted a chart review of all passengers and crew who attended the hospital Emergency Department (ED) and consulted with the attending ED physician. Twenty-three crew and passengers reported feeling unwell on the three flights over a six week summer period. Symptoms included dizziness, headache, and throat and eye irritation. On one flight there was a severe odour. Fifteen crew and passengers from the first two incidents were treated at a hospital ED. One case had a low oxygen saturation, and another required oral steroids and nebulised bronchodilator. The AAIU did not find a cause for illness on assessment of all three aircraft. The three aircraft incidents described highlight the potential safety risk of air quality alterations. While there is no evidence that serious health events occurred in these events, sharing of experiences on similar events may lead to increased understanding of these complex events and ensure that aircrafts are a safe environment in which to travel and work.

Quality and Efficiency Between Public and Private Firms: Evidence From Ambulance Services

Economic theory predicts that outsourcing public services to private firms will reduce costs, but the effect on quality is ambiguous. We explore quality differences between publicly and privately owned ambulances in a setting where patients are as good as randomly assigned to ambulances of different ownership statuses. We find that privately owned ambulances are better at responding to contracted quality measures but perform worse on noncontracted measures, such as mortality. In fact, a randomly allocated patient has a significantly higher risk of death if a private ambulance is dispatched. We also present suggestive evidence on the mechanism, supporting that private firms cost innovate at the expense of ambulance staff quality.

A forgotten cause of myocardial infarction in an octogenarian patient: Type 1 Kounis Syndrome

A non-steroidal antiinflammatory drug, diclofenac sodium, was initiated to 81 year-old male patient for his knee pain by a general practitioner. After 30 minutes of ingestion of 100 mg diclofenac sodium, severe chest pain and generalized erythema had started and he was brought to our emergency department by the ambulance staff. Owing to the chest pain , an ECG was performed and it revealed 2-3 mm ST segment elevation in DII-DIII and aVF leads and reciprocal changes in other leads (Figure 1A). Immediately the patient underwent to catheter laboratory and the coronary angiogram showed normal coronary arteries without any obstruction (Figure 2,3). Then Kounis Type 1 was diagnosed and intravenous antihistaminic and 40 mg of prednisolone was administered. The patient was discharged on the second day. Our case is an example of type 1 Kounis syndrome in an octogenarian patient which we should keep in mind.

Ambulance clinicians' perspectives of sharing patient information electronically.

Introduction:Communication in the NHS is vital to patient care and safety. Government bodies are pushing for the digitisation of patient health records so that access and transfer of information is easier between patient care teams. Many ambulance trusts have issued their clinical staff tablet computers as a step in the transition from paper-based to electronic-based patient health records. This study aims to evaluate whether these ambulance clinicians perceive tangible benefits to digitisation, particularly regarding collaborative working with other healthcare professionals.Methods:Registered and non-registered clinical staff in one ambulance trust completed an online questionnaire utilising five-point Likert scales to collect data about their experiences of using electronic incident summary notifications to report back to the patient’s GP, and on direct patient referrals to community teams for falls and hypoglycaemic episodes. Participants only completed questions relevant to the process they had experienced.Results:From approximately 2115 members of staff eligible to participate, there were 201 respondents (9.50%) who provided information concerning GP summary notifications, fall referrals or hypoglycaemia referrals (n = 154, 76.62%; n = 178, 88.56%; n = 101, 50.25%, respectively).Overall, staff perceived the electronic communication of patient information as useful, but not essential, to their practice. The applications were seen as easy to use and a safer way to handle patient data. Though their use was felt to prolong the time spent on scene, this was regarded as an efficient use of a clinician’s time.Many staff would prefer to talk directly to a patient’s GP, but fewer felt that this was required for community referrals. While most participants did not feel obliged to send a GP summary notification of every encounter, the majority believed that the rates of appropriate falls and hypoglycaemia referrals would be improved with direct electronic communication.Respondents felt that recording and sharing patient information electronically improved collaborative working with other healthcare professionals, and they preferred having this ability.Conclusion:NHS ambulance trusts are transitioning to electronic patient records and this article suggests that ambulance staff are in favour of this transition when the technology is readily accessible and easy to use. Staff believe this approach is a safer way to store and share patient data and that collaborative working is enhanced. However, many clinicians would still prefer to discuss some incidents directly with a GP rather than sending a summary, highlighting the value staff place on real-time professional interaction when managing a patient.

Optimising ambulance service contribution to clinical trials: a phenomenological exploration using focus groups.

Introduction:Out-of-hospital cardiac arrest trials can prove challenging and there is a need to share learning from those that have recruited successfully. We have just completed three years of recruitment to PARAMEDIC2, a placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. This study was designed to describe the experience of operational ambulance staff involved in recruiting patients into PARAMEDIC2.Methods:Four focus groups involving trial paramedics and supporting members of the emergency care team were conducted across different geographical regions of a single UK ambulance service participating in the PARAMEDIC2 study. Data analysis was supported by NVivo 12 and themes were identified using a thematic analysis approach.Results:Forty-four participants contributed to the focus groups. Four overarching themes were identified: context for the research, ethical concerns, concerns at the patient’s side and ongoing trial support. Participants felt that research such as PARAMEDIC2 is important and necessary to drive medical progress. They valued the opportunity to be part of a large project. Due to the deferred consent model employed, public awareness of the trial was felt to be important. Most expressed equipoise regarding adrenaline, but some felt concerned about enrolling younger patients and there was discussion around what constitutes a successful outcome. Struggles with ethical concerns were overcome through training and one-to-one discussion with research paramedics. Participants valued feedback on their performance of trial tasks, but also wanted feedback on their resuscitation skills. Cardiac arrest places a high cognitive demand on paramedics; simplicity and reinforcement of trial processes were key to facilitating recruitment. Caring for relatives was a high priority for paramedics and some felt conflicted about not discussing the trial with them.Conclusions:This study has provided insights into paramedic experience of a large-scale pre-hospital trial. Investment in time and resource to provide face-to-face training and personalised feedback to paramedics can foster engagement and optimise performance.

Optimising ambulance service contribution to clinical trials: a phenomenological exploration using focus groups.

Introduction:Out-of-hospital cardiac arrest trials can prove challenging and there is a need to share learning from those that have recruited successfully. We have just completed three years of recruitment to PARAMEDIC2, a placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. This study was designed to describe the experience of operational ambulance staff involved in recruiting patients into PARAMEDIC2.Methods:Four focus groups involving trial paramedics and supporting members of the emergency care team were conducted across different geographical regions of a single UK ambulance service participating in the PARAMEDIC2 study. Data analysis was supported by NVivo 12 and themes were identified using a thematic analysis approach.Results:Forty-four participants contributed to the focus groups. Four overarching themes were identified: context for the research, ethical concerns, concerns at the patient’s side and ongoing trial support. Participants felt that research such as PARAMEDIC2 is important and necessary to drive medical progress. They valued the opportunity to be part of a large project. Due to the deferred consent model employed, public awareness of the trial was felt to be important. Most expressed equipoise regarding adrenaline, but some felt concerned about enrolling younger patients and there was discussion around what constitutes a successful outcome. Struggles with ethical concerns were overcome through training and one-to-one discussion with research paramedics. Participants valued feedback on their performance of trial tasks, but also wanted feedback on their resuscitation skills. Cardiac arrest places a high cognitive demand on paramedics; simplicity and reinforcement of trial processes were key to facilitating recruitment. Caring for relatives was a high priority for paramedics and some felt conflicted about not discussing the trial with them.Conclusion:This study has provided insights into paramedic experience of a large-scale pre-hospital trial. Investment in time and resource to provide face-to-face training and personalised feedback to paramedics can foster engagement and optimise performance.