I was giving a lecture recently to a group of student paramedics about prehospital research – why it’s an exciting, developing area to work in and why it’s so important for patients that we do it.
At the time of my lecture, Care at the scene, a themed review published by the National Institute for Health Research (NIHR) Dissemination Centre (@NIHR_DC) hadn’t been released yet, but would have demonstrated this point perfectly.
Their themed review brings together recent research evidence on urgent and emergency care, focussed on the ambulance service. They organised almost 40 NIHR funded studies into three main areas – understanding system and population factors that affect ambulance services; decision-making by patients, ambulance staff and services, workforce and patient experience; and clinical interventions in prehospital care(http://www.dc.nihr.ac.uk/highlights-and-reviews/pre-hospital-care).
The role of ambulance service staff and the care they provide for patients has seen a paradigm shift in the last couple of decades. From historically adhering to the ‘load-and-go’ ethos of ‘ambulance drivers’, to now delivering high levels of care and sophisticated interventions on scene. Not only has the level of acute-care advanced, but the ambulance service is now considered part of the wider system of urgent and emergency care services. We are treating more and more patients with complex health and social needs, long-term and chronic conditions.
Not only this, but with emergency departments under such relentless demand, the ambulance service has a part to play in ensuring patients are being seen and treated at the most appropriate place; whether that be at home, minor injury units or GP surgeries. Staff are undertaking more training to gain specialist skills and new approaches to managing patients at scene.
As the landscape of what we do as an ambulance service changes, we also need the research and evidence to show that the care we provide is effective, beneficial, safe and cost-effective. As a clinician, this review has highlighted important studies that can influence my practice and make sure I’m providing evidence-based care for the patients I see.
As a paramedic involved in research, I’m so encouraged to read about the variety of great studies that have happened and are ongoing. It shows how research plays such an important role in improving ambulance services and the care patients receive. It’s great to see that a range of well conducted research is being undertaken covering the different aspects involved in prehospital care, from large randomised controlled trials focussing on cardiac arrest, to qualitative studies looking at decision-making and safety in ambulance service transitions. And while it’s encouraging to see this research being done, it also highlights the fact that more research is still needed.
The review was launched at Sheffield University with a selection of presentations from some of the investigators involved in the research included in the review, as well as lay representatives and commissioners. It was great to hear the researchers talk about the results of their studies, as well as providing insights into the challenges and opportunities of conducting research in the prehospital setting that they found along the way. There was a passionate talk followed by a lively discussion by Derek Prentice, who chairs the lay group for the Royal College of Emergency Medicine, on whether the NHS truly does provide patient-centred care. The event also provided a great opportunity to (though, I loathe the saying) ‘network’ and meet others involved or interested in prehospital research from around the country. A gathering of like-minded folk to discuss common interests, potential collaborations and share ideas. Sometimes I can feel quite isolated whilst working on my research, but I came away from this event with renewed encouragement from meeting others that are also interested in research that is going to improve the care provided to patients.
I think that this is an important document for front-line clinicians who are providing out-of-hospital care to read, to help make them aware them of some of the existing evidence that can help inform their practice. The review also provides recommendations on how ambulance services can make better use of evidence and support research to drive improvement. It’s also important that chief executives, medical directors, those involved in policy-making, commissioners and opinion leaders understand the impact and potential that research has for helping adapt the ambulance service in the changing healthcare care landscape.
Postgraduate Researcher | School of Health Sciences: PhD