This UK-based study investigates Paramedics' perceptions of research in pre-hospital settings with a particular emphasis on clinical trials.
Five paramedics participated in semi-structured interviews which focused on participants' opinions about the value and use of clinical trials, the challenges encountered when undertaking pre-hospital clinical trials, and possible ways to manage these challenges. The themes that emerged through processes of thematic analysis informed the development of a survey questionnaire which, subsequently, was distributed to 300 paramedics in the Yorkshire Ambulance Service.
The survey used both open and closed questions and was structured into five sections: 1) demographic data and information about clinical experience and training/education; 2) participants' knowledge and experience in clinical trials and their access to and use of published literature; 3) attitudes toward evidence based practice; 4) issues surrounding strategies for randomisation within pre-hospital clinical trials; 5) gaining consent, preparing Paramedics to participate in research, and practicalities involved with pre-hospital clinical trials.
In total, responses were received from 96 (32%) Paramedics. Of these, 55 (57%) people had followed an Institute of Health Care Development (IHCD) programme; 35 (37%) were educated through a foundation degree/diploma route; and six (6%) people followed an alternative route that was not specified in this paper.
Primary data analysis involved employment of descriptive statistics such as percentages, mean and standard deviation to identify trends; and secondary data analysis focused on testing six, pre-stated hypotheses looking at relationships between paramedic characteristics and identified perceptions.
The hypotheses examined whether being educated through a degree/diploma route effected participants' understanding of clinical trials and/or feelings of professional responsibility to participate in trials; whether previous participation in clinical trials impacted on participants' beliefs about evidence based practice and how they viewed prospective, written consent; whether length of service influenced opinions as to the importance of personal experience vs evidence from clinical trials, and ideas about additional education and training related to pre-hospital clinical trials.
The complexities of the results cannot be represented fully in a brief review but in summary the results revealed no association between the education/training route and understanding of clinical trials, nor did there appear to be any significant difference between education/training route and feelings that participation in clinical research was a professional responsibility. In addition, the researchers found no evidence to support that participants' opinions differed according to their previous involvement in research or their length of service.
It was clear that difficulties pertaining to methods of randomisation and gaining consent from patients remain a concern to paramedics, especially if undertaking these activities causes any delay to patient treatment.
The researchers identify a number of limitations to their study such as the low response rate which could have produced a non-representative sample with associated potential for bias; and reliance on self report when using this type of research instrument. Equally there are clear methodological strengths such as the utilisation of interviews to provide stand-alone data as well as informing the development of the questionnaire, thus enhancing the rigour of the study.
Despite the identified limitations, some interesting perspectives are presented which may be useful to consider in discussions about clinical research within ambulance services.
The authors conclude that a majority of participants demonstrated understanding of research with a commitment to the development of the evidence base underpinning clinical practice. At the same time, participants highlighted several practical barriers to increasing pre-hospital research activity including lack of time, funding and limited career opportunities. All of these factors could slow down the development and expansion of paramedic research if solutions are not found in the near future.