Please find below our current and recent projects on prehospital emergency quality and outcomes:
Recently completed projects
- Community First Responders: scoping review, qualitative study and database study of out-of-hospital cardiac arrest outcomes (CFR study)
- Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain (ExPLAIN)
- Understanding Variation in Rates of Ambulance Service ‘Non-conveyance of Patients to an Emergency Department (VAN)
- Prehospital Differences In Care by eThnicity (PreDICT)
- Ambulance Service Cardiovascular Quality Initiative (ASCQI)
- Improving Prehospital Ambulance Care and Treatment following the Ambulance Services Cardiovascular Quality Initiative (ImPACT-ASCQI)
- The ‘Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial’ (RIGHT)
- Interview Study of Patients and Practitioners for Developing PROVE (IS-PROVE)
- Decision-Making and Safety in Emergency Care Transitions
Community First Responders’ role in the current and future rural health and care workforce 2020-2022
Funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme, awarding £471,000. Key contact: Professor Niro Siriwardena
This is a mixed methods study which aims to work with PPI and stakeholders throughout to develop recommendations for future innovations in rural CFR provision by investigating current activity, costs of provision, and views of patients, public, CFR schemes and rural care providers.
Improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): A realist informed intervention development and feasibility study 2023-2027 Funded by Health Education England (HEE)/National Institute for Health and Care Research (NIHR) Integrated Clinical and Practitioner Academic (ICA) Advanced Clinical and Practitioner Academic Fellowship (ACAF). Key contact: Dr Greg Whitley
This study will explore experiences of children and young people who have been attended by ambulance for a painful condition, along with their parents/carers and ambulance clinicians, and to develop and test a new method to improve pain management,
Researching Emergency Ambulance calls to Care Homes: a mixed methods study (REACH) 2021-2023
Funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, awarding £133,607. Key contact: Professor Niro Siriwardena
This is a multi-method study with systematic review, complex mixed methods, and consensus study which aims to evaluate demographic and clinical predictors of ambulance conveyance to hospital following an emergency call from a care home and explore how outcomes and experiences of care home residents with emergency conditions and the practice capabilities and management experiences of staff involved can be improved.
Mixed Methods in Prehospital Research – a Systematic Review Update (MMPR) 2023-2024
Unfunded. Key contact: Dr Greg Whitley
This study will update a previous systematic review (McManamny et al, 2015) and critique the utilisation of mixed methods in prehospital research.
Evaluation of Digital Deterioration Monitoring in Care Homes in Derbyshire (eDDMoCH) 2021-2022
Funded by the National Institute for Health Research (NIHR) East Midlands Academic Health Science Network, awarding £14,948. Key contact: Professor Niro Siriwardena
This is a mixed methods study using a real-world evaluation approach to investigate whether and how digital deterioration monitoring using CliniTouch Vie (CTV) works to inform future spread.
Effect of implementing an ambulance clinician delivered hypoglycaemia intervention (‘Hypos can strike twice’) on repeat ambulance calls, attendances and transportation to hospital: non-randomised stepped wedge and process evaluation (Ambu-HS2) 2020-2022
Funded by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, awarding £200,000. Key contact: Professor Niro Siriwardena
This is a non-randomised stepped wedge study with a mixed-methods process evaluation study which aims to evaluate the effect of implementing the ‘Hypo’s can strike twice’ intervention to patients with diabetes and hypoglycaemia attended by East Midlands Ambulance Service NHS Trust in the East Midlands region.
Patient, family member and staff experiences and perceptions of prehospital management of acute pain in adults: A systematic review and meta-synthesis 2021
Unfunded. Key contact: Professor Niro Siriwardena
This systematic review would enable a comprehensive and broad understanding of how prehospital pain management is perceived by the patients, family members and staff to inform better clinical as well as policy decisions.
Post-doctoral bridging fellowship: paediatric prehospital pain 2021
Funded by Health Education England, awarding £13730. Key contact: Dr Greg Whitley
This is work to design a mixed methods study to improve quality of care for children suffering pain who are attended by ambulance.
Optimising ambulance response outcomes and costs pilot evaluation study (OptiAmbuROC) 2021
Funded by the Quality Research Strategic Priority Fund (QR SPF), awarding £17337. Key contact: Dr Colin Ridyard
This is a decision analytic modelling study exploring outcomes and costs of single-crewed rapid response vehicles (RRVs) versus dual-crewed ambulances (DCAs).
Building an understanding of Ethnic minority people’s Service Use Relating to Emergency care for injuries (BE SURE) 2020-22
Funded by NIHR Health Services and Delivery Research, awarding £737,510. Key contact: Professor Niro Siriwardena
This is a multimethods study which will describe differences in how people from ethnic minority groups who have an injury contact emergency ambulance services and emergency departments and that happens to them, compared to White British people.
Health Experiences of Asylum seekers and Refugees: how well are their interpretation needs met?(HEAR2) 2020-22
Funded by Research for Patient and Public Benefit, Health and Care Research Wales, awarding £229,988. Key contact: Professor Niro Siriwardena
This is a mixed methods study which will provide preliminary data about demand for, and experience and quality of interpretation services in primary and emergency care in Wales; and assess the feasibility of a comprehensive evaluation of provision of interpretation services in these settings across the UK.
Randomised trial of clinical and cost effectiveness of Administration of Prehospital fascia Iliaca compartment block for emergency Pre-Hospital hip fracture care Delivery (RAPID 2) 2021-24
Funded by National Institute for Health Research Health Technology Assessment programme awarding £1,784,766. Key contact: Professor Niro Siriwardena
This is a mixed methods study designed to help NHS paramedics make better decisions about when to continue and when to stop resuscitation.
Exploring and Improving Resuscitation Decisions in Out of Hospital Cardiac Arrest (PROTECTeD) 2019-24
Funded by National Institute for Health Research Health Services and Delivery Research Programme awarding £617,200. Key contact: Professor Niro Siriwardena
This is a randomsied controlled trial designed to test the clinical and cost-effectiveness of paramedics providing FICB as pain relief to patients with suspected hip fracture in the prehospital environment.
Promoting Staff Wellbeing in UK NHS Ambulance Personnel – what works and how can we do better? (SWAP) 2019-20
Funded by Health Education England, awarding £180,000. Key contact: Professor Niro Siriwardena
This is a mixed methods study analysing staff absence rates by staff group and ambulance service, exploring characteristics of successful employee mental wellbeing services and seeking to understand how existing services could be improved in UK ambulance services.
Medical student first responder schemes: mixed methods study (MSFRS) 2020-21
Unfunded. Key contact: Professor Niro Siriwardena
This is a mixed methods study investigating the contribution of medical student first responder (MSFR) schemes to the ambulance response and the experiences and perceptions of medical students of MSFR schemes.
Delivering ambulance service care that meets the needs of EU Accession migrants in Lincolnshire 2018-2022
University of Lincoln doctoral funding. Key contact: Viet-Hai Phung
This is a multimethods doctoral study exploring the needs of recent migrants from European accession countries when accessing ambulance services and seeking to understand ways to improve this.
Ambulance (Emergency Medical Service) interventions in response to pandemics: a scoping review (EMS pandemic review) 2020-2021
Unfunded study. Key contact: Dr Ffion Curtis.
This a one year study led by University of Lincoln which aims to conduct a systematic scoping review of the literature on interventions, outcomes and experiences of the ambulance service response to pandemics.
Identifying and explaining clusters of acute physical and mental health conditions in the East Midlands of the UK and Ontario using ambulance call condition data: SatScan analysis and evaluation of health care system effectiveness (Emergency Medical Service Call Condition Cluster Study [EMSC3]) 2020-2022
Funded by University of Lincoln School of Geography, awarding £2000. Key contact: Dr Harriet Moore.
This is a three year study led by the University of Lincoln with University of Leicester, McMaster University, Ontario, Canada, East Midlands Ambulance Service and Niagara Emergency Medical Services which aims to investigate the epidemiology of 999 ambulance attendances for ambulatory care sensitive conditions in East Midlands, UK and Ontario, Canada.
What TRIage model is safest and most effective for the Management of 999 callers with suspected COVID-19? A linked outcome study (TRIM) 2020-2021
Funded by Medical Research Council (DHSC/UKRI COVID-19 Rapid Response Initiative) awarding £358,400. Key contact: Prof Niro Siriwardena.
This is a one year study led by Swansea University with Universities of Stirling, St George’s and Kingston (University of London), and Lincoln with Welsh, East Midlands and East of England Ambulance Service NHS Trust which aims to evaluate models used to triage and manage emergency ambulance service care for patients with COVID-19 who call 999 in England, Wales and Scotland.
Prehospital Outcomes for Evidence-Based Evaluation (PhOEBE) 2011-16
Funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research, awarding £2,035,959. Key contact: Professor Niro Siriwardena
This is a five-year NIHR funded Programme Grant for Applied Health Research co-led by Professor Niro Siriwardena from the University of Lincoln with colleagues from the University of Sheffield School of Health & Related Research (ScHARR), East Midlands Ambulance Service (EMAS), Yorkshire Ambulance Service (YAS) and the University of Swansea. The work programme adopted a range of different methods, including systematic reviews, consensus methods, service user interview, data linkage and modelling. The aim of the programme was to develop meaningful outcome measures for the pre-hospital care delivered by the ambulance service. The results will change the way in which the quality of ambulance service is measured. It is anticipated that PhOEBE will impact on the operation of the ambulance service from one that concentrates on meeting response time targets towards one that is geared to improving the quality of patient care.
Prehospital Evaluation of Sensitive Troponin (PRESTO) study 2018-20
Funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme, awarding £338,089. Key contact: Professor Niro Siriwardena
This is a 3-year NIHR Research for Patient Benefit funded project led by Professor Rick Body (University of Manchester) to assess the accuracy of the ‘Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid’ in prehospital diagnosis of chest pain.
Evaluating effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments (GPs in EDs) 2017-2020
Funded by the National Institute for Health Research Health Services and Delivery Research Programme, awarding £954,863. Key contact: Professor Niro Siriwardena.
This is a three year study led by Cardiff University (chief investigator: Professor Adrian Edwards), in collaboration with the Universities of Swansea, Oxford, Northumbria, Macquarie (Australia) and Lincoln which aims to evaluate using realist methods the effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments understanding the effects and the mechanisms by which they are brought about in different contexts.
Predictors and outcomes of ambulance calls to care homes for emergencies in people with diabetes – retrospective observational database study (Diabetes Emergencies in Care Homes) 2018
Funded by the NIHR CLAHRC East Midlands, awarding £23,851. Key contact: Professor Niro Siriwardena
This 9-month NIHR CLAHRC East Midlands project led by Professor Siriwardena involves an evaluation of diabetes emergency calls from care homes to an ambulance service. Our overall aim is to evaluate the demographic and clinical factors which predict ambulance conveyance to hospital together with health service costs of ambulance calls to patients with diabetes-related problems residing in care homes.
What are the predictors, barriers and facilitators to effective management of acute pain in children by ambulance services? 2018-21
Funded by the NIHR CLAHRC East Midlands, awarding £56,244. Key contact: Greg Whitley
This 3-year NIHR CLAHRC East Midlands funded doctoral study by Greg Whitley seeks to identify why pain is poorly managed in injured children within a UK ambulance service NHS Trust and to explore ways to improve this.
Electronic Records in Ambulances to support the shift to out of hospital care: challenges, opportunities and workforce implications (ERA) 2016-17
unded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme, awarding £380,318. Key contact: Professor Niro Siriwardena
The aim of this project is to find out how ambulance services can make the best use of information technology to support staff to provide good quality care out of hospital.
Network exploring Ethics of Ambulance Trials (NEAT) 2016-17
Funded by the Wellcome Trust, awarding £49,681. Key contact: Professor Niro Siriwardena
The aim of this project is to develop a network exploring the ethics of conducting randomised controlled trials (RCTs) involving ambulance services, to undertake a systematic review of ethical approaches in published RCTs and protocols involving ambulance services since 2000 and to conduct pilot qualitative studies with patients and ambulance staff to explore perceptions of the ethics of ambulance trials.
Improving Cardiac Arrest Recognition and Effectiveness (ICARE) 2015-16
Funded by the NIHR Policy Research Programme, awarding £595,408. Key contact: Professor Niro Siriwardena
The aim of the ICARE study is to explore whether the recognition of, and response to, out of hospital cardiac arrest by English ambulance services can be improved.
The ‘Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial’ (RIGHT-2) 2015-18
Funded by the British Heart Foundation, awarding £1,370,708. Key contact: Professor Niro Siriwardena
The aim of the RIGHT-2 trial, a major trial following the results of the RIGHT trial, is to assess the safety and efficacy of transdermal glyceryl trinitrate (GTN) in ultra-acute stroke . Its primary objective is to compare GTN versus no GTN for death, disability, mood, cognition and quality of life in patients with hyper-acute stroke.
Preventing Repeat Hypoglycaemic Episodes in People with Diabetes: the Ambulance Hypo Study 2014-16
Funded by East Midlands Collaboration for Leadership in Applied Health and Care, awarding £291,952. Key contact: Professor Niro Siriwardena
This randomised controlled study has as its main aim to implement and evaluate an enhanced care pathway for patients with diabetes who request an ambulance call out to treat a hypoglycaemic event. Its objectives include: reporting increases in uptake of advice and/or change in medication aimed at preventing future hypoglycaemia. Other outcomes to be measured include rates of repeat ambulance call out, rates of cardiovascular disease, cardiovascular related mortality and all-cause mortality, patient satisfaction, fear of hypoglycaemia and knowledge about hypoglycaemia.
Prehospital Care of Patients After a Suspected Seizure: Incidence, Patient Characteristics and Costs’ (Prehospital Seizures) 2015-18
Unfunded study. Key contacts: Dr Zahid Asghar
This study aims to investigate the incidence, patient characteristics and costs of suspected seizure and which clinical factors predict transport to hospital.
Community First Responders: scoping review, qualitative study and database study of out-of-hospital cardiac arrest outcomes (CFR study) 2016-18
Funded by the College of Social Science Research Fund, awarding £2,721. Key contact: Dr Murray Smith
The aim of this project is to explore the role of the Community First Responder (CFR), to assess the effect of CFRs on out-of-hospital cardiac arrest outcomes and to propose recommendations to the service and role..
Exploring factors increasing Paramedics’ likelihood of administering Analgesia in prehospital pain (ExPLAIN) 2016-17
Funded by the Falck Foundation, awarding €33,000. Key contact: Professor Niro Siriwardena
The aim of this study is to investigate patient and practitioner factors affecting paramedic pain management practice in adult patients attended by ambulance services and to explore whether paramedic initiated analgesia differs according to factors such as the age, sex, ethnicity or type of pain of the adult patient and paramedic factors such as sex or role seniority.
Understanding Variation in Rates of Ambulance Service ‘Non-conveyance of Patients to an Emergency Department’ (VAN) 2015-18
Funded by National Institute for Health Research Health Services and Delivery Research Programme, awarding £328,706. Key contact: Professor Niro Siriwardena
This mixed methods study aims to investigate the determinants of variation between and within ambulance services for non-conveyance and potentially inappropriate non-conveyance of patients to hospital. The study seeks to understand how to increase non-conveyance rates without compromising patient safety in terms of higher recontact rates or other adverse consequences.
Prehospital Differences In Care by eThnicity’ (PreDICT) 2015-18
Unfunded study. Key contacts: Dr Zahid Asghar and Viet-Hai Phung
This study aims to investigate how processes and outcomes of prehospital care for common emergencies attended by ambulance staff vary by ethnicity and to conduct a systematic review of the barriers and facilitators for ethnic minority groups in accessing urgent and pre-hospital care.
Ambulance Service Cardiovascular Quality Initiative (ASCQI) 2009-12
Funded by the Health Foundation: Closing the Gap in Clinical Communities Award, awarding £475,000. Key contact: Professor Niro Siriwardena
The aim of ASCQI was to improve delivery of pre-hospital cardiovascular care through collaboration with frontline clinicians. All patients presenting with Acute Myocardial Infarction (AMI or heart attack) or stroke were to receive critical-to-quality care. The objectives were to increase the delivery to at least 70 per cent of AMI patients and more than 90 per cent of stroke patients by April 2012 using a Quality Improvement Collaborative (QIC). The QIC involved educating ambulance staff in Quality Improvement (QI) methods, and the use of plan-do-study-act cycles (PDSA) to implement changes. Ambulance staff were provided with feedback on the effect of the PDSA cycles using control charts and the QIC provided an environment to share successful strategies within and across services to improve care bundles for AMI and stroke. The delivery of the AMI care bundle has increased from 43% to 79% of patients nationally. For stroke, the delivery of the care bundle has increased from 83% to 96% of patients nationally. The main results were published in a highly accessed paper in Implementation Science: Siriwardena AN, Shaw D, Essam N, Togher F, Davy Z, Spaight A, Dewey M. The effect of the Ambulance Services Cardiovascular Quality Initiative on prehospital care for acute myocardial infarction and stroke in England. Implementation Science 2014; 9:17. doi:10.1186/1748-5908-9-17.
Improving Prehospital Ambulance Care and Treatment following the Ambulance Services Cardiovascular Quality Initiative (ImPACT-ASCQI) 2014-15
Funded by the Health Foundation: Spreading Improvement Award, awarding £29,572. Key contact: Professor Niro Siriwardena
The aim of ImPACT-ASCQI is to widen the impact of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) by providing a sustainable and long-term increase in quality improvement (QI) knowledge and skills to a wider proportion of ambulance staff ((including front-line staff, managers, executives) and to extend this further to other healthcare (medical, nursing and allied health) staff. We will achieve this aim by applying the learning from ASCQI through a variety of educational activities (including local workshops, webinars, E-learning and an electronic toolkit), disseminating knowledge from both ASCQI and ImPACT-ASCQI to a range of key stakeholders, opinion leaders and decision-makers in order to continue to improve outcomes for patients with a broader range of emergency and non-emergency conditions.
The ‘Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial’ (RIGHT) 2010-13
Funded by Nottingham University Hospital Charity, awarding £9,038. Key contact: Professor Niro Siriwardena
This study had two main aims: to assess the feasibility of using ambulance service practitioners to assess and deliver treatments for stroke in the ultra-acute setting after stroke; and to assess the effect of GTN use in ultra-acute stroke on safety, clinical, functional, and haemo-dynamic outcomes. Its objectives included: reporting the proportion of randomised patients with a final diagnosis of ischaemic stroke, primary intra-cerebral haemorrhage, or transient ischaemic attack; and assessing the proportion of patients randomised and treated according to protocol. Comparison of systolic blood pressure at two hours post randomisation between GTN and no GTN groups was chosen as a primary outcome since it represented the sum of the trial feasibility and intervention. The RIGHT trial is the world’s first completed ambulance-based, randomised, controlled stroke trial and has tested using GTN patches within four hours of a stroke by recruiting and treating 41 patients in the ambulance. The results of the RIGHT trial were published in Stroke: Ankolekar S, Fuller M, Cross I, Renton C, Cox P, Sprigg N, Siriwardena AN, Bath P. Feasibility of an ambulance-based trial, and safety of glyceryl trinitrate, in patients with ultra-acute stroke: the ‘Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial’ (RIGHT, ISRCTN66434824). Stroke 2013; 44(11): 3120-3128. doi: 10.1161/STROKEAHA.113.001301. An accompanying paper was published in the Annals of Emergency Medicine: Ankolekar S, Parry R, Sprigg N, Siriwardena AN, Bath PMW. Views of paramedics on their role in an out-of-hospital ambulance-based trial in ultra-acute stroke: qualitative data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial (RIGHT). Annals of Emergency Medicine 2014 (online first). doi.org/10.1016/j.annemergmed.2014.03.016
Interview Study of Patients and Practitioners for Developing PROVE (IS-PROVE) 2009-12
Funded by the Health Foundation, awarding £475,000 as part of ASCQI. Key contact: Fiona Togher
Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are questionnaires designed to measure outcomes and experience of care that are important to patients. Their routine use is becoming increasingly important in the evaluation of health care services. The purpose of this study was to undertake the preliminary work which would inform development of a PROM and PREM for patients presenting with stroke or heart attack in the pre-hospital setting that could be routinely used by ambulance clinicians to improve the quality of care provided in the pre-hospital setting. The results were published in the EMJ: Togher F, Davy Z, Siriwardena AN. Patients’ experiences and outcomes for prehospital care of acute myocardial infarction and stroke: qualitative study of patients and ambulance clinicians. Emergency Medical Journal 2013;30(11):942-8. doi: 10.1136/emermed-2012-201507.
Decision-Making and Safety in Emergency Care Transitions 2010-13
Funded by the National Institute for Health Research, Service Delivery and Organisation (NIHR SDO), awarding £168,690. Key contact: Professor Niro Siriwardena
This study aims to identify areas of high-risk regarding decision-making about service user options. It has three objectives: to map the emergency care system in a sample of ambulance services; to investigate the factors influencing decision-making by ambulance service staff; and to feedback study findings to participating ambulance services and stakeholders. The study uses a range of qualitative methods to explore influences on safe decision-making during key emergency care transitions. These include: interviews with key members of ambulance service staff; ethnographic methods involving operational ambulance service staff; and focus groups with operational ambulance service staff and service users. It is expected that the findings of the study will be directly relevant to emergency care services in identifying potential influences on decision-making and the delivery of safe care.