Ethical approval and consent

The ethical considerations relating to prehospital research are challenging.5 Patients in cardiac arrest are unconscious, and in Scotland, the Adults with Incapacity Act strictly governs research involving these individuals. Ethical approval from a national Research Ethics Committee (REC) is required before undertaking research involving this patient group. For the TOPCAT study the REC agreed that consent should be sought from the participant's next-of-kin at the earliest opportunity. Should the patient recover sufficiently, retrospective, informed consent is sought from them. This approach of waiving initial consent is being more widely adopted to facilitate research involving incapacitated adults in an emergency setting.6

Coordinating across agencies

For prehospital research to be successful, cooperation between members of the research team, Emergency Medical Dispatch Centre (EMDC), Emergency Medical Services (EMS) personnel, Emergency Department and Intensive Care Unit is vital. All EMS personnel likely to be involved in the study need to be informed and aware of the research protocol.5 7 Although EMS personnel may not be responsible for data collection on-scene, interaction between all members of the clinical and research team ensures optimum patient care and data collection.

Collecting prehospital data

Prehospital research requires excellent relations with the local ambulance service. EMS in the United Kingdom do not routinely task a prehospital doctor to OHCA but in the present study, an Emergency Medicine Specialty Registrar performs the field research. In order to gather data it may be necessary to perform clinical interventions not routinely carried out by EMS such as oesophageal temperature probe insertion or jugular vein cannulation to obtain enough blood for subsequent analysis. Blood samples are promptly transported back to the hospital, being kept cool with disposable chemical cooling packs.

Dispatch

In order to allow EMDC to track the registrar's location and availability to respond the TOPCAT research, the registrar's car is fitted with a compatible satellite transponder. On receipt of a possible cardiac arrest call, EMDC first dispatches an ambulance response then contacts the research registrar on a mobile phone, which is switched on only during on-call periods. A marked response car equipped with audible and visual warning systems is used, which has the authorisation of the local police.

Training, insurance and liability

The research registrar received formal response driver training from the Scottish Ambulance Service but such training is available from the police or commercial sources. A specific insurance policy is required to cover emergency driving. This is available through several motor insurance brokers adding approximately 10% to the regular car insurance policy (eg, Towergate MIA, London).

On-scene data recorded by the EMS crew and research doctor are correlated with electronic data from EMDC. Ambulance and doctor response, together with on-scene times are automatically recorded via the tracking systems, which update every 13 s.

On arrival at the scene, the research registrar may be requested to assist the attending EMS crew. Clinical care of the patient always remains a priority and data collection only commences when life-saving interventions have been performed. Although no additional medical equipment is carried by the research registrar, he frequently assists with endotracheal intubation, intravenous cannulation and provides reassurance and encouragement.

Only through novel, prehospital research studies involving close collaboration between clinical researchers and frontline EMS crews is outcome from OHCA likely to be improved.