Each year in Northern Ireland, there are approximately 1,400 out-of-hospital cardiac arrests (OHCA). With an increasing incidence of up to one third of OHCA, pulseless electrical activity (PEA) continues to present a challenge for paramedics, due to inadequate diagnostic capabilities, coupled with a lack of clinical guidelines to inform decision-making. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provide the only nationally accepted guideline for decision-making in PEA, which acknowledges the lack of supporting literature regarding termination of resuscitation for PEA in OHCA. Rapid transport to hospital and contacting senior clinical advice are key factors in JRCALC’s guidance, which is adopted by Northern Ireland Ambulance Service (NIAS) due to lack of a locally agreed decision tool. Subsequently, issues arise from failure to consider circumstances in which there is a lack of senior support, and transport is infeasible, which mirrors challenges faced by paramedics in Northern Ireland (NI). There is conflicting literature on the relationship between intra-arrest transport and survival rates, with one study concluding statistically significant higher survival rates with rapid intra-arrest transport, whilst another reports opposing statistically significant results of continued on scene resuscitation. Protracted transport times in NI, due to geographical and logistical constraints, in conjunction with the conflicting literature and absence of local PEA guidance, reinforces the difficultly faced by paramedics in deciding to terminate resuscitation. In NIAS, access to critical care clinical support is only available during the hours of 7am – 12am, depending on the availability of critical care paramedics, therefore, paramedics must rely on clinical judgement and shared decision-making to inform their rationale for termination of resuscitation of PEA. Despite the notable complexity of decision making in PEA, only one study exists exploring senior paramedic decision making when terminating PEA in OHCA in the United Kingdom. To date, no literature exists in relation to paramedic decision-making for PEA in NI, indicating the need for a study to understand how paramedics decide to terminate resuscitation in these circumstances. The proposed research question intends to develop evidence in this area for paramedics in NI. Paramedics working for the Northern Ireland Ambulance Service will be contacted to voluntarily complete a survey consisting of quantitative and qualitative questions relating to decision-making for termination of resuscitation of pulseless electrical activity in adult out-of-hospital cardiac arrest. Quantitative data will be analysed using descriptive statistics to provide a summary of the participants, without making statistical inferences. Qualitative data will be analysed using reflexive thematic analysis and displayed in themes. The study will be written up and submitted to the University of Hertfordshire as part of a Master's degree in Advanced Paramedic Practice.
Scoping review of literature to determine if there is any evidence supporting the PICO question directly and indirectly. Research evidence supporting the intervention of POCUS at a timeline within a patient care episode that would predict or rule in/rule out the need for CT head before clinical signs and symptoms of raised ICP due to mild to moderate TBI manifest.
Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive the barriers and facilitators to the use of appropriate care pathways (ACPs) in NI are.
This study explores how family members experience and perceive bereavement care provided by the ambulance service when a loved one dies in the pre-hospital setting. Bereavement care refers to the support provided to families after the death of a loved one. The study aims to understand what families need during this time and how ambulance services can improve their support. We will invite people who, in the past two years, have lost a family member while receiving care from the ambulance service. This includes cases where the patient died at the scene or shortly after being transported to the hospital. The two-year time frame ensures that experiences reflect current practices, without focusing on care during the COVID-19 pandemic. Participants will be interviewed either in person at a local ambulance service site or online via Microsoft Teams. The interviews will explore family members' experiences and what they felt was helpful or could have been done differently. Each interview will last between 30 and 60 minutes, and all responses will be anonymised to protect participants’ privacy. The results will be analysed to identify themes about what families value and need during this difficult time. This will help the ambulance service improve how it supports grieving families. We will recruit participants through posters in healthcare settings, social media, and partnerships with bereavement charities. Participation is voluntary, and people can withdraw at any point up to 24 hours after the interview. The study aims to highlight family members’ voices to ensure bereavement care is compassionate and meets their needs. Findings will be shared with the ambulance service and published to improve care standards.
The method for training paramedics has changed over the last 20-30 years as the paramedic profession has evolved itself and this has resulted in a situation where there are paramedics operating within this field of clinical practice with varying levels of education. This may not represent a major challenge, however, many of those who were trained under the older style programmes have a desire to top-up for reasons of personal development and career progression. The number of registered paramedics with non-degree level education across the UK is unknown and there is a paucity of research in this area. Additionally, their educational needs and aspirations have not formally been identified. This could prove useful to higher education institutions seeking to develop such programmes, the regulator in terms of the overall education status of the paramedic profession as a whole and employers in relation to the continuous professional development of their workforce.
This study will explore how real-time feedback affects ambulance clinicians’ ability to perform ventilations during a simulated cardiac arrest scenario over six months. Ventilations, typically given via a bag-valve-mask (BVM), are a basic life support skill performed by paramedics in emergency situations, but evidence suggests that many clinicians struggle to deliver ventilations according to guidelines. Feedback during training can help improve these skills, but without regular updates or refresher training, the skills may deteriorate over time. The study will involve participants from a single ambulance service, randomly assigned to three groups. All of these groups will participate in a simulation using a resuscitation manikin. The first group will receive feedback on their ventilations at every session, the second will receive feedback only at the first session, and the third will receive no feedback and act as a control. Ventilation rates and volumes will be measured using a Zoll X-series monitor, which provides real-time feedback. The main aim of the study is to compare the quality of ventilations at the six-month mark between the three groups. A secondary focus will be tracking any changes in ventilation quality across the six months, to identify potential skill improvements or fade.
Whilst research on MECC implementation and evaluation is fairly established in other areas of healthcare, there is limited existing evidence specific to the ambulance service setting, despite paramedics being in a unique position where they engage with a wide range of the population, some of whom may not routinely be seen by other healthcare professionals. Without clear evidence on how MECC has been implemented and how staff utilise this framework on a day-to-day basis, it is hard to evaluate or further improve its use. The study will be conducted in at least three UK NHS Ambulance Trusts, focus groups will seek to explore the content of MECC conversations discussed by participants, as well as the perceived barriers and facilitators of paramedics having MECC conversations.
This project is in partial fulfilment of a PhD that is exploring the relationship and impact of ethnic diversity and diversity training on cultural competence in frontline ambulance service staff. The first study in this PhD was a review of WRES data from all ten ambulance services in England, in order to gain an understanding of workforce equality. The second study was a scoping review of factors impacting cultural competence in healthcare personnel. This was conducted as the third study (this project) aims to survey frontline ambulance service staff diversity demographics, life experiences, training and cultural competence. However, to understand the relationship between these factors and cultural competence, the other factors impacting cultural competence need to be known and accounted for. The fourth and final study in this PhD (also part of this project), aims to explore frontline service staffs’ acquisition of cultural competence, and their experiences and perspectives of cultural competence, its associated diversity training and importance on professional practice.
Background and rationales: Recognising that someone has deteriorating health can be a trigger for a change in their care plan, and potentially for advance care planning and introducing palliative care. While there are tools that can provide an objective measure of someone’s health status (for example scales designed to measure functional status), changes in a patient’s general appearance may be the first sign that their health is deteriorating. For example, people with white skin may look ‘grey’ or ‘sallow’ as their illness advances. For people with advanced and life-limiting illness, these subtle cues can be a trigger for health care professionals to discuss goals of care, the risks and benefits of further treatment, or to refer to specialist palliative care teams. We know that people from minoritised ethnic groups are less likely to access specialist palliative care and more likely to have frequent Emergency Department visits towards the end of life, though the reasons for this are not clear. We also know that identification of a diverse range of skin signs (such as rashes, pressure damage) can be challenging among people of colour. If health professionals are less able to identify deteriorating health among people of colour, this could lead to higher rates of Emergency Department attendance near the end of life, or delay in referral to palliative care. Whether and how skin colour influences how health professionals make judgements about people’s health in advancing illness is unclear, but is a potential source of racial bias. Research Questions: 1/ What are the skin changes that are used by health and care professionals as an indication that someone with advanced illnesses is deteriorating? 2/ How confident and competent are health and care professionals in identifying these skin changes in people of colour? Method: Two workstreams will occur in parallel. WS1: A rapid review will be undertaken to identify published evidence on (i) changes in skin and appearance that may indicate that someone with advanced illness is deteriorating, (ii) whether these changes are as readily identifiable among people of colour, and (iii) health and care professionals’ confidence in identifying these changes. Using guidance on literature searching for rapid reviews from the Cochrane Rapid Reviews Methods Group, we will perform focused searches on MEDLINE and Embase databases via OVID and utilise citation searching of known relevant references to supplement. Based on scoping searches, we anticipate that the rapid review will identify relatively little evidence. Therefore, in WS2 we will draw on health and care professionals’ experiential knowledge. WS2 Expert consultations will be held with health and care professionals to explore their experience in using skin and appearance changes to identify deterioration in health for people with advanced illnesses. At least two expert consultations will be held online, each lasting 90-120 minutes, and each including 6-10 health and care professionals who regularly care for people with advanced illness. Professional groups will include GPs, geriatricians, community nurses, care home professionals and specialist palliative care professionals. One expert consultation will be for professionals who practice in the UK, selecting those who practice in areas with high levels of ethnic diversity. Another will be for professionals who practice outside the UK in countries where the majority of the population are people of colour. A facilitated conversation will explore professionals’ experience in identifying deteriorating health in people who have advanced illness, their confidence to identify these changes, and whether there are differences for people of colour. Findings from the rapid review will be used to guide questions. PPI: We will convene a group of patients and public members who represent diverse ethnicities to guide the research, meeting with them regularly to discuss the research questions and emerging findings. As part of WS2 we will invite PPI members to observe (with their cameras off) the expert consultations and feed back their reflections about the discussions to the research team, to guide interpretation. In the expert consultations, we will aim to explore: 1/ health and the professionals’ experience in identifying changes in skin that may indicate that someone with an advanced illness is deteriorating; 2/ whether these changes are as readily identifiable among people of colour; and 3/ health and care professionals’ confidence and competence in identifying these changes among people of all skin tones Eligibility of taking part in the online expert consultation includes all of the following (for UK-based professionals): 1/ Health and care professionals who regularly care for adults with advanced illnesses 2/ GPs, geriatricians, community nurses, care home professionals, paramedics, or specialist palliative care professionals 3/ practice in the UK and in areas with high levels of ethnic diversity The online expert consultation meeting will last 90 minutes and involve 6-10 health and care professionals who regularly care for adults with advanced illnesses. We are planning to hold the consultation for health and care professionals based in the UK on Thursday, 13 February 2025, 11.00-12.30 (GMT) on Microsoft Teams.
This study addresses the overuse of healthcare interventions in UK primary care, which can harm patients and strain healthcare systems. Overuse includes unnecessary tests, treatments, referrals, or diagnoses that are unlikely to benefit patients but could cause harm, such as side effects, psychological distress, or financial burdens. Healthcare professionals (HCPs) face challenges balancing necessary care with avoiding overuse, often due to factors like diagnostic uncertainty, fear of complaints, time pressures, patient expectations, and rigid clinical guidelines. This research explores HCPs’ experiences and perceptions of ‘not doing’, the intentional decision to avoid unnecessary interventions based on patients’ medical needs, values, and preferences. It also examines the under-researched area of documenting such decisions. Current professional guidelines offer limited direction in the documentation of ‘not doing’, and HCPs are often apprehensive about potential repercussions. This study, grounded in social constructivism, uses 40 semi-structured interviews with HCPs, including GPs, Paramedics and Nurses. Participants are recruited through purposive sampling. An interview guide, co-designed with PPI representatives and GP advisors, uses text-based vignettes to prompt discussion. Interviews conducted via video call are audio recorded, transcribed, and analysed using Reflexive Thematic Analysis (RTA) with NVivo software. This method highlights patterns and variations while ensuring reflexivity and rigour.
The demand for mental health support in England has risen sharply in recent years, exceeding the capacity of available services. Approximately 1.2 million people are currently on NHS community mental health waiting lists, placing increased strain on paramedics, who now spend an estimated 1.8 million hours annually responding to mental health-related calls. As frontline responders, paramedics play a critical role in providing urgent care to individuals experiencing mental health difficulties. However, existing research highlights that paramedics tend to feel frustration, uncertainty, and lack of confidence when managing patients with mental health presentations. Despite this, there is currently no standardised mental health education or training requirement for paramedics in England, and limited research has explored the specific knowledge gaps that hinder their ability to provide effective care. This study aims to identify and assess the knowledge gaps and educational needs of paramedics regarding mental health care. Findings will inform the development of targeted educational initiatives, equipping paramedics with the necessary skills to improve patient outcomes and bridge gaps in pre-hospital mental health care.
The EPiCC study aims to better understand the challenges and opportunities around equality, diversity, and inclusion (EDI) in prehospital critical care roles—jobs like those held by paramedics and doctors in air ambulance and ambulance services. While more women have entered emergency medical services in recent years, people from minority ethnic groups and other underrepresented backgrounds are still not well represented, especially in high-level critical care positions. This research will collect survey responses from clinicians currently in critical care roles, those aiming for these roles, and those who have tried but not succeeded. The study will explore their experiences—both positive and negative—to identify what helps and what hinders a diverse and inclusive workforce. The goal is to provide clear insights that ambulance services and other employers can use to create fairer and more supportive working environments. By improving diversity and inclusion in these high-stakes medical teams, we hope to support staff wellbeing, improve career access for underrepresented groups, and ultimately deliver better patient care.