Paramedics contribute to research shaping future of pre-hospital care

Critical Care Paramedics (CCPs) from South East Coast Ambulance Service (SECAmb) have contributed to two major publications aimed at strengthening the evidence base and guiding best practice in pre-hospital care.

The first study, led by SECAmb Interim Head of Critical Care Alan Cowley and Consultant Paramedic Dan Cody, examined the use of clot-busting thrombolysis during out-of-hospital cardiac arrest. The research was carried out in collaboration with the Trust’s Medicines and Health Informatics teams.

Published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, the study analysed several years of cardiac arrest data to determine whether administering the drug tenecteplase in the pre-hospital setting improved outcomes when a blood clot was suspected.

The findings showed that thrombolysis did not improve survival and may be associated with poorer outcomes in cases of undifferentiated cardiac arrest, underlining the challenges of accurately diagnosing the cause of cardiac arrest in the field.

Commenting on the findings, Cowley said the research highlighted the risks of using empiric thrombolysis based on suspicion alone.

“Our research reinforces that empiric thrombolysis in cardiac arrest based on suspicion alone may not be prudent,” he said. “As a result, we have refined our guidance to ensure it is only used for patients where the index of suspicion of a blood clot is significantly higher.”

He added that the study aimed to support future research into the use of high-risk interventions in pre-hospital settings. “As well as adding to the current literature base, we hope this helps inform future research to better identify when these treatments should be used and which patients truly benefit,” Cowley said.

In a separate publication, SECAmb Critical Care Paramedic Claire Foweraker co-authored a national consensus statement with the Faculty of Pre-hospital Care focusing on the management of critically ill or injured pregnant patients.

The guidance addresses the unique challenges pregnancy presents during emergencies, particularly in trauma and cardiac arrest, and brings together the best available evidence and expert consensus. It aims to support pre-hospital clinicians with assessment, resuscitation, patient positioning and time-critical decision-making, while prioritising maternal care to optimise outcomes for both mother and baby.

SECAmb Acting Chief Medical Officer Richard Quirk said the two publications reflected the growing contribution of paramedics to clinical leadership and research.

“I would like to thank everyone involved in these important pieces of work,” he said. “They demonstrate the expanding role of paramedics as clinical leaders and researchers. By working collaboratively across teams and national organisations, colleagues are continuing to improve patient care while contributing to the wider evidence base for pre-hospital medicine.”

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