Back in the ‘old days’ I was taught that if anyone looked poorly or had stroke symptoms or chest pain that I was to administer as much oxygen as I could to them! Research and published evidence has changed our practice by highlighting that too much oxygen can actually cause harm. Now, our guidance only indicates oxygen under certain circumstances for stroke to prevent reperfusion injuries.
In the Greater Manchester Area, the reconfiguration of stroke services has led to the establishment of three hyperacute stroke units, meaning paramedics can actually bypass their nearest emergency department to one that provides specific stroke care, namely thrombolysis or clot busting drugs. This service was built on robust data and further research indicates that such centres of expertise have reduced the length of stay and improved outcomes for patients who are treated for stroke. It would previously have been unheard of for an ambulance crew to bypass a nearer emergency department, but now it is common-place.
Research has demonstrated the benefit of early recognition, constructing a system of care enabling early administration of life-saving thrombolytic therapy (and access to rehabilitation), the door has opened to paramedics being more closely involved in stroke research. There are currently two large studies recruiting patients which rely on paramedics. PASTA (Paramedic Acute Stroke Assessment) is a multi-site, cluster randomised control trial that aims to demonstrate whether a specific assessment (the PASTA pathway) can improve the time to thrombolysis and improve outcomes. In addition, RIGHT2 (Rapid Intervention with GTN in Hypertensive stroke) is a clinical trial aiming to demonstrate whether the application of a GTN transdermal patch to patients exhibiting symptoms of hyperacute stroke improves outcomes. The RIGHT2 trial is blinded, so the paramedics do not know if they are applying a GTN patch or a placebo. Both studies highlight that paramedics and ambulance services can and should take part in complex trials.
As a Consultant Paramedic, I’m now responsible for ensuring that the service I work for is involved with clinical trials and research. As a newly emerging profession, paramedics are on a journey towards greater involvement in research through collaborations that will build increased capacity and individual capability to conduct projects. Only through research can we ensure the care we give is safe, effective and based on robust evidence, that is why #wedoresearch in NWAS!
You can follow Duncan on twitter @NWAmb_Duncan