Case study: Not all paramedics wear green - the role of the research paramedic
In Your Path in Research - a series that uncovers the research community across the National Institute of Health Research Clinical Research Network Kent, Surrey and Sussex region – we speak with Jack about the role of a research paramedic and what his plans are after completing his CDRF.
When did you become a paramedic and when did you start your research journey?
I qualified as a paramedic in 2014 and I was in post for three years when the research paramedic post became available in SECAmb. I applied for the role off the back of a few small pieces of work I had already undertaken that was published in the Journal of Paramedic Practice, and some work I had been doing with the University of Hertfordshire. My initial research experience began during my degree in sport science, where I had done some laboratory-based experiments in human physiology and biomechanics. That is where I gained the foundation of my research skills from and it snowballed from there.
What does a research paramedic do?
The research paramedic role differs as it very much depends on what's going on in the trust at the time. When I came into post the portfolio was quite small, we only had one randomised controlled trial running at the time. Now SECAmb has several clinical trials starting, about to start or in development. We are tasked with the delivery of portfolio studies and developing research projects and ideas to work up to grant applications and to then expand the department. We work with a range of partners including other ambulance trusts, acute trusts, charities and higher education institutes, for example, on studies exploring mental health and well-being, end-of-life and palliative care, and clinical drug trials.
Some days you're trying to engage with staff, either virtually or through social media. We visit different ambulance stations to run drop-in clinics to get staff more familiar with what research is and how they might be involved, or to see if they have an interest in being involved. Essentially there are three to four core elements to our role - research delivery, research design and research engagement and dissemination.
Tell us about your NIHR Clinical Doctoral Research Fellowship?
I started my NIHR Clinical Doctoral Research Fellowship on 1 April 2020, just as lockdown had begun. I am developing a clinical decision rule to help paramedics identify those older adults who are at risk of a traumatic brain injury and who would benefit from being transported directly to a hospital where there's neurosurgical services on site. The study is called Clinical Decision Rule for TBI in Older adults (CEREBRAL) - Derivation and narrow validation of a clinical decision rule for paramedics to triage older adults with a traumatic brain injury. The study has been included on the NIHR portfolio
I have conducted a literature review to see if there are any clinical predictors or variables that we can use as paramedics to help assess and triage older adults. I am now beginning my data collection to build a prediction model. I've now got all the approvals I need to start my data collection which will involve going to various hospitals throughout Sussex and Kent to identify patients who have had a traumatic brain injury or were suspected to have one, collecting their records and linking them back to their ambulance records.
The biggest challenge is getting hold of patient data; it can be a very arduous and slow process to get the permissions to use it and then have it released from the hospitals. The pandemic has confounded things because staff that might be involved in research are concentrating on their clinical roles. However, it has been good learning with regards to how to navigate different trusts and different teams. The CDRF will finish in March 2023 and I have until April 2022 to gather all the data I need. I will then build the model and validate it and hopefully publish it by the end of next year, along with writing up the thesis.
What do you want to do next after your NIHR Clinical Doctoral Research Fellowship?
I am keen to continue on the NIHR pathway and go down the postdoctoral clinical lectureship route. It is a great pathway for clinicians who want to develop a clinical academic career and there are clinicians within the paramedic profession who have the ability to pursue an NIHR pathway. It is an exciting time in the profession; we are seeing more paramedics get their PhD and becoming leaders in research, both in the ambulance service and other clinical settings (#NotAllParamedicsWearGreen). It would be great to see more investment from ambulance trusts to support paramedic research careers, as the evidence being generated through both collaborative and paramedic led research has a positive impact on our patients and the care we can provide.
What other pieces of research are you working on?
I am working with Air Ambulance, Kent, Surrey and Sussex on a clinical trial that's based out of King's College Hospital in London. We are assessing whether or not a portable head scanner can detect intracranial bleeding in head-injured patients. The device does not have a CE mark and we have worked with the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure permissions are in place to use it. (A CE mark shows that the manufacturer has checked that the product meets EU safety, health or environmental requirements). It’s been a great experience working with industry partners and a novel piece of technology. I’m excited to see whether it can improve the care we provide to head-injured patients in the prehospital setting.
What do you enjoy about a research career?
What I find most enjoyable about research is when analysing data, I am sitting with a piece of information that only I know about at that time and then I have the opportunity to disseminate it and share it with colleagues. It may not necessarily be particularly ground-breaking, but it could just be another piece of the jigsaw.
What challenges do you encounter in research?
It does take time gaining approvals to use patient data and then gathering the data. But that's not a bad thing, because we need proper governance in place. Sometimes you are seeking approvals from people who are not familiar with what your particular research entails, so you need to be able to communicate effectively.
What advice would you give to other paramedics considering going into research?
First, you have to find a subject matter that you are interested in and have a passion for. Once you have an idea, or something you are passionate about. It is always tempting to jump for the ‘big study’ first, start small to build your evidence base.
The next thing is to network, which has helped me be where I am. Because of the way the ambulance service works you don't necessarily have the same networking opportunities you might have in other clinical settings where everyone is working under the same roof for 12 hours a day and you can have those important informal conversations.
It is important to put yourself out there, which is quite difficult to do. Twitter is a good way of becoming involved in conversations and getting your opinion out there, or just asking for the opinions of experts. Contact people who have published papers on areas that you are interested in, as there is no harm in reaching out to them and you are more likely to then be introduced to other people who either are at a similar level to you or want to support your development. I would also strongly recommend paramedics who have an interest in research to reach out to our professional body, the College of Paramedics.