Paramedic perceptions of the feasibility and practicalities of prehospital clinical trials: a questionnaire survey

Hargreaves, Kate; Goodacre, Steve; Mortimer, Peter

doi:10.1136/emermed-2013-202346

Cited by 21 publications

(21 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whilst response rates were low in this present study (32%), this is a limitation that has been found in similar studies with paramedics (Boyle et al, 2007;Glencorse et al, 2014;Hargreaves, Goodacre, & Mortimer, 2014). Given the low response rate, it cannot be assumed that these findings are representative of all NEAS employees or those employed elsewhere.…”

Section: Limitationscontrasting

confidence: 54%

A survey of paramedics and alcohol related work: ascertaining fear of and level of assault in the North East Ambulance Service

Newbury‐Birch¹,

Martin²,

Giles³

et al. 2017

BPJ

View full text Add to dashboard Cite

show abstract

Section: Limitationscontrasting

confidence: 54%

A survey of paramedics and alcohol related work: ascertaining fear of and level of assault in the North East Ambulance Service

Newbury‐Birch¹,

Martin²,

Giles³

et al. 2017

BPJ

View full text Add to dashboard Cite

show abstract

“…Ambulance services often have small research departments, an interested5 but research-naive workforce and lack experience of complex trials. Paramedics are under ever increasing pressure and any increase in the workload on staff may meet resistance.…”

Section: Research With Ambulance Servicesmentioning

confidence: 99%

The challenges of conducting prehospital research: successes and lessons learnt from the Head Injury Transportation Straight to Neurosurgery (HITS-NS) trial

et al. 2015

View full text Add to dashboard Cite

Head Injury Transportation Straight to Neurosurgery was a cluster randomised trial studying suspected severe head injury treatment pathways conducted in the North East Ambulance Service NHS Foundation Trust and North West Ambulance Service NHS Trust between January 2012 and March 2013. This was the world's first large scale trial of any trauma bypass and was conducted as a feasibility study. This short report will describe some of the lessons learnt during this ground breaking and complex trial.

show abstract

“…Pre-hospital care is a challenging environment in which to recruit and randomise patients. 94 NHS paramedics currently have little experience of recruiting to trials or providing pre-hospital CPAP. A trial would be feasible only if there were sufficient eligible patients to support a reasonable recruitment rate and if these patients could be recruited and randomised in the challenging pre-hospital environment.…”

Section: Suggested Research Prioritiesmentioning

confidence: 99%

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Pandor

Thokala

Goodacre

et al. 2015

Health Technol Assess

Self Cite

View full text Add to dashboard Cite

BackgroundNon-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources.ObjectivesWe aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to the emergency services with acute respiratory failure and to identify priorities for future research.Data sourcesFourteen electronic databases and research registers (including MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2013, supplemented by hand-searching reference lists and contacting experts in the field.Review methodsWe included all randomised or quasi-randomised controlled trials of pre-hospital NIV in patients with acute respiratory failure. Methodological quality was assessed according to established criteria. An aggregate data network meta-analysis (NMA) of mortality and intubation was used to jointly estimate intervention effects relative to usual care. A NMA, using individual patient-level data (IPD) and aggregate data where IPD were not available, was carried out to assess whether or not covariates were treatment effect modifiers. A de novo economic model was developed to explore the costs and health outcomes when pre-hospital NIV (specifically CPAP provided by paramedics) and standard care (in-hospital NIV) were applied to a hypothetical cohort of patients with acute respiratory failure.ResultsThe literature searches identified 2284 citations. Of the 10 studies that met the inclusion criteria, eight were randomised controlled trials and two were quasi-randomised trials (six CPAP; four BiPAP; sample sizes 23–207 participants). IPD were available from seven trials (650 patients). The aggregate data NMA suggested that CPAP was the most effective treatment in terms of mortality (probability = 0.989) and intubation rate (probability = 0.639), and reduced both mortality [odds ratio (OR) 0.41, 95% credible interval (CrI) 0.20 to 0.77] and intubation rate (OR 0.32, 95% CrI 0.17 to 0.62) compared with standard care. The effect of BiPAP on mortality (OR 1.94, 95% CrI 0.65 to 6.14) and intubation rate (OR 0.40, 95% CrI 0.14 to 1.16) compared with standard care was uncertain. The combined IPD and aggregate data NMA suggested that sex was a statistically significant treatment effect modifier for mortality. The economic analysis showed that pre-hospital CPAP was more effective and more expensive than standard care, with an incremental cost-effectiveness ratio of £20,514 per quality-adjusted life-year (QALY) and a 49.5% probability of being cost-effective at the £20,000-per-QALY threshold. Variation in the incidence of eligible patients had a marked impact on cost-effectiveness and the expected value of sample information for a future randomised trial.LimitationsThe meta-analysis lacked power to detect potentially important differences in outcome (particularly for BiPAP), the intervention was not always compared with the best alternative care (in-hospital NIV) in the primary studies and findings may not be generalisable.ConclusionsPre-hospital CPAP can reduce mortality and intubation rates, but cost-effectiveness is uncertain and the value of further randomised evaluation depends on the incidence of suitable patients. A feasibility study is required to determine if a large pragmatic trial of clinical effectiveness and cost-effectiveness is appropriate.Study registrationThe study is registered as PROSPERO CRD42012002933.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Paramedic perceptions of the feasibility and practicalities of prehospital clinical trials: a questionnaire survey

Abstract: Paramedics reported interest and understanding of research, but a number of practical and ethical barriers were recognised that need to be addressed if prehospital clinical trials are to increase.

Cited by 21 publications

References 15 publications

A survey of paramedics and alcohol related work: ascertaining fear of and level of assault in the North East Ambulance Service

A survey of paramedics and alcohol related work: ascertaining fear of and level of assault in the North East Ambulance Service

The challenges of conducting prehospital research: successes and lessons learnt from the Head Injury Transportation Straight to Neurosurgery (HITS-NS) trial

Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation

Contact Info

Product

Resources

About