An international team of researchers led by Prof Niro Siriwardena with statistician Dr Zahid Asghar from CaHRU has been awarded funding from the Falck Foundation to study prehospital pain management. The study involves collaboration between CaHRU at the University of Lincoln, with East Midlands, East of England and South Central Ambulance Service NHS Trusts, together with the Universities of Swansea, Hertfordshire and the Sunshine Coast (Australia).
The study, ‘Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain: cross sectional study (ExPLAIN)’ aims to identify how patient factors such as age, gender, ethnicity and the cause of pain together with clinician factors such as sex or role seniority affect pain assessment and use of analgesic drugs by ambulance staff. The study builds on previous research conducted by members of the team in the area of prehospital pain management and the findings will be used to inform recommendations to improve the rate and quality of acute pain relief provided by ambulance staff and to reduce unintended variations in care.
The study is part of CaHRU’s ongoing research as part of its Prehospital and Emergency Quality and Outcomes (PEQO) workstream which involves collaboration with other ambulance services in England and which has already led to new measures and improvements in the quality of ambulance service care provision.
A new study focusing on decision making by paramedic and specialist paramedic staff and conducted in three English National Health Service (NHS) Ambulance Service Trusts was published this month. The study, entitled ‘A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety‘ published in the Journal of Health Services Research and Policy was led by Dr Rachel O’Hara from ScHARR at the University of Sheffield and included Professor Niro Siriwardena, director of CaHRU, and Debbie Shaw, visiting fellow at CaHRU, and both members of the East Midlands Ambulance Research Alliance at East Midlands Ambulance Service NHS Trust.
The study involved observation and interviews, analysis of digital diaries and focus groups with paramedic staff. Different types of decision were identified, ranging from the decision to convey a patient to the emergency department, use of specialist emergency pathways or the decision to treat and leave a patient at home. Systemic influences and risk factors affecting decision making included demand, performance priorities, access to care options, risk tolerance, training, communication, feedback and resources.
The study highlighted the complexity of paramedic decision making and system factors which could worsen risk. Decision making has been studied in other settings but rarely in the prehospital environment, and the uncertainty which paramedics have to face when making decisions needs further work. The study forms part of the Prehospital Emergencies Quality and Outcomes programme at CaHRU.
Novel treatments for stroke are increasingly being tested and delivered in the ultra-acute period during initial presentation to ambulance services. In the first feasibility trial of nitroglycerin (glyceryl trinitrate) in ultra-acute stroke (RIGHT) there were early indications of improvements in outcomes and disability at three months. The research team was led by Prof Philip Bath and his team at Nottingham University, together with Sandeep Ankolekar, Prof Niro Siriwardena from CaHRU and researchers at East Midlands Ambulance Service NHS Trust.
A nested qualitative study entitled ‘Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: qualitative data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT)‘ explored facilitators and barriers to paramedic involvement in clinical trials. The fieldwork was conducted by Dr Sandeep Ankolekar and the team. Barriers to participation included the pressure of the emergency setting, difficulties obtaining informed consent, institutional support for research, the steep learning curve for research naive staff and relative rarity for individual paramedics of clinical conditions seen, and difficulty in attending training sessions.
Suggestions for improvement included a simple diagnostic tool for stroke, use of assent and proxy consent on behalf of patients (as in the trial), and simpler trial processes.Recruitment became easier with each new randomisation attempt. Paramedics in the study were motivated to participate in research. Treatment of acute stroke in the out-of-hospital environment was feasible, but important barriers needed to be addressed.