Evaluation of Paramedic Views of Their Role in Ambulance Based Clinical Trials: An Interview Study

Abstract

Background: Prehospital ambulance-based research is a relatively new and growing field, with paramedics increasingly being asked to take on a new research role. We sought to understand paramedic perceptions of this role with particular emphasis on the ethical challenge of gaining consent and enrolling patients onto clinical trials in this setting. Methods: We undertook semi-structured interviews with paramedics who were actively involved in recruiting and consenting patients to UK trials. Participants were questioned on their views about the ethical considerations in clinical trials including different consent processes and perceived barriers to research. Participants were chosen because they had enrolled at least one patient to a clinical trial within the 12 months prior to the interview taking place. Results: Fifteen paramedics from East Midlands NHS Ambulance Trust UK (EMAS) were interviewed. Analysis highlighted seven themes: barriers and facilitators to participation; benefits of research; consent methods; future trials; managing patient participants; problems with consent; and reasons why paramedics participate (or not). Paramedics were generally comfortable with gaining consent for research and most did not see this as an additional burden. However, excessive paperwork and the prolonged handover times needed for paramedics to participate in research were seen to be problematic. All paramedics interviewed felt that research was important for advancing their practice and ensuring better outcomes for patients as a result of evidence-based practice. Conclusions: Our findings highlight the need for future trials to consider how to minimize impact on the operational practice of paramedics through the use of existing processes that reduce additional paperwork and time pressures on paramedics.

Challenges and opportunities for conducting pre-hospital trauma trials: a behavioural investigation

“…The importance of designing pre-hospital trials with minimal paperwork to reduce the participation burden for pre-hospital staff was identified in our study, both directly and indirectly (i.e. limited bandwidth) and has been highlighted in other pre-hospital trials, as well as the logistical challenges related to handover procedures with regards to data collection [1]. Lazarus et al [10] reported that patient enrolment to the PARAMEDIC-2 trial was often constrained by contrasting views and opinions of paramedics who were not involved in the trial.…”

“…Author details 1 Health Services Research Unit, 3Rd Floor Health Sciences Building, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK. 2 Barts Health NHS Trust, Royal London Hospital, St. Bartholomew's Hospital, London, England.…”

“…Trials conducted in pre-hospital trauma are associated with a number of specific logistical and methodological challenges, which may have resulted in relatively few trials being conducted in this setting. For example, randomisation and intervention delivery are often difficult because they occur in remote locations, public spaces, private residences, or emergency vehicles (ambulance, helicopter and/or fast response car) [1]. Pre-hospital trauma trials in the UK may also face challenges in relation to the range of organisations, and their potentially competing priorities, when tasked with trial delivery (e.g.…”

“…Previous studies have explored clinicians' perspectives of the challenges and opportunities for the delivery of pre-hospital trials, but these have tended to focus on individual trials rather than the perspectives of clinicians involved in multiple trials across the pre-hospital trial landscape. A significant focus to date has also been on the experiences of emergency medical service personnel, largely paramedics, in land-based ambulance crews [1,2,8,9]. Few studies have considered the challenges of conducting pre-hospital trauma trials that involve Helicopter Emergency Medical Service (HEMS) teams, yet many pre-hospital trauma trials are delivered by these services and involve doctors and paramedics delivering the trial intervention [4].…”

Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow testing and direct admissions pathway: exploring why well-received ideas have low uptake

“…Other studies have identified factors affecting participation in pre-hospital clinical trials and embedding a culture of research, highlighting the importance of peer communication in recruitment, rather than electronic communication ( Pocock et al, 2019 ). Studies evaluating experiences of and challenges to taking part in pre-hospital research have focused principally on the experiences of paramedics who have recruited patients to clinical trials and the ethical challenges faced ( Ankolekar et al, 2014 ; Armstrong et al, 2021 ; Lazarus et al, 2019 ; Pocock et al, 2019 ). While these studies have similarly identified the high level of motivation of research-active paramedics, there is a clear need for further research exploring barriers to participation among paramedics who are not research active and particularly to understand what might motivate paramedics who are not currently research active to become so.…”