ABSTRACT
 Background Studies demonstrate TIA patients are at risk of further TIAs, stroke and death. TIA incidence is unknown, however estimated at 35 per 100,000 people annually in the UK, costing approximately £7 billion. Many TIA patients call 999, are assessed, stabilised and conveyed to Emergency Department (ED). Rapid assessment of TIA severity and risk and intervention is emerging as the new standard for TIA care leading to alternative pathways with direct referral to specialist services. However, uncertainties exist over this new model of care.
 We will develop and assess feasibility of paramedic assessment and referral of low-risk TIA patients directly to TIA clinic for early review, thus providing timely specialist review without: adverse consequences; inconvenience of ED attendance; unnecessary cost to the NHS.
 MethodsThis feasibility trial is designed to test the methods of a pragmatic cluster randomised trial, utilising data linkage for capturing outcome data, but with a qualitative component. To develop the treatment protocol, training and referral processes, working with clinicians/stakeholders, we will conduct:
 
 survey across UK ambulance services to find referral pathways for low-risk TIA patients
 systematic review of TIA prehospital care
 paramedic focus groups pre-implementation
 
 Then:
 
 randomise paramedics (intervention/control)
 recruit patients
 interview patients, key clinicians and service managers
 collect routine data via data linkage using the SAIL databank
 hold paramedic focus groups post-implementation
 
 We will:
 
 measure uptake and compliance with treatment protocols
 validate TIA assessment tool
 analyse qualitative data
 pilot recruitment processes
 test data collection methods
 estimate key outcomes effect size to inform full trial sample size calculation
 
 ResultsWill inform full trial development using criteria: intervention acceptability to practitioners and patients; trial design feasibility; outcome data completeness.
 Conclusions
 
 If indicated, full trial conducted
 If not, but positive results - advise intervention development for immediate implementation
 If not, but negative results – advise delivery of intervention should cease.