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Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: Qualitative data from the Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT)

journal contribution
posted on 23.04.2018, 15:08 authored by Sandeep Ankolekar, Ruth Parry, Nikola Sprigg, A. Niroshan Siriwardena, Philip M. Bath
Study objective Optimal practices for recruiting, consenting, and randomizing patients, and delivering treatment in out-of-hospital ultra-acute stroke trials, remain unclear. We aim to identify key barriers and facilitators relevant to the design and conduct of ambulance-based stroke trials and to formulate preliminary recommendations for the design of future trials. Methods Using semistructured interviews, we investigated the experiences and challenges faced by paramedics who took part in a randomized controlled trial in suspected ultra-acute stroke, the Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT), in which recruitment, consent, randomization, assessment, and treatment were delivered by paramedics before hospitalization. Results We purposively selected a diversity sample of 14 of the 78 paramedics who participated in RIGHT. We identified 13 themes (7 facilitators and 6 barriers to out-of-hospital stroke research). A simple stroke diagnostic tool, use of proxy consent on behalf of patients, and straightforward trial processes were identified as the main facilitators. Recruitment became easier with each new randomization attempt. Key barriers reported were informed consent in the emergency setting, lack of institutional support for research, learning curve and rarity (each paramedic treats only a few eligible patients), and difficulty in attending training sessions. Interviewed paramedics were motivated to participate in research. Conclusion Ultra-acute stroke research in the out-of-hospital environment is feasible, but important barriers need to be addressed. Proxy consent by paramedics addresses some of the difficulties with the consent process in the out-of-hospital setting.

Funding

RIGHT was jointly funded by the Nottingham University Hospitals National Health Service Trust R&D Pump Priming competition and by the Stroke Trials Unit, University of Nottingham. Dr. Ankolekar was funded by the UK Medical Research Council (grant G0501797).

History

School

  • Social Sciences

Department

  • Communication, Media, Social and Policy Studies

Published in

Annals of Emergency Medicine

Volume

64

Issue

6

Pages

640 - 648

Citation

ANKOLEKAR, S. ... et al, 2014. Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: Qualitative data from the Rapid Intervention With Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT). Annals of Emergency Medicine, 64 (6), pp.640-648.

Publisher

Elsevier © American College of Emergency Physicians

Version

VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

Publication date

2014

Notes

This paper is closed access.

ISSN

0196-0644

Language

en