Recent research studies

The EEAST feasibility study, KARMA2, evaluated the use of blood ketone meters by ambulance clinicians to determine whether could reliably and safely identify diabetic ketoacidosis and start fluid therapy, and determine whether a full-scale clinical trial is warranted.

The findings have now been published in Diabetic Medicine: KARMA2

The key aims of the CESSATION study were to identify current menopause guidance, policies and support offered by UK ambulance services; understand work and personal impacts of the menopause on female ambulance staff and their managers; and identify service developments that may best support female ambulance staff during this life phase.

Two CESSATION papers have now been published: CESSATION - Interviews, CESSATION - National Survey.

The STRETCHED research study (STRategies to manage Emergency ambulance Telephone Callers with sustained High needs) evaluated the care given to people who make high use of emergency ambulance services.

The findings of STRETCHED have now been published: STRETCHED

The aims of the TRIM study were to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used during the first wave of the COVID-19 pandemic in the UK.

The first findings of this study can be found: TRIM

The main aims of the Factors impacting vitamin D in ambulance staff study (EVOLVED) were to explore the behaviours and lifestyle factors of ambulance staff in relation to their vitamin D levels (following the service screening evaluation, VITALS). 40 EEAST staff took part in a research interview, with their service roles including control room (n=9), operational delivery (n=20) and service support (n=11).

Five themes were identified: Reaction to VITALS result; diet; deficiency symptoms and impacts; impact of work on maintaining adequate vitamin D levels; and personal activity levels. A lack of awareness of vitamin D-related issues was identified. Various improvement suggestions were shared, which included raising staff awareness of the importance of vitamin D, to allow staff to take responsibility to promote their own health and wellbeing. Strategies to promote awareness of vitamin D should be considered to improve staff wellbeing in this area. EVOLVED participants positively perceived this research exploring staff health and wellbeing, highlighting this as an area for future research.

Further information about EVOLVED can be found via https://emj.bmj.com/content/41/Suppl_3/A10.1

A hip fracture is an exceedingly painful injury and pain relief given by a paramedic usually includes morphine. This may not always work very well and can lead to side effects, such as confusion. In the RAPID2 study, paramedics may give a local anaesthetic injection (known as fascia iliaca compartment block or FICB) to patients with an injured hip before they are transported to hospital. Giving this injection may provide better pain control and better long-term outcomes than the alternatives currently in use.

The aim of RAPID2 is to test the safety, and effectiveness of paramedics providing FICB pain relief to patients with suspected hip fracture prior to hospitalisation.

The RAPID2 study has now closed in EEAST but more information can be found on the study website: https://rapid2trial.wordpress.com

The PARAMEDIC-3 trial, sponsored by the University of Warwick, investigated whether, in adult patients experiencing out-of-hospital cardiac arrest (when their heart stops), an intraosseous (into the bone) access-first strategy is clinically and cost-effective compared with an intravenous (through the vein) access–first strategy.

A total of 6,082 participants were recruited to the trial from across 11 Ambulance Trusts in the UK. EEAST trial trained clinicians recruited 186 patients, with seven surviving patients followed up.

What the trial found:

• People given drugs through the bone (IO) did not survive more often at 30 days than those given drugs through a vein (IV).
• There was no difference in brain function among survivors when leaving the hospital.
• Fewer people in the IO group got their heartbeat back compared with the IV group, which suggests the drugs may have worked less well through bone access.

Why this might be the case:

• Sometimes the IO needle might not be placed properly, so drugs don’t get into the bloodstream as well.
• Even when placed correctly, drugs given through the bone may not reach peak levels in the blood as quickly as when given through a vein.
• Certain drugs may simply be less effective when given through bone than through a vein.

For adults who have a cardiac arrest outside of hospital, IV access remains the best first choice when possible. IO access is still useful especially if a vein can’t be found quickly but it may not be quite as effective.