Human factors in prehospital research: lessons from the PARAMEDIC trial
Pocock, Helen Deakin, Charles D. Quinn, Tom Perkins, Gavin D. Horton, Jessica Gates, Simon
Pocock, Helen
Deakin, Charles D.
Quinn, Tom
Perkins, Gavin D.
Horton, Jessica
Gates, Simon
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Abstract
Background There is an urgent need to develop
prehospital research capability in order to improve the
care of patients presenting to emergency medical
services (EMS). The Prehospital Randomised Assessment
of a Mechanical compression Device In Cardiac arrest
trial, a pragmatic cluster randomised trial evaluating the
LUCAS-2 device, represents the largest randomised
controlled trial conducted by UK ambulance services to
date. The aim of this study was to identify and analyse
factors that may influence paramedic attitudes to, and
participation in, clinical trials.
Methods Personal and organisational experience from
this trial was assessed by feedback from a workshop
attended by collaborators from participating EMS and a
survey of EMS personnel participating in the trial. A
work systems model was used to explain the impact of
five interwoven themes—person, organisation, tasks,
tools & technology and environment—on trial conduct
including gathering of high-quality data.
Results The challenge of training a geographically
diverse EMS workforce required development of multiple
educational solutions. In order to operationalise the trial
protocol, internal organisational relationships were
perceived as essential. Staff perceptions of the
normalisation of participation and ownership of the trial
influenced protocol compliance rates. Undertaking
research was considered less burdensome when
additional tasks were minimised and more difficult when
equipment was unavailable. The prehospital environment
presents practical challenges for undertaking clinical
trials, but our experience suggests these are not
insurmountable and should not preclude conducting
high-quality research in this setting.
Conclusions Application of a human factors model to
the implementation of a clinical trial protocol has
improved understanding of the work system, which can
inform the future conduct of clinical trials and foster a
research culture within UK ambulance services
https://emj.bmj.com/content/emermed/33/8/562.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2015-204916