Journal Of Paramedic Practice - Where to look: sources of research in paramedicine

Abstract

This article explains how to approach searching for paramedicine research, and the order in which you should consider types of sources, from synthesised sources to individual studies. Databases and sources for literature are covered and common issues about the search process are addressed, including when a search is complete and finding a gap in the literature.

This article summarises key sources for paramedicine research. It sets out an approach to searching that is most likely to bring you success, starting with synthesised sources and working towards individual studies. The types of sources you should include in your search are described and specific examples are given. Common questions about the search process are addressed.

Approaches to searching

This summary is arranged with the synthesised sources first and individual studies last.

When searching, you are advised to work through these resources in this order, starting with synthesised sources and finishing with individual studies. This is because high-quality sources synthesised by experts are most likely to give you an overview or ‘helicopter view’ of the topic based on the best research available.

Using this sound foundation, you can extend the boundaries of your topic in a direction you wish to go by searching other sources. If the synthesised source is not recent, you can fill in the gap between the date it was published and the current date with more recent research.

There are two caveats to this approach. First, not all topics will have literature in each of the categories described. The point here is to look. Your search is considerably weakened if, for example, a systematic review exists but you did not locate it. If nothing appropriate exists, you can move on to other sources confident that you have checked.

Second, as with all searching, it is best to view the process as iterative. As you review the results of your search, you may want to rethink your approach to your topic and revisit the process again. Flexibility is always advised.

Synthesised sources

Synthesised sources are systematic summaries conducted by experts in the field using the best available research. Typically, such reviews comment on the quality of the evidence to give you an idea of the reliability of the conclusions.

Synthesised sources include:

Systematic reviews and meta-analyses: these are high-level overviews of primary research studies that aim to identify, select and synthesise relevant research published on a particular topic using a rigorous methodology.

Point-of-care tools: these give fast access to filtered summaries of evidence, providing background, context and current recommendations for the management of clinical problems and conditions

Clinical practice guidelines: these are systematically developed statements to assist practitioner decisions about care for specific clinical circumstances.

Tools for synthesised sources

To locate systematic review and meta-analyses, search the Cochrane Library and Trip Pro. You should also consider searching BestBETS, a resource that originally specialised in emergency medicine but has extended its coverage into other clinical areas.

Starting your search with synthesised sources and moving towards individual studies will yield the best results

The main point-of-care tool used in the NHS in England is BMJ Best Practice. You may also have access through a university or NHS library to DynaMed (EBSCO) or UpToDate (Elsevier).

The primary set of guidelines for ambulance services in the UK are the UK Ambulance Services Clinical Practice Guidelines (Joint Royal Colleges Ambulance Liaison Committee and Association of Ambulance Chief Executives, 2019). You can search other clinical practice guidelines using NHS Evidence Search. For more general clinical guidelines, use the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) websites.

Specialised finding tools

These tools are created with a specific audience in mind. They provide fast access to the most relevant literature. However, they should always be supported by searches of a more general database such as Medline and Cumulative Index to Nursing & Allied Health (CINAHL) to give a broader perspective.

For paramedicine, specialised finding tools include amber, the research repository for ambulance services in England, and BestBets. They might also include databases aimed at the emergency preparedness, resilience and response community, such as Disaster Lit from the National Library of Medicine and Special Collection: All-Hazards Articles In The Scholarly Literature form the US Fire Administration.

Primary studies

These are studies reporting original research that are published in peer-reviewed journals, and occasionally published in conference proceedings or conference abstracts reporting presentations at peer-reviewed conferences.

Exceptionally, you might also include preprints, a version of an article or paper published before peer review. Preprints precede the normal but lengthy publication process in areas where fast dissemination of research is important; most recently, research around COVID-19.

Finding tools for primary studies

To find primary studies, you should use the major bibliographic medical databases PubMed, MEDLINE and Embase. Additionally, you should search databases aimed at nursing and allied health professionals, including CINAHL (which indexes the Journal of Paramedic Practice and the British Paramedic Journal) and EMCARE.

How do I know my search is finished?

Knowing when your search is finished is a judgement you make based on the criteria you should have set in your search plan.

Broadly, these points would be an indication that you have or are reaching the end of your search:

Triangulation: your search finds articles you have already located elsewhere. At this point, further searching is unlikely to add anything new to your set of journal articles

Critical mass: it is unwise to set numeric targets but, if you had 15–30 relevant journal articles that might include a recent systematic review or summary of the literature, then you should have a sound basis for your research or project

Closing the gap: if you are working from a relevant systematic review or meta-analysis, you need only search for the period from the year it was published to the current year, which will set useful parameters to your search

Hitting your target journals: this advice is highly dependent on your topic and the profile of the literature it generates; with that qualification, if you locate relevant results in core journals in your area of research, then you can be reasonably confident in your search. In paramedicine this might include: the British Paramedic Journal, the Emergency Medicine Journal, the Journal of Paramedic Practice, Prehospital Emergency Care, Resuscitation, the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

What if I cannot find anything relevant?

One possible outcome of your search is not finding anything that is relevant. If this happens, you have either a problem with your search or a problem with the literature.

Problems with your search might include spellings, a structural problem with the way your search is implemented or not identifying the right language or vocabulary to describe your topic.

Problems with the published literature might include a topic that is too recent to have generated much published research. In addition, some areas of clinical practice are so accepted or routine that they have not generated recent research, although there may be extensive older studies. It might be that the context is inappropriate and changing the focus of your search will yield better results, for example by moving from a focus on only prehospital/paramedic to including community and primary care. Ultimately, you may have identified a gap in the literature.

Gaps in the literature

If there simply is no literature, what you decide to do depends on the reason for your research.

If finding literature is a priority, for example for an assignment or a course, you may have to change topic. If it is the topic which is important, you might try to answer these questions based on the outcome of your search:

Where in the literature does your topic sit? What is the broader context where published research does exist? At what point does the research stop?

Why is there a gap? Articulate a coherent explanation for the lack of published research

What research needs to be completed to fill the gap?

Show that you understand the questions that need to be addressed and methodologies that need to be deployed to fill the gap, even if you don't have the resources to do it. This demonstrates your grasp of the topic.

Key points

When considering sources, you should start with synthesised research and finish with individual studies

Different databases have specific purposes. You should consider what it is you want to achieve and choose the right databases for each stage of your search

It can be difficult to know when to stop searching. However, there are pointers to assess how complete your search is and when you should stop

You may find that there is no literature on your topic. This article looks at how you might deal with this and what to consider if you identify a gap in the literature

CPD Reflection Questions

Apply the model described in this article to your next literature search. Did it improve your search results?

Check what access you have to the databases identified in this article and to other resources through LKS ASE and NHS healthcare libraries. Remember to register for your NHS OpenAthens account

Review this article in conjunction with the two other articles in this series (see References)