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Case study: SECAmb’s CEREBRAL study

The NIHR funded CEREBRAL study, which investigates the way brain injury in older patients is triaged by paramedics, has finished recruiting. CRN Kent, Surrey and Sussex talks with Chief Investigator Jack Barrett about his experience as a Research Paramedic.

When CRN KSS published its annual recruitment figures for the 2021-22 financial year, one remarkable statistic that emerged was that nearly half the volunteers recruited to Trauma & Emergency Care studies across the region were recruited by a single trust - the South East Coast Ambulance Service NHS Foundation Trust (SECAmb).

This is particularly remarkable when you consider the nature of Trauma & Emergency Care. Recruiting patients to studies in this area is notoriously difficult. By definition, patients in this area need to be treated fast, and under incredibly stressful circumstances for both the patient and the clinician.

When we look deeper into the figures, there was one study that accounted for the majority of patients recruited by SECAmb – the Clinical Decision Rule for Traumatic Brain Injury in Older Adults (CEREBRAL) study.

The CEREBRAL study has been designed by Research Paramedic Jack Barratt to investigate how serious head injuries sustained by older patients might be triaged differently to those sustained by young adult patients.

“When we get older you don’t necessarily need to hit your head in order to sustain a brain injury,” Jack explains. “Because your brain shrinks with age, it is possible to damage it by sudden movements - like falling. Our study is looking into how such potential brain injuries might be assessed in the prehospital setting.

Jack says that, in his view, SECAmb was so successful at recruiting in this particularly vulnerable and high-risk patient group, because of the support from Acute Trusts within the Trauma networks of Sussex and Kent:
“To develop the decision rule, we needed data from paramedics collected on scene but also data about what happened to the patient once they were transported to hospital,” he says. “Tracking and tracing patients through the system is challenging, and requires expertise from clinicians, research teams and information data managers. Without this collaboration the study would not have been a success.”


Opportunities for Research Paramedics

While more paramedics are leading in studies like CEREBRAL, there is still a great deal of work that can be done to improve evidence-based practice in unscheduled emergency and urgent care.

Paramedicine is a surprisingly young profession - dating back to 1971 and only becoming a protected role in 2001. Since 2001, paramedicine has been a degree-based profession. And since then, the appetite for research and the use of evidence-based practice has been growing.

“We have seen a significant expansion in the scope of practice of a paramedic in the ambulance service, as well as the development of advanced paramedic roles in both urgent and critical care,” says Jack. “Through collaborative research the treatments and care patients receive have improved. But we can be doing a lot more to find out whether there are better ways to care for our patients.

“Paramedic clinicians are constantly questioning whether a certain intervention is right for the patient in front of them, which makes them natural researchers,” he explains. “So when a new trial or study is presented to them, there is an appetite to get involved and contribute to the evidence base, because it means the next patient could benefit. Even if that new intervention doesn't work, it gives us increased confidence in the established pathways.”

Jack is currently analysing the massive amount of data that has been collected for CEREBRAL, hoping to identify the clinical variables that might predict whether or not an older adult might have a significant head injury.

Working on excel databases is a far cry from where he started as a field-based paramedic, but he is not alone. There is a growing community of research paramedics with whom he can share experiences.

“When I started my study, I had to do quite a bit of digging and networking to find the right people to advise and help me. I found the NIHR very supportive and helpful in facilitating some of the introductions I’ve needed. It’s been particularly challenging as I have needed to gather information from a number of different Trusts, all of whom have slightly different processes and systems.

“But things will hopefully get easier from now on. There is a small, but growing, network of research paramedics. We are starting to build a research support network through the College of Paramedics. So now paramedics looking into research could approach the group and connect with someone to provide support and guidance.

“This is the wonderful thing about working in a research-active profession - the researchers who have gone before you have helped to carve out a path, and you in turn are making the journey easier for the next researcher.

“But of course - as a researcher, you need a challenge, it’s part of your development, and the fun in research. There is a diverse portfolio of research being undertaken by paramedics each with their unique challenges, this is creating a wealth of knowledge and expertise making the research paramedic career path more accessible and easier to walk down.”