Spotlight on Research

Overcoming challenges to research in pre-hospital careAlthough over recent years there has been an increased volume of research relating to out-of-hospital emergency and unscheduled care, Lerner et al (2015) suggest the evidence base remains limited, partly because of the relative newness of the speciality, and also because there are unique challenges to successfully undertaking research in the pre-hospital setting.This study set out to determine how researchers carry out pre-hospital clinical trials and to examine how emergency medical systems (EMS) can develop capacity to continue to undertake successful clinical research.Using, prospective studies were identified based on the following inclusion criteria: study initiated after 2000; has at least one study site based in the USA; and involves data collection activities in the pre-hospital setting. is an open access registry and results database that provides information on publicly and privately supported clinical studies round the world.A total of 39 study sites were selected and the principal investigator (PI) for each site was invited to participate. In addition, the PIs were asked for permission to contact the study coordinators and/or the EMS liaison in order to get different perspectives on barriers and enablers to pre- hospital research.In total, 25 PIs, 9 study coordinators and 7 EMS liaisons participated in the study, representing a total of 27 EMS systems from 22 different states in the USA.The interviews were conducted by one researcher and explored potential and actual barriers and enablers to pre- hospital research, as well as discussing how researchers overcame the challenges they encountered during their research. Interestingly, these interviews were not recorded and the interviewer took notes during each event—there is no discussion offered within this paper as to how the process of note-taking impacted on the dynamics of the interviews or why the researchers decided not to record the interviews.These notes were analysed, resulting in identification of emergent common themes which were reviewed by the research team and sent to all participants for further comment.‘ A key message is that pre-hospital research can be unpredictable, but that there are ways to overcome barriers to successful research in these settings ’The following issues were identified within the emergent themes as being a challenge to pre- hospital research: gaining ethics approval; acquiring funding; recruiting EMS agencies to participate in the research; collecting data and maintaining protocol compliance; training EMS providers to enrol patients; collecting outcome data from hospitals; and adequately staffing research studies.The authors identify that these findings are similar to previous studies but suggest that the differences found in this research study are that these barriers were not necessarily seen as insurmountable. The supplementary information (which can be accessed online) to this paper provides more in-depth information about the emergent themes and is certainly worth reading in conjunction with the paper itself to provide context to the issues included within the paper's discussion.Despite the study's findings pertaining to American research and EMS systems, there are some similarities to the UK experience, and this paper provides useful information in relation to paramedic research.Overall, a key message is that pre-hospital research can be unpredictable, but that there are ways to overcome barriers to successful research in these settings. The authors emphasise that we should learn from each other's experiences and avoid making the same mistakes. By developing a research culture which embraces open discourse about research processes and activities, it is possible to build on the work of researchers who have overcome challenges in their pre-hospital research, hence avoiding unnecessary pitfalls. In turn, this could help to develop both capability and capacity in relation to increasing both the quality and quantity of research relevant to the paramedic profession.

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