Explore the vast range of titles available.

BackgroundThe NIHR HTA funded RAPID2 trial aims to test the safety, clinical and cost-effectiveness of paramedics providing pre-hospital fascia iliaca compartment block (FICB) pain relief for patients with suspected hip fracture. FICB is not routinely available in pre-hospital care but may improve patient outcomes through better pain relief and avoiding morphine side effects. However, training paramedics in FICB is not straightforward. RAPID2 seeks to train 160 paramedics across four sites. This poster will outline some of the strategies employed, challenges encountered, and reflections of research paramedics involved.MethodsChallenges encountered:Co-ordinating hospital and ambulance service staff availability with FICB training opportunities.Increased service demand during the training period, resulting in increased fatigue and reduced morale.Staff withdrawal due to career progression/secondment opportunities.Other commitments competing for staff time.Approaches used:Training was coordinated by RAPID2 site research paramedics and hospital PIs, employing strategies as follows.Increasing training opportunities by recruiting multiple anaesthetists to support trial training.Regular face-to-face contact from RAPID2 Research Paramedics at each site, including ‘drop in’ sessions and refresher training.Promotion of the rationale for the trial and the benefits it may bring to patient care, alongside the opportunity to enhance skill sets.Providing CPD hours and overtime payments for time spent undertaking RAPID2 training.Providing training sessions on different days and at different times to allow hospital and ambulance staff to carry out training at a time that suits them.ResultsThe trial was well received, with 150 expressions of interest gained from paramedics across sites, most of whom have begun training.ConclusionBy adapting to circumstances and employing a range of engagement and promotion strategies, paramedic engagement with training has improved. These strategies could be adopted in other trials.

BackgroundThis project evaluated whether practice change occurred amongst Paramedics directly after the publication of the PARAMEDIC2 trial, regarding adrenaline administration during out-of-hospital cardiac arrest (OHCA) without a change in guidelines. When Paramedics are exposed to a seminal publication there is anecdotal concern their autonomous practice changes, based on comprehension of findings ahead of potential guideline changes, however little evidence appraises whether this really occurs.MethodsA service evaluation to determine any variation in adrenaline administration during OHCA, before and after publication of the PARAMEDIC2 trial.WMAS electronic patient record data that has been collected for use within OHCA ambulance quality indicators was used to evaluate practice variation.Proportion of adult patients receiving adrenaline, number of administrations and time to first administration from EMS arrival (or arrest if EMS witnessed) are reported.This evaluation assesses from the day after recruitment ended on 18th October 2017 until the trial results publication on 19th July 2018, and the same timeframe (273 days) post-publication.Results Proportion receiving adrenaline Pre-publication: 88.7% of 3026 casesPost-publication: 88.0% of 2682 cases Mean number of adrenaline administrations Pre-publication: 4Post-publication: 4 Mean time to adrenaline Pre-publication: 30:02 minutesPost-publication: 30:11 minutesConclusionsIn both datasets, average time to first adrenaline administration and number of administrations were found to be similar. This suggests Paramedic practice adheres to current guidelines when a highly anticipated article is published, however this may vary by intervention so further work is recommended. Limitations of retrospective observational evaluations include uncontrolled treatment variables; however randomised controlled trials cannot assess standard practice. Individuals need continued awareness for implications of changing practice following a trial publication, as patient safety could be breached whilst the wider medical community are scrutinising the trial results. This demonstrates how routine data can be used to evaluate practice and changes within it.

BackgroundParamedic engagement is crucial for the success of prehospital research studies. The Head injury evaluatiOn and aMbulancE Diagnosis (HOME) study aims to examine the feasibility of a diagnostic-test accuracy study to assess using the Canadian CT Head Rule in the prehospital setting to improve prehospital triage. However, significant recruitment challenges led to undertaking this qualitative study, aiming to identify barriers and facilitators to paramedic research engagement.MethodsA qualitative study was conducted using semi-structured interviews with 13 paramedics with varying experience, both participants and non-participants in the HOME study, to understand their perspectives. Interviews were recorded, transcribed, and analysed using an accepted thematic analysis approach, with data saturation guiding sample size.ResultsFour themes were identified. The first, Paramedic Perspectives on the HOME study, highlighted potential benefits for practice and patient care and identified recruitment challenges, including the unpredictable nature of paramedic work, geographical restrictions to recruitment, and poor awareness among hospital staff. The second, Personal and Professional Constraints Impacting Engagement, identified barriers such as time constraints due to demanding work schedules, burnout from high-intensity work, and mixed attitudes toward clinical studies, influenced by factors such as generational differences and past research experiences. The third, Considerations for Research Engagement Among Paramedics, explored factors influencing paramedics’ decisions to participate in research, including personal interest in the study topic, its relevance to their practice, flexibility in engagement, and ethical concerns about patient care. The fourth, Strategies for Enhancing Paramedic Research Engagement, suggested offering incentives for participation, enhancing interaction and recognition, and improving communication and organisational support.ConclusionWith unpredictable workloads, a complex prehospital environment and multiple demands on their time, paramedics face substantial barriers to research engagement. This can be mitigated by remunerating and rewarding participation, adopting flexible approaches to training and research design and optimising communication and organisational support.

BackgroundDebriefing post out-of-hospital cardiac arrest (OHCA) is emerging as a strategy to improve patient outcomes and is recommended by JRCALC and Resus Council UK. There is limited research on debriefing post OHCA and no ‘gold standard’ for paramedics to use. A scoping exercise was conducted to gain insight into current practice and to inform the development of a PhD proposal exploring debriefing post OHCA in the prehospital setting.Methods24 paramedics employed by a UK ambulance service were approached by the author and asked to complete a questionnaire. Inclusion criteria: NHS employed paramedics, who had attended at least 1 OHCA over the past 6 months.ResultsPreliminary results showed that mean experience of participants was 4.5 years and median exposure of OHCA over 6 months was 5 (interquartile range 2-7). 55.48% of OHCA were followed by a debrief. When a debrief was not conducted, 58.33% of paramedics felt they did not need one. Debriefs were led by Team Leader (n=16), HEMS personnel (n=10), self-directed (n=8), Paramedic (n=4) and Clinical Team Educator (n=2). Debriefs took place at hospital (n=19), at scene (n=9) and ambulance station (n=4). Further analysis will look at differences between newly-qualified paramedics and experienced paramedics.ConclusionMore needs to be done to improve the debriefing rate for OHCA. A debrief post OHCA was twice as likely to take place at hospital compared to on scene, despite a low conveyance rate for OHCA. A Team Leader was most likely to lead a post OHCA debrief, but staff in this role are not provided formal training. Further research is needed to explore paramedics’ interpretations of debriefs, what paramedics want from debriefs, and the willingness of paramedics to participate in the debriefing process.

BackgroundDeciding which medical resources are needed for trauma incidents often results in over- or under-triage. Evaluation of innovations aimed at improving dispatch decision-making (e.g., video livestreaming) requires retrospective assessment of the appropriateness of these decisions, but no tools currently exist.MethodsWe aimed to develop a tool through expert consensus to assess the need for enhanced medical resources (either critical care and/or Helicopter Emergency Medical Services) for trauma incidents. A modified Delphi approach was used, comprising three meetings with an Expert Panel who developed the criteria iteratively. The resulting criteria – the Retrospective Assessment Tool in Emergency Trauma Dispatch (RATED) - were applied to data from a feasibility randomised controlled trial by research paramedics to test reliability: (i) pilot stage: two cases rated independently by two research paramedics; (ii) all cases (n=58) rated independently by two research paramedics (blind to allocation and resource dispatch). A sub-sample (n=30) of cases were rated by the Expert Panel (blind to research paramedic ratings, allocation, and resource dispatch).ResultsCriteria across four areas of decision-making were developed (i) pre-hospital clinical interventions; (ii) injury pattern/physiology/anatomy; (iii) pre-hospital clinical decision making; (iv) patient disposition and geographical considerations. Reliability of ratings between research paramedics was high (2/2 cases, 100% agreement for pilot application; 56/58, 97% agreement for all cases). Expert Panel members agreed with each other in 24/30 cases (80%) and agreed with the research paramedics ratings in 16/30 cases (53%). Expert Panel members discussed cases that lacked agreement (n=14) until consensus was reached. Final agreed ratings were: appropriate (n=40, 70%), over-resourced (n=10, 17.2%) and under-resourced (n=8, 13.8%) dispatches.ConclusionRATED is a novel tool developed to aid evaluation of interventions in the pre-hospital setting. RATED was found to be reliable and easily applied across a range of clinicians. Further evaluation and critique are needed.

This study aimed to assess perspectives and approaches of paramedics in the Saudi Red Crescent Authority regarding spine trauma management. Given the high prevalence of spinal injuries in Saudi Arabia, particularly from traffic incidents. A descriptive, cross-sectional survey was conducted among 236 Saudi red crescent authority paramedics. A structured questionnaire measured participants' perspectives and approaches on spine trauma management. The findings indicated that paramedics demonstrated adequate foundational knowledge, particularly regarding the mechanisms of spinal injury and basic immobilization techniques, with an average knowledge score of 4.01 out of 5. However, gaps were observed in familiarity with advanced protocols, such as ATLS, where responses were neutral. Attitudes toward evidence-based guidelines were generally positive, with a mean attitude score of 3.57, though confidence in handling complex spine trauma cases was lower. Practice scores revealed consistent application of basic immobilization techniques, yet documentation and reassessment practices were less rigorously applied. The study highlights a solid knowledge base among Saudi Red Crescent Authority paramedics but identifies specific areas for improvement, particularly in advanced protocol training, practical skills reinforcement, and documentation practices. Targeted training programs, scenario-based simulations, and feedback mechanisms are recommended to enhance paramedics' confidence, skills, and consistency in managing spine trauma.

Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.

BackgroundYorkshire Ambulance Service NHS Trust (YAS), West Midlands Ambulance Service University NHS Foundation Trust (WMAS) and The University of Warwick (UoW) collaborated to deliver the first clinical trial of an investigative medicinal product (CTIMP) of controlled drugs in the UK: PACKMaN (paramedic analgesia comparing ketamine and morphine in trauma).YAS Research Institute and collaborators reflected on the lessons learnt delivering this CTIMP across two ambulance services with reference to training, logistics, recruitment, and follow-up processes.Methods489 paramedics were trained and recruited 458 participants between Oct-2021 and May-2023. UoW monitored location and timing of paramedics training and patient recruitment, alongside follow-up rates.Paramedics’ pain score collection data (PACKMaN’s primary outcome) was compared to YAS clinical audit compliance adult pain management.Participants recruited by YAS (n=243) were compared to 2015 census data regarding index of multiple deprivation status.ResultsYAS conducted facilitated training resulting in more paramedics trained faster, resulting in higher recruitment. However, an IMP stock shortage impacted YAS’ recruitment more so than WMAS. Both sites used different consenting and follow up models, WMAS resulted in only 22 lost to follow up compared to YAS’ 63.Pain score collection data was high across both sites: 100% for YAS and 96.9% for WMAS, compared to 71% in the YAS-wide clinical audit for adult pain management, evidencing research involvement can improve routine data collection.Descriptive statistics indicated that YAS’ recruitment sample was similar to the population of Yorkshire regarding index of multiple deprivation scores demonstrating the ambulance services’ ability to conduct research with populations commonly underrepresented in research.ConclusionsThis study highlighted the challenges and opportunities two ambulance services encountered when delivering the first CTIMP with controlled drugs in the UK. Devoting time to specific tasks like facilitated training aided recruitment. These reflections will inform best practice for future research delivery.

BackgroundThe PACKMaN Study is a multi-centre, randomized, double blinded control drug trial which compared the clinical and cost effectiveness of ketamine against morphine for severe pain in adults with acute traumatic injury. This study was conducted in collaboration by Warwick Clinical Trials Unit (WCTU) West Midlands Ambulance Service University NHS Foundation Trust (WMAS) and Yorkshire Ambulance Service NHS Trust (YAS). Both Ambulance services choose to include Newly Qualified Paramedics (NQPs) and Experienced Paramedics (EPs) in the recruitment of the PACKMaN Trial. NQPs are HCPC registered paramedics that are expected to work autonomously on frontline ambulances with up to 2 years post qualification experience. In the PACKMaN trial, NQPs were permitted to enrol to the study after completing relevant training as they would be expected to use the study intervention, were it brought into clinical practice. Currently evidence is limited around the NQP role and any potential link with research participant safety.MethodsAn analysis was conducted of NQPs contribution to enrolment, to include review of protocol compliance and safety events, broken down by post-registration period of the paramedic: NQPs (<2 years) or experienced paramedics (EPs - >2 years). Both ambulance services provided the following data: trained paramedic numbers, enrolled participant numbers, adverse events (AEs)and serious adverse events (SAEs), and protocol non-compliances.Results160/489 (32.7%) of trial-trained paramedics were NQPs. 199/458 (43.4%) of participants were enrolled by NQPs. Of participants enrolled by NQPs, 45.7.32% experienced an AE, versus 49.4% of participants enrolled by EPs . 4.0% of all NQP-enrolled participants experienced an SAE, versus 1.5% of all those enrolled by EPs. Protocol non-compliances were 6 (3.0%) in NQPs and 3 (1.2%) in EPs.ConclusionNQP’s made an important contribution to this study, both in terms of patient enrolment, but also in improving the generalisability of the study findings. We found similar levels of adverse events in NQP versus EPs. We found no evidence of safety implications to including NQPs in this trial. Study training and participation was optional; different considerations may apply for research where participation is mandated.