# Facilitators and barriers to the delivery of the PARAMEDIC2 trial

## TL;DR

This study explores the challenges and successes of conducting a cardiac arrest drug trial by UK emergency medical services.

## Contribution

The study identifies key factors influencing the delivery of a large-scale EMS-based clinical trial.

## Key findings

- Professionalism and organizational investment were key facilitators in trial delivery.
- Geographical challenges were addressed through technology and team relationships.
- Infrequent exposure to cardiac arrest cases and role instability posed significant barriers.

## Abstract

PARAMEDIC2 was a medicines trial comparing adrenaline with placebo in out-of-hospital cardiac arrest (OHCA). At the time, United Kingdom (UK) Emergency Medical Systems (EMS) were inexperienced in delivering such research.

To identify barriers and facilitators to delivery of the PARAMEDIC2 (Adrenaline) trial by five UK NHS EMS.

This qualitative study took a grounded theory approach to thematic analysis of workshop data. Members of the trial teams from each service attended a workshop in November 2018 and discussed their experiences in answer to two prompt questions. Data were coded and themes presented.

Three main themes were identified: professionalism, organisational investment and unique features of EMS. The study provided an opportunity for recruiting paramedics and research paramedics to demonstrate their professionalism. Research paramedics felt it was part of their professional duty to initiate discussions with the patient/family regarding the trial rather than leave this task to the hospital teams as would usually happen. Organisational investment was reflected by prioritising trial training and further development of research paramedics. By these means, research culture was developed. The unique features of EMS such as geographical challenges were often addressed with technological solutions and through building relationships with internal teams.

Barriers to trial delivery included infrequent exposure to the condition of interest and lack of continuity in research paramedic roles. Facilitators identified included flexibility of the research protocol, and organisational investment in the development of research paramedics.

Participating in PARAMEDIC2 was challenging for the EMS involved, but ultimately strengthened their research culture.