Pocock Helen, Thomson Michelle, Taylor Sarah, Deakin Charles D, England Ed
South Central Ambulance Service NHS Foundation Trust: ORCID iD: http://orcid.org/0000-0001-7648-5313.
South Central Ambulance Service NHS Foundation Trust.
Br Paramed J. 2019 Dec 1;4(3):55-56. doi: 10.29045/14784726.2019.12.4.3.55.
Out-of-hospital cardiac arrest trials can prove challenging and there is a need to share learning from those that have recruited successfully. We have just completed three years of recruitment to PARAMEDIC2, a placebo-controlled trial of adrenaline in out-of-hospital cardiac arrest. This study was designed to describe the experience of operational ambulance staff involved in recruiting patients into PARAMEDIC2.
Four focus groups involving trial paramedics and supporting members of the emergency care team were conducted across different geographical regions of a single UK ambulance service participating in the PARAMEDIC2 study. Data analysis was supported by NVivo 12 and themes were identified using a thematic analysis approach.
Forty-four participants contributed to the focus groups. Four overarching themes were identified: , , and . Participants felt that research such as PARAMEDIC2 is important and necessary to drive medical progress. They valued the opportunity to be part of a large project. Due to the deferred consent model employed, public awareness of the trial was felt to be important. Most expressed equipoise regarding adrenaline, but some felt concerned about enrolling younger patients and there was discussion around what constitutes a successful outcome. Struggles with ethical concerns were overcome through training and one-to-one discussion with research paramedics. Participants valued feedback on their performance of trial tasks, but also wanted feedback on their resuscitation skills. Cardiac arrest places a high cognitive demand on paramedics; simplicity and reinforcement of trial processes were key to facilitating recruitment. Caring for relatives was a high priority for paramedics and some felt conflicted about not discussing the trial with them.
This study has provided insights into paramedic experience of a large-scale pre-hospital trial. Investment in time and resource to provide face-to-face training and personalised feedback to paramedics can foster engagement and optimise performance.
院外心脏骤停试验可能颇具挑战性，因此有必要分享那些成功招募患者的试验经验。我们刚刚完成了PARAMEDIC2试验三年的患者招募工作，这是一项关于院外心脏骤停使用肾上腺素的安慰剂对照试验。本研究旨在描述参与PARAMEDIC2试验患者招募工作的急救人员的经历。
在参与PARAMEDIC2研究的英国单一急救服务机构的不同地理区域，组织了四个由参与试验的急救人员和急救团队支持成员组成的焦点小组。数据分析得到NVivo 12软件的支持，并采用主题分析法确定主题。
44名参与者参与了焦点小组。确定了四个总体主题： 、 、 和 。参与者认为PARAMEDIC2这样的研究对于推动医学进步很重要且必要。他们重视参与大型项目的机会。由于采用了延迟同意模式，他们认为提高公众对该试验的认知很重要。大多数人对肾上腺素持 equipoise态度，但有些人对招募年轻患者表示担忧，并且围绕什么构成成功结果展开了讨论。通过培训以及与参与研究的急救人员进行一对一讨论，克服了伦理方面的困扰。参与者重视关于他们试验任务表现的反馈，但也希望得到关于他们复苏技能的反馈。心脏骤停对急救人员的认知要求很高；简化和强化试验流程是促进招募的关键。照顾亲属是急救人员的首要任务，有些人对不与亲属讨论试验感到矛盾。
本研究深入了解了急救人员在大规模院前试验中的经历。投入时间和资源为急救人员提供面对面培训和个性化反馈，可以促进他们的参与并优化表现。
