Research and Development Annual Report 2024-25

The East of England Ambulance Service NHS Trust (EEAST) is committed to improving the care and experience of our patients and staff through the undertaking of high-quality sponsored and hosted research and evaluations. We believe that all our patients and staff should be given the opportunity to participate in research and contribute to the evidence base that informs and improves emergency medical health and social care.

Research is considered core business for the NHS, bringing benefits to patients, clinicians, and the NHS Organisation (see why do we do research below). The NHS Long Term Plan launched in January 20191 highlights the need for “Research and innovation to drive future outcomes improvement” and states that “Patients benefit enormously from research and innovation, with breakthroughs enabling prevention of ill-health, earlier diagnosis, more effective treatments, better outcomes and faster recovery.” The Care Quality Commission has incorporated clinical research enquiries into its Well-Led Framework2.

Supporting the development and delivery of paramedic-led research, NHS England now provides a research and innovation strategy for allied health professionals, AHPs; Allied Health Professions’ Research and Innovation Strategy for England | NHS England | Workforce, training and education, whilst the National Institute for Health and Care Research (NIHR) offers funding support for AHP career development Extra career funding for health and care professionals | NIHR.

To develop, support, and promote research across EEAST, the Trust’s Research Support Service (RSS) has developed strong links and works in partnership with a broad range of academic institutions, other ambulance services throughout the United Kingdom, NHS and other health and social care partners, as well as the National Ambulance Research Steering Group (NARSG).

As in previous reporting periods, RSS has continued to work hard to develop and attract high-quality research to ensure that EEAST patients and staff have every feasible opportunity to participate safely in relevant pre-hospital ambulance research.

This report presents an overview of clinical research activity and achievements within EEAST during the timeframe April 2024 to March 2025. Such continued participation in high quality clinical research activity has demonstrated EEAST’s on-going commitment to improving the care it offers, in addition to contributing to wider health improvement. Research findings are increasingly used to inform clinical and other service developments, where such high-quality evidence is available.

Why do we do research?

Benefits of research

For our patients:

• Improved health outcomes for all not just those participating in research
• Most patients want to take part in clinical research for new knowledge
• Taking part in clinical trials results in improved clinical care

For the NHS:

• Research findings result in better treatment for patients
• Improves use of scarce NHS resources
• Enables fair use of resources and reduces inequalities

For healthcare clinicians:

• Involvement in research increases clinical skills
• Helps clinicians to understand evidence and use this in clinical practice
• Improves job satisfaction
• Encourages team working

For healthcare organisations:

• Involvement in research helps attract more forward-looking staff
• Increases the number of clinicians with expertise in research
• Drives the development of research relevant to the population served

A copy of the current approved Research and Development (R&D) Policy can be obtained from the Trust website. The aim of this policy is to advise the conduct of research activity within EEAST to ensure compliance with good research practice as detailed in the UK Policy Framework for Health and Social Care Research3. The Policy is reviewed and updated every two years.

The principle aim of the Research and Innovation Enabling Strategy 2020-2024 was to provide a credible and ambitious direction to the EEAST research function. A copy is available within the Clinical Directorate/RSS folder, Research Support Services. It should be noted that a new Strategy will be considered and developed following the 2025 Trust reorganisation.
EEAST research and development management arrangements, organisational study capabilities, and research and development interests are available via the Research and Development Operational Capability Statement (RDOCS). This document signposts interested parties to the best person to contact within EEAST for differing research enquiries, for example capacity and capability assessments, research passports, contracts, etc. It is reviewed and updated every two years.

Research Delivery Networks (RDNs) are responsible for allocating NIHR monies to support delivery of NIHR Portfolio-adopted research activity. EEAST maintained Partner Organisation status with RDN-East of England and regularly attended associated meetings throughout the reporting period. In addition, RDN-North London continued their financial support which has enabled the delivery of research in their area of the Trust region.

NARSG continued to meet bi-monthly and EEAST remained actively involved and represented NARSG at National Trauma & Emergency Care Research meetings. The group continues to share good practice in research, as well as encouraging collaboration with external partners including academia, commercial organisations and other health and social care providers to inform research funding bids. NARSG is accountable to, and a sub-group of, the Association of Ambulance Chief Executives (AACE).

RSS team members also attended a variety of academic and research network groups, from which was sought guidance, support and linkages to researchers and other resources. Examples of such activity included RDN-East of England Stroke Specialty group, regional Research Managers meetings, College of Paramedics events, and Council for Allied Health Professions Research East Anglia group.

In September 2024, EEAST RSS successfully co-hosted the 999 EMS Research Forum Conference in Cambridge, in collaboration with NARSG and PRIME Centre Wales. Speakers of note included Professors Helen Snooks, Julia Williams and Rachael Fothergill, Associate Professor Alan Batt, and Dr Adrian Boyle.

Health Research Authority (HRA) Approval provides a single governance approval for all NHS research, consisting of assessments by HRA staff alongside the independent Research Ethics Committee (REC) opinion where required. NHS Trusts assess their capacity and capability to deliver HRA Approved studies, before giving permission to start if feasible. Up to date HRA guidance is available via www.hra.nhs.uk.

RSS team members have been trained to undertake the capacity and capability assessments, ensuring all arrangements are in place to successfully deliver a study via:

• Review of costings / research contracts / agreements (as necessary)
• Liaison with required support department(s)
• Advice regarding issuing of Research Passports or Letters of Access
• Provision of guidance on HRA requirements and applications
• Review of impact of amendments to existing studies

A summary of research projects with delivery activity in the reporting period is presented in Table 1 (see overleaf). Further details can be obtained from the Trust intranet within the Clinical Quality/RSS folder or from RSS directly.

The Trust has continued to collaborate with a broad range of stakeholders and organisations in the development and delivery of research activities. This reporting period has again been busy, notably with more MSc student and PhD projects alongside the ongoing large-scale studies. Eleven studies which commenced in previous reporting periods remained active during 2024-2025.

RSS received a total of eight new research study proposals requiring capacity and capability assessments during 2024-2025, all of which were given approval to proceed, and two await final documentation prior to study start. Three of the eight new studies were NIHR RDN Portfolio projects, there were three MSc student projects, three PhD studies, and one homegrown Trust-sponsored study (MAPA Pilot).

In addition to these studies, EEAST RSS was successful in obtaining funding (College of Paramedics Small Grant Award) for a national study regarding clinical advice delivery (CLEAR), and an initial proposal was submitted for NIHR funding for a national ambulance service decarbonisation study (DAISY).

RSS continued to notice researchers approaching the Trust without HRA approvals in place, particularly for student-level research projects. NARSG discussion has revealed this to be a national issue affecting capacity to deliver student studies and guidance has been created to navigate this problem. Student research - Health Research Authority.

During 2024-2025, EEAST recruited 295 participants (patients and Trust staff) as a site into 7 NIHR RDN Portfolio-adopted research studies. (What does Portfolio adoption mean? See RDN Portfolio | NIHR. Where EEAST acts as a Participant Identification Centre (PIC) or hosts smaller-scale student level projects being undertaken by Trust staff and external parties, the recruitment to such activity is not routinely captured.

Individual study recruitment was:

• MAPA Pilot n=167
• AMBOFALL n=43
• RADIOS n=36
• PARAMEDIC3 n=25
• CRASH4 n=16
• RAPID2 n=4
• CATNAPS n=4

Table 1: Research projects which had delivery activity in reporting period 2024 to 2025.

Research impact is the effect, change, contribution and benefit of research to patients, the public, society, or the economy. For the NIHR, research impact is therefore how knowledge generated from research benefits peoples' health and wellbeing, how health and care services are delivered, and how these can bring about benefits to our society and economy.

Examples of types of research impact include:

a) an increase or decrease in something (e.g. speed of intervention uptake) b) the cost of a treatment decreasing c) an increase in the number of follow-up visits d) starting or stopping something (such as the development of a new service) e) stopping a treatment option or policy f) changing a way of working g) changing the way people think or behave h) making no change due to equipoise of treatment/service.

RSS continued to share the findings from high-quality research at Clinical Best Practice Group (CBPG) meetings, to inform recommendations for decisions about future direction of clinical practice.

At the time of writing, impacts of current recruiting studies have yet to established. However, the findings of EEAST’s study, CESSATION, remain to be of national interest, facilitating consistent support for menopausal women in the workplace.

The findings of the KARMA2 study (evaluation of use of ketone meters for diabetic ketoacidosis management and clinical decision making) continue to facilitate the introduction of ketone meters, both in EEAST and nationally.

Financial support for the RSS function was obtained from contracted income related to delivery of some of the research studies during the reporting period. Over and above such income, the Trust received Research Capability Funding (RCF) and monies from the RDNs amounting to approximately £182k, a slight increased level of support from previous years.

RDN funds enabled the full-time Advanced Research Paramedic role, one full-time Research Paramedic, and the Head of Research role within RSS, to facilitate delivery and development of NIHR RDN Portfolio research activities. Contracted income supported a further 2.6 WTE Research Paramedics on secondments for NIHR RDN Portfolio study delivery. Monies were also used to strengthen research delivery, build workforce capability and promote inclusive participation via the Cross Organisational Research Collaboration (CORC) and Research Internship Schemes.

During 2024-2025, the substantive RSS function remained at 3.0 Whole Time Equivalent (WTE) staff, supported during the year by seconded Research Paramedic roles on fixed-term contracts for delivery of the PARAMEDIC3, RAPID2, MAPA Pilot and CRASH4 studies.

Research awareness and knowledge-raising activity throughout the Trust involved dissemination of research findings on the Trust website, discussion at CBPG, Medicine Management and Clinical Directorate meetings, as well as regular articles in Trust publications.

Wider dissemination of the findings from research activities has been achieved through oral and poster presentations at external peer-reviewed meetings and conferences (in particular, the 999 EMS Research Forum), as well as publications in peer-reviewed journals, copies of which can be obtained from RSS.

Trust staff undertaking graduate or post-graduate studies with a research element, whether financially supported by the Trust or not, continued to be encouraged to contact RSS for mentoring and support alongside their Higher Education Institution supervision. Research capacity and capability activities undertaken by Trust staff have included a NIHR RDN Research Internship, the HEE Pre-Masters Internship Programme and Masters in Health and Clinical Research Delivery.

It is expected that all EEAST student paramedics will have undertaken an ‘Introduction to Research’ module during their university training. Similarly, all clinicians participating in research studies are expected to successfully complete appropriate Good Clinical Practice training. The NIHR-accredited learning module ‘Fundamentals of Clinical Research in the Ambulance Setting) remains available for staff to complete via NIHR Learn, access via Identity Gateway.

The national Participant in Research Experience Survey (PRES) is standard requirement for Patient and Public Involvement and Engagement within the NIHR RDN Performance and Operating Framework (POF). It is promoted to capture feedback for NHS Trusts regarding their research delivery.

The challenges for ambulance services to meaningfully participate in PRES have been recognised during 2024/2025 (EEAST responses for 2024-2025 = 6), such that PRES for ambulance research participants has been paused for all national ambulance services as of April 2025.

Further information about PRES and its recent findings can be found via Participant in research experience survey | NIHR.

The Research Involvement Group (RIG) is now recognised as one of EEAST’s Volunteer groups and continues to be a useful forum for EEAST RSS to engage with patient, public and staff members.

With limited members, RIG met online once during this reporting period, however, in early 2025, RIG joined the Trust Volunteer platform, Assemble, with the main aim to facilitate volunteer engagement and communication.

Individual RIG members have volunteered to take a special interest in the studies being delivered across EEAST to give local patient and public involvement (PPI) perspectives and provided specialist PPI input for EEAST RSS-developed research studies.

EEAST subscribes to the Library and Knowledge Service for NHS Ambulance Services in England (LKS ASE). The service provides all employed EEAST staff with free access to library services, including document supplies, literature searching, current awareness updates (collections of latest published research), and guides and help on various aspects of information skills.

During 2024-2025, a continued increase in LKS ASE usage by EEAST staff was noted. The LKS ASE can be contacted via ambulance.libguides.com/home1/home or directly via emailing Matt.Holland@nwas.nhs.uk.

The RSS newsletter has continued to be produced at least twice a year. Current and future studies are showcased, and relevant findings shared. The RSS newsletter has been cascaded using EAST24 and Safety Matters Newsletter, as well as hard copy via internal post.

Copies can also be obtained by contacting the RSS team.

EEAST staff continue to generate peer-reviewed literature. Known publications include:

Couper, K et al (2024) A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest, https://www.nejm.org/doi/10.1056/NEJMoa2407780

Duncan, E (2024) Challenges and strategies in paramedic training for the RAPID2 trial of FICB for hip fractures. https://doi.org/10.1136/emermed-2024-999.20

Duncan, E et al (2024) Exploration of behaviours and lifestyle factors impacting levels of vitamin D within a UK ambulance service workforce (EVOLVED). https://doi.org/10.1136/emermed-2024-999.21

Prothero, L et al (2024) Ambulance clinician use of capillary blood ketone meters to improve emergency hyperglycaemia care: a stepped-wedged controlled, mixed-methods feasibility study. https://doi.org/10.1111/dme.15372

Prothero, L et al (2024) Use of a lateral flow assay (LVOne) test for ambulance large vessel occlusion stroke recognition and management: feasibility study protocol (RADIOS). https://doi.org/10.1136/emermed-2024-999.31

Prothero, L et al (2025) Survey-based exploration of menopause transition experiences of female staff employed in UK ambulance services (CESSATION Phase 2). https://doi.org/10.29045/14784726.2025.3.9.4.7

Strudwick, T (2024) Wristwatches in bare-below-the-elbows out-of-hospital policies: time for a review. https://doi.org/10.12968/jpar.2024.16.6.235

Wells, B et al (2024) Challenges in prehospital diagnosis of acute stroke in women: a case-based reflection. https://doi.org/10.1161/STROKEAHA.124.046112

EEAST RSS staff have disseminated study findings and provided study progress reports at the following events during this reporting session:

Prothero, L (2024) College of Paramedics Research Conference: An in-depth qualitative interview study of female ambulance staff experiences of the menopause transition (CESSATION phase 3).

Prothero, L (2024) Emergency and Urgent Care Research Cambridge: Ambulance clinician use of capillary blood ketone meters to improve emergency hyperglycaemia care.

Brown, C. (2025) Community for Allied Health Professions Research: Measuring Air Pollution from Ambulances.

No concerns or incidences have been raised during 2024-2025.

In line with the Best Research for Best Health Strategy (2022)4, the primary focus of RSS will be supporting and seeking funds to generate health-related research, leading to improved outcomes for people (patients and staff). Additionally, the Trust will explore means to support more internal research projects, for instance through collaborations with regional and national universities. Any commercial activity will be mindful of the recently published Lord O’Shaughnessy review (2023)5.

The Research & Innovation Enabling Strategy 2020-2024 provided a framework for the advancement of research within the Trust. Given the 2025 Trust reorganisation that commenced during this reporting period, the Strategy will be reviewed once the reorganisation has been completed.

At a local, regional, and national level, the Trust will continue to attract high quality studies and drive the development of research grant applications in under-developed areas of pre-hospital ambulance research and areas of importance to Trust patients and staff. Guidance and support will be sought from NARSG membership. Identified areas of future research include end-of-life care, frailty, dementia, children and young people, mental health, nutrition and impact of ambulances on air quality.

RSS will continue to communicate opportunities for research skills development throughout the Trust, particularly at senior management level, to increase research knowledge.

1. Department of Health and Social Care (2019) The NHS Long-term Plan https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/

2. Care Quality Commission (2018) Key lines of enquiry, prompts and ratings characteristics for healthcare services https://www.cqc.org.uk/guidance-providers/healthcare/key-lines-enquiry-healthcare-services

3. Health Research Authority (Nov 2017) UK Policy Framework for Health and Social Care Research. https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/

4. Department of Health and Social Care (2022) Best research for best health. A new national health research strategy. Best research for best health: a new national health research strategy - GOV.UK

5. Department of Health and Social Care (2023) Commercial clinical trials in the UK: the Lord O’Shaughnessy review. Commercial clinical trials in the UK: the Lord O’Shaughnessy review - final report - GOV.UK