Very few people working in the NHS could have failed to notice that research involving ambulance services is expanding. There has been a growing increase in research activity in this setting, with the National Institute for Health Research (NIHR) reporting a number of landmark studies completed and in progress. Latest figures show that between 2014/15 and 2016/17 alone, the number of studies increased fivefold from nine to 46, whilst recruitment increased significantly from 270 to more than 8,300.
Professor Niro Siriwardena is a co-opted member of the NIHR Clinical Research Network’s Injuries and Emergencies National Specialty Group and chair of the National Ambulance Research Steering Group (NARSG). He explains: “Studies involving ambulance services really began to take off with the formation of the NARSG in 2007.
“This enabled research leads in the ten regional ambulance services to meet regularly, work together and with leading academics across the country, and build a much needed evidence base for ambulance care.”
The STREAM trial, comparing two different treatments for a heart attack, was an early study randomising and consenting patients in the ambulance. Other studies followed, such as the SAFER2 trial; a large recruiter to the CRN and funded by the NIHR Health Technology Assessment Programme, this study looked into community falls pathways.
Since starting to conduct studies in this challenging setting there have been many hundreds of paramedics and other ambulance staff trained across the country. The ongoing RIGHT2 study looking at whether quickly lowering blood pressure after a stroke could help a patient’s recovery involves 940 paramedics in seven ambulance services.
AIRWAYS2, comparing ways for NHS ambulance staff to provide rescue breathing in cardiac arrest, involves 1,500 paramedics in four ambulance services.
Research paramedics and ambulance research staff are vital to successfully conducting these studies and the professionalisation of services. Many are undertaking masters and doctoral programmes, paving their way as research leaders of the future.
Mark Dixon is a research paramedic for the East Midlands Ambulance Service and works on the stroke study RIGHT-2, which looks at the outcomes of a drug when administered to patients in a pre-hospital setting. Explaining how recruiting patients to research studies in A&E can be tricky, Mark says:
“A&E is such an unpredictable environment, so recruitment to studies can be challenging. For example, we want to recruit ‘stroke’ patients to the RIGHT-2 study which means we’re totally reliant on ‘stroke’ calls coming in. But also, that a paramedic who is trained in the trial procedure is closest to the call.
“Getting A&E sites on board is therefore crucial to a study’s performance. A big part of my role is working with new sites and providing the support and training they need to deliver the study.”
Graham McClelland is a research paramedic who splits his time between North East Ambulance Service (NEAS) and Newcastle University, as a result of a stroke association fellowship he is studying. Having been involved with multiple research studies within NEAS, and now continuing that involvement within the university, he explains why he thinks research in ambulance trusts is so important:
“Ambulance services have unique issues so paramedic involvement is really important to making pre-hospital research work. If we are to deliver the best care to our patients evidence needs to be generated in a pre-hospital setting as opposed to assuming hospital based research automatically applies.”
“Research also gives paramedics control over their profession and the quality of care they deliver. Paramedics being involved in research will hopefully lead to better studies, better care and a stronger pre-hospital evidence base.”
Professor Siriwardena concludes: “Although ambulance services have demonstrated their ability to conduct world-class and much needed research, risks to sustainability remain in the form of limited infrastructure, lack of funding and flexible research support.
“Ambulance services themselves are questioning whether they should support research activity in the face of funding cuts, service pressures and conflicting priorities.
“The future of research in ambulance services depends on developing a sustainable ambulance research workforce with the capability and capacity to support studies in areas such as early interventions and novel ambulance to community pathways – this is a research setting where there is no shortage of ideas, enthusiasm or great staff.
“Coordinated support from the NIHR CRN and ambulance services themselves will be vital to continuing this success.”