• Addressing the challenges of paramedic recruitment and engagement in AIRWAYS-2

      Pilbery, Richard; Green, Jonathan; Hall, Helen; Whitley, Gregory (2016-09)
      AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial. The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been: ▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics ▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion ▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues. How have these challenges been overcome? ▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates ▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance ▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development ▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts. Key achievements By November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2. Conclusion The research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial. https://emj.bmj.com/content/emermed/33/9/e12.1.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-2016-206139.38
    • A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures

      Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Daniel; Coster, Joanne; Siriwardena, Aloysius (2018-02)
    • Emergency Medicine Journal COVID-19 monthly top five

      Tonkins, Michael; Miles, Jamie; O'Keeffe, Colin; Jiminez Forero, Sonia; Goodacre, Steve (2021-02-12)
      Following from the successful ‘RCEM weekly top five’ series starting in April 2020, this is the third of a monthly format for EMJ readers. We have undertaken a focused search of the PubMed literature using a standardised COVID-19 search string. Our search between 1 December and 31 December 2020 returned 1183 papers limited to human subjects and English language. We also searched high impact journals for papers of interest. https://emj.bmj.com/content/early/2021/02/11/emermed-2021-211203 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. http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2021-211203
    • Perceived areas for future intervention and research addressing conveyance decisions and potential threats to patient safety: stakeholder workshops

      O'Hara, Rachel; Johnson, Maxine; Hirst, Enid; Weyman, Andrew; Shaw, Deborah; Mortimer, Peter; Newman, Chris; Storey, Matthew; Turner, Janette; Mason, Suzanne; et al. (2016-09)
      Background As part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention. Methods A total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample. Findings The two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety. Conclusions Feedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda. https://emj.bmj.com/content/emermed/33/9/e7.3.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-2016-206139.25
    • Research paramedics’ observations regarding the challenges and strategies employed in the implementation of a large-scale out-of-hospital randomised trial

      Green, Jonathan; Robinson, Maria; Pilbery, Richard; Whitley, Gregory; Hall, Helen; Clout, Madeleine; Reeves, Barnaby; Kirby, Kim; Benger, Jonathan (2020-06-01)
      Introduction: AIRWAYS-2 was a cluster randomised controlled trial (RCT) comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of out-of-hospital cardiac arrest (OHCA). In order to successfully conduct this clinical trial, it was necessary for research paramedics to overcome multiple challenges, many of which will be relevant to future emergency medical service (EMS) research. This article aims to describe a number of the challenges that were encountered during the out-of-hospital phase of the AIRWAYS-2 trial and how these were overcome. Methods: The research paramedics responsible for conducting the pre-hospital phase of the trial were asked to reflect on their experience of facilitating the AIRWAYS-2 trial. Responses were then collated by the lead author. A process of iterative revision and review was undertaken by the research paramedics to produce a consensus of opinion. Results: The main challenges identified by the trial research paramedics related to the recruitment and training of paramedics, screening of eligible patients and investigation of protocol deviations / reporting errors. Even though a feasibility study was conducted prior to the commencement of AIRWAYS-2, the scale of these challenges was underestimated. Conclusion: Large-scale pragmatic cluster randomised trials are being successfully undertaken in out-of-hospital care. However, they require intensive engagement with EMS clinicians and local research paramedics, particularly when the intervention is contentious. Feasibility studies are an important part of research but may fail to identify all potential challenges. Therefore, flexibility is required to manage unforeseen difficulties. Abstract published with permission.