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

McClelland, Graham; Pennington, Elspeth; Byers, Sonia; Russell, William Howard; Lecky, Fiona

doi:10.1136/emermed-2014-203870

Cited by 8 publications

(7 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This allows for a dedicated resource that can track and trace patients and continuously communicate to paramedics expected to enrol patients. Constant communication, through dedicated channels has been known to improve protocol compliance and recruitment [24]. One way of doing this with limited funding may be to second operational paramedics to coordinate the study [25].…”

Section: Discussionmentioning

confidence: 99%

“…It is essential to plan research projects within other programmes a priori, as many of the administrative and staff costs can be covered within the programme budgets [26]. Within the African context, such resource-lean approaches should be developed and employed towards the generation of good quality evidence [24].…”

Section: Discussionmentioning

confidence: 99%

“…In retrospect, it is suggested that future trials be started on a much smaller scale and optimised to allow for testing of study procedures and to elicit immediate feedback from a small group of paramedics, addressing any issues or misunderstandings early on [24]. Further to this, focusing on a smaller group may allow for more intensive support to those enrolling and could facilitate in building a better research culture.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

Stassen

Wallis

Castrèn

et al. 2019

African Journal of Emergency Medicine

View full text Add to dashboard Cite

The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

Stassen

Wallis

Castrèn

et al. 2019

African Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…This exploration of stakeholders' views of prehospital critical care for OHCA is nested within a quantitative analysis of the effects of this complex intervention on survival after OHCA. The limitations and challenges of research in prehospital care and particularly OHCA require a certain degree of flexibility to the methods used . We, therefore, adopted a pragmatic research paradigm, which is reflected in the mixed‐methods structure of the overarching project .…”

Section: Methodsmentioning

confidence: 99%

“…The limitations and challenges of research in prehospital care and particularly OHCA require a certain degree of flexibility to the methods used. 14 We, therefore, adopted a pragmatic research paradigm, which is reflected in the mixed-methods structure of the overarching project. 15,16 Research paradigms can be seen as the link between the aim and the methods of a research project, and described by their ontology, epistemology, and methodology.…”

Section: Research Paradigmmentioning

confidence: 99%

Variations in stakeholders' priorities and views on randomisation and funding decisions in out‐of‐hospital cardiac arrest: An exploratory study

Vopelius-Feldt

Brandling

Benger

2018

Health Science Reports

View full text Add to dashboard Cite

Background and aimsPrehospital critical care for out‐of‐hospital cardiac arrest (OHCA) is a complex and largely unproven intervention. During research to examine this intervention, we noted significant differences in stakeholders' views about research, randomisation, and the funding of prehospital critical care for OHCA. We aimed to answer the following questions: What are stakeholders' priorities for prehospital research? What are stakeholders' views on randomisation of prehospital critical care? How do stakeholders consider allocation of resources in prehospital care?MethodsWe undertook an explanatory qualitative framework analysis of interviews and focus group with 5 key stakeholder groups: patients and public, air ambulance charities, ambulance service commissioners, prehospital researchers, and prehospital critical care providers.ResultsWe undertook 3 focus group discussions with a total of 23 participants and 8 interviews with a total of 9 participants. Despite sharing a common appreciation of the concepts of scientific enquiry, fairness, and beneficence, the 5 relevant stakeholder groups displayed divergent views of research and funding strategies regarding the intervention of prehospital critical care for the condition of OHCA. The reasons for this divergence could largely be explained through the different personal experiences and situational contexts of each stakeholder group. Many aspects of the strategies suggested by the stakeholder groups only partially aligned with principles of traditional evidence‐based medicine, but were held with strong conviction.DiscussionAnalysis of the views of 5 stakeholder groups regarding research and the funding of prehospital critical care for OHCA revealed shared values but a variety of different strategies to achieve these. This knowledge can help researchers in similar fields in the planning and presentation of their research, to maximise impact on decision making.

show abstract

A systematic review of ambulance service-based randomised controlled trials in stroke

et al. 2023

View full text Add to dashboard Cite

Background Treatment for stroke is time-dependent, and ambulance services play a vital role in the early recognition, assessment and transportation of stroke patients. Innovations which begin in ambulance services to expedite delivery of treatments for stroke are developing. However, research delivery in ambulance services is novel, developing and not fully understood. Aims To synthesise literature encompassing ambulance service-based randomised controlled interventions for acute stroke with consideration to the characteristics of the type of intervention, consent modality, time intervals and issues unique to research delivery in ambulance services. Summary of review Online searches of MEDLINE, EMBASE, Web of Science, CENTRAL and WHO IRCTP databases and hand searches identified 15 eligible studies from 538. Articles were heterogeneous in nature and meta-analysis was partially available as 13 studies reported key time intervals, but terminology varied. Randomised interventions were evident across all points of contact with ambulance services: identification of stroke during the call for help, higher dispatch priority assigned to stroke, on-scene assessment and clinical interventions, direct referral to comprehensive stroke centres and definitive care delivery at scene. Consent methods ranged between informed patient, waiver and proxy modalities with country-specific variation. Challenges unique to the prehospital setting comprise the geographical distribution of ambulance resources, low recruitment rates, prolonged recruitment phases, management of investigational medicinal product and incomplete datasets. Conclusion Research opportunities exist across all points of contact between stroke patients and ambulance services, but randomisation and consent remain novel. Early collaboration and engagement between trialists and ambulance services will alleviate some of the complexities reported. Registration number PROSPERO 2018CRD42018075803

show abstract

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

Cited by 8 publications

References 6 publications

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

Variations in stakeholders' priorities and views on randomisation and funding decisions in out‐of‐hospital cardiac arrest: An exploratory study

A systematic review of ambulance service-based randomised controlled trials in stroke

Contact Info

Product

Resources

About