This year’s annual EMS 999 Research Forum, ‘Research for impact in 999 Emergency Care’ was held in the University of Stirling’s picturesque campus from 26-27 March 2018 and was attended by members of CaHRU, Viet-Hai Phung, Laura Simmons, Greg Whitley and Professor Niro Siriwardena. The preconference sessions included two workshops: Professor Rowena Murray from the University of the West of Scotland led a session on how to write a peer reviewed paper; the other session involved CaHRU’s Professor Niro Siriwardena, with Professor Helen Snooks from the University of Swansea and Roy Norris from Service Users for Primary and Emergency Care Research (SUPER), leading a session on designing and planning research projects and getting them funded.
Shona Robison, the Cabinet Minister for Health and Sport in the Scottish Government introduced the start of the second day. This started with presentations on research that makes a difference and the links between prehospital research and Out-of-Hospital Cardiac Arrest (OHCA). There then followed a series of four oral presentations, which included a sensitive one from Kelly Hird and Fiona Bell from Yorkshire Ambulance Service about suicide among ambulance staff, and Belinda Flanagan, from the University of the Sunshine Coast in Australia, who presented her work on unplanned births in paramedic care.
There was a CaHRU representation in the post-lunch poster session with Viet-Hai Phung presenting on the ‘Perceptions and experiences of community first responders on their role and relationships: qualitative interview study’, Rob Spaight from East Midlands Ambulance Service NHS Trust presenting work led by Dr Murray Smith on ‘Modelling of patient outcomes after emergency treatment for out-of-hospital cardiac arrest by paramedics and community first responders’ and Prof Niro Siriwardena presenting an interview study led by Dr Stephanie Armstrong of paramedics’ perceptions of the ethics of ambulance-based trials. Last year’s prize winner, Dr Edward Duncan, from Stirling University, subsequently recounted his experience of presenting at the Paramedic Australasia International Conference.
The final substantive session of the conference was a lively and thought-provoking panel discussion which included Janette Turner from the University of Sheffield and Professor Niro Siriwardena, on future priorities for prehospital research. The conference closed with a prize giving session for some excellent presentations and posters that were given throughout the conference.
By Viet-Hai Phung
Viet-Hai Phung presented his work on the perceptions and experiences of Community First Responders (CFRs) in Lincolnshire at the recent Mediterranean Emergency Medicine Congress (MEMC). The Congress, organised by the American Academy of Emergency Medicine (AAEM), took place in the very smart surroundings of the Corinthia Hotel in Lisbon, Portugal from 8-10 September 2017. Despite the title of the Congress, this was a truly international conference, with delegates from North America, the Middle East, Africa and Australasia presenting.
Professor Lee Alan Wallis, Head of Emergency Medicine for the Western Cape Government, was the keynote speaker at the opening ceremony. He talked about the particular challenges of emergency medicine provision in southern Africa, where in some countries the infrastructure is extremely basic. Other plenary speakers included: Professor James Ducharme from McMaster University in Toronto, who talked about the complex relationship between pain relief, patient satisfaction and addiction and Dr Eveline Hitti from the American University in Beirut, who spoke about the glass ceiling for women working in emergency medicine.
Viet-Hai presented the interview study that has been undertaken with colleagues Prof Niro Siriwardena, Ian Trueman and Prof Roderick Ørner on the first morning of the conference. The presentation was well-received with only minor points of clarification from the audience concerning the extent of their use in the UK and the levels of training they undertake.
What was interesting about the conference was the sharing of best practice from around the world on many salient problems in emergency medicine, such as alleviating patient overcrowding in the emergency department. All this within the setting of the wonderful city of seven hills, Lisbon.
By Viet-Hai Phung
Viet-Hai Phung presented the findings of a University of Lincoln study on Community First Responders at a meeting of the National Ambulance Service First Responder Managers Forum at East Midlands Ambulance Service NHS Trust at Beechdale, Nottingham on 25th April 2017. The presentation set out the aims and objectives of the research, which were to explore the role of CFRs in a rural location, using a systematic scoping review followed up by qualitative interviews.
This study team of Viet-Hai Phung, Fiona Togher, Ian Trueman, Prof Roderick Ørner and Prof Niro Siriwardena, began the research in April 2016 with a systematic scoping review of CFR schemes in the UK which was published recently. Then followed a qualitative study involving 16 interviews of CFRs, conducted from June-July 2016. After describing the progress of the study, Viet-Hai Phung outlined the key findings of the scoping review. These included that: volunteers became CFRs mainly for altruistic reasons; they wanted more training and feedback on incidents they had attended; there were concerns about the possible emotional impact on CFRs responding to incidents; there was low public recognition of CFR schemes and sometimes confusion with ambulance staff; relationships with the ambulance staff were sometimes affected by confusion over roles; CFRs wanted local autonomy for CFR schemes but with greater sharing of best practice. Some of the findings from the scoping review were reinforced by the interview study. These findings, alongside others, were reinforced by the interview study.
The broad consensus among the regional ambulance managers was that further research was needed on CFRs and CFR schemes building on the work so far, and CaHRU is committed to working with ambulance trusts to further develop the work on CFRs. Professor Niro Siriwardena, who was also present at the event, said there were plans to discuss this further with ambulance service research leads at the next meeting of the National Ambulance Research Steering Group.
By Viet-Hai Phung
Viet-Hai in his new role as Research Assistant
A new study entitled, ‘Community First Responders (CFRs) and schemes in the United Kingdom: systematic scoping review‘, conducted by members of CaHRU was published on 19th June 2017 in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. This article was the culmination of an initial idea for research proposed by Ian Trueman from the School of Health and Social Care. He undertook the scoping review with former colleague, Fiona Togher. Viet-Hai Phung took over from Fiona after the scoping review was completed and subsequently led writing the paper, with substantial constructive comments from Ian, Professor Niro Siriwardena and Dr Roderick Ørner, a consultant psychologist.
From an initial search of six databases, 15,696 publications were identified as being potentially relevant. After several stages of screening by title and abstract, narrowing the geographical focus and for relevance of content, as well as removing duplicates and full-text screening, nine studies were included in the final analysis.
A number of key themes were identified by the nine publications. The study showed that people were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low with patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles.
These findings establish a baseline of evidence on the work of CFRs in the UK. The team are building on this by undertaking an interview study of CFRs. Opportunities for future research include exploring the experiences and perceptions of patients who have been treated by CFRs as well as other stakeholders, including ambulance staff, while also evaluating the effectiveness and costs of CFR schemes.
By Viet-Hai Phung