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Abstract

Background A recent national review of English ambulance services, Taking Healthcare to the Patient: Transforming NHS Ambulance Services 1 published by the Department of Health, recommended that pre-hospital care research topics should be prioritised to ensure that service provision and development are evidence based wherever possible and that limited available funds are targeted to the most pressing needs.

Study objectives To identify gaps in research evidence related to delivery of pre-hospital care; and to rank topics in order of priority for research.

Methods Research priorities were initially identified by delegates at the UK Ambulance Service Association's annual conference, AMBEX 2006. An examination of research reviews in pre-hospital care identified other research evidence gaps. Relevant websites, databases and review bibliographies were also searched. Management, service delivery and treatment recommendations in UK policy/guidance documents published since 2000 were matched to research evidence. A list of evidence gaps was circulated in a Delphi-style three-round consultation to experts in pre-hospital care, including clinicians, managers and researchers. Round 1 confirmed/identified research gaps; Round 2 focussed on ranking topics; and Round 3 reviewed the scores and provided an option to rescore. Scores were analysed using SPSS.

Results Ninety-six research issues were identified for circulation and prioritisation from 52 reviews and expert consultation and these were matched against 30 policy and guidance documents. Forty people participated in the Delphi exercise. The subject receiving highest priority for research was the development of new performance measures other than emergency ambulance response times. Other highly ranked priorities included treatment of stroke, cardiac conditions, children and people who self-harm; alternatives to Accident and Emergency (A&E) treatment; patient information sharing across care providers; access issues; decision support systems; and demand management systems for pre-hospital care. These priorities reflect three key issues: measuring activity to benefit patients; development of safe non-A&E care; and providing appropriate evidence-based clinical care in the pre-hospital environment.

Implications There are many evidence gaps related to current pre-hospital policy and practice including management, clinical and service delivery issues. This Delphi consultation combines expertise of clinicians, managers and researchers to generate consensus on future research priorities in pre-hospital care. The need to develop meaningful performance measures plus alternative methods of patient management illustrates the synergistic relationship between service delivery and performance measurement. It suggests an opportunity to identify alternatives to response times as indicators of quality of pre-hospital care. The final results from this study will be useful to commissioners when developing their strategic approach to decision making about which research should be funded to facilitate continued development of quality patient care in the pre-hospital setting.

View full report here (.pdf)

Reference

Department of Health (Peter Bradley) (2005). Taking Healthcare to the Patient: Transforming NHS Ambulance Services.

Funding This study was funded by the UK Department of Health and conducted by the 999 EMS Research Forum.

Acknowledgements We would like to thank the individuals and organisations that contributed to this piece of work, with particular thanks to the Joint Royal Colleges Liaison Committee (JRCALC) and the British Paramedic Association (BPA) for their support in promoting the study. Thanks also to Moira Morgan for administrative support throughout the study.

Note The 999 EMS Research Forum is a partnership of international academics, clinicians and pre-hospital care practitioners and managers, formed in 1999, whose aim is to encourage, promote and disseminate research and evidence based policy and practice in 999 emergency healthcare. Since its inception, the Forum has been sponsored by the UK Department of Health and other funders to undertake training, to hold an annual conference, and to undertake other activities to promote and develop capacity in pre-hospital care research.

For further information about this publication or any other activity by the 999 EMS Research Forum, please contact:

Helen Snooks Professor of Health Services Research Centre for Health Information, Research and Evaluation (CHIRAL) School of Medicine Swansea University Swansea, Wales UK SA2 8PP Telephone: +44 01792 513418 Fax: +44 01792 513423 Email: h.a.snooks@swan.ac.uk

Author Biography

Frank Archer BMedSci(Hons), MBBS, MEd, MPH, FRACGP, FIMC(RCSEd), FAFPHM, FASMF

Frank is currently the director of the Monash University Centre for Ambulance and Paramedic Studies. He was previously the State Ambulance Medical Director for Victoria in the Department of Human Services - a position he had held for the previous 20 years. He also has a concurrent appointment as one of the four Medical Directors for the Metropolitan Ambulance Service in Melbourne.

Frank's first contact with the ambulance service was when he was employed as an Ambulance Officer during his long vacations whilst a medical student. He presented his first paper at the First Seminar on the Management of Road Traffic Casualties conducted by the Royal Australasian College of Surgeons in 1999. The title of his paper was, "Care Before Casualty - Current Shortcomings".

Following his graduation and hospital residencies, Frank combined clinical practice as a general practitioner with (initially) a four year period teaching anatomy to medical students at Monash University and later in a range of appointments within the Ambulance Service. Frank commenced a formal appointment as the "Ambulance Service Medical Officer" in 1976, combining responsibilities primarily for the development of the Mobile Intensive Care Ambulance program in Victoria, within both the Department of Human Services and the Metropolitan Ambulance Service, whilst based at the Ambulance Officers' Training Centre. These concurrent appointments continued until his appointment at Monash University in May 1999.

During these ambulance appointments, Frank has been a member of many teams which have led a series of innovations in ambulance policy, research and development, clinical practice education and operations, many of which have been benchmarks for interstate programs and have attracted international attention.

Frank has post graduate clinical fellowships in general practice, immediate medical care and public health medicine. He is also a member of a number of national and international committees in the area of prehospital care.

Malcolm Woollard

MPH, MBA, Dip IMC (RCSEd), PGCE, RN, SRPara, FASI, ILTM

Professor Malcolm Woollard is the Director of the Pre-hospital Care Research Unit in the James Cook University Hospital's Department of Academic Emergency Medicine and a Visiting Professor in Pre-hospital Emergency Care at the University of Teesside. He is a State Registered Paramedic and Nurse. He was formerly an Honorary Lecturer at the University of Wales Swansea and the University of Wales College of Medicine, where he led the establishment of the Pre-hospital Emergency Research Unit. Malcolm is an examiner for the Diploma in Immediate Medical Care of the Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh, and for the University of Bath's Diploma/MSc in Sports and Exercise Medicine. He was previously the Deputy Chief Ambulance Officer of the South and East Wales Ambulance Trust. In 1998 Malcolm won a National Assembly for Wales research scholarship, completing a Masters degree in Public Health. Malcolm also has a Masters degree in Business Administration, a Post-Graduate Certificate in Education, and a Diploma in Immediate Care from the Royal College of Surgeons of Edinburgh. He is a Fellow of the Ambulance Service Institute and a member of the Institute of Learning and Teaching in Higher Education. Malcolm's research background includes projects investigating continuous ECG telemetry; telephone pre-arrival instructions for cardiac arrest; a comparison of simplified and standard CPR training; intravenous analgesia in the pre-hospital setting; changes in skill acquisition using a voice assisted CPR training manikin; stress and post-traumatic stress disorder in emergency ambulance staff; identification of emergency ambulance calls suitable for referral to appropriate alternative agencies; and evaluation of the Department of Health (England) public access defibrillation training programme.

Malcolm is currently reading for a PhD and a Masters in Education.

Bsc (Hons) Economics, Sociology, Statistics; PhD in Health Services Research

Helen Snooks is Chair of AWARD and Senior Lecturer in Health and Social Care Research. Her research interests and expertise lie in the fields of Emergency Pre-hospital and Immediate Care, Clinical Audit and Effectiveness, and research support. This encompasses work to evaluate new models of service delivery and often focuses on changing roles and boundaries between service providers. Her work is strongly patient-focused and collaborative, and uses mixed methods to achieve study aims. Helen's research support work has taken her to new areas and she has recently been involved in diverse studies concerning nursing retention, telemedicine and community action research.

Helen has PhD in 'Post Traumatic Stress Disorder in seriously injured accident victims' and has co-authored numerous publications on the subject of Ambulance Dispatch, use of Ambulance Services and Ambulance Service Delivery.

Contact Details:

CHIRAL, Clinical School, Swansea University Singleton Park, Swansea, SA2 8PP

Tel: +1792 513418 Fax: +1792 513430 E-mail: h.a.snooks@swan.ac.uk

For further information, please contact:

Helen Snooks Professor of Health Services Research Centre for Health Information, Research and Evaluation (CHIRAL) School of Medicine Swansea University Swansea, Wales UK SA2 8PP

For further information, please contact:

Helen Snooks Professor of Health Services Research Centre for Health Information, Research and Evaluation (CHIRAL) School of Medicine Swansea University Swansea, Wales UK SA2 8PP

For further information, please contact:

Helen Snooks Professor of Health Services Research Centre for Health Information, Research and Evaluation (CHIRAL) School of Medicine Swansea University Swansea, Wales UK SA2 8PP

For further information, please contact:

Helen Snooks Professor of Health Services Research Centre for Health Information, Research and Evaluation (CHIRAL) School of Medicine Swansea University Swansea, Wales UK SA2 8PP

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