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Phenomenological study exploring ethics in prehospital research from the paramedic’s perspective: experiences from the Paramedic-2 trial in a UK ambulance service
  1. Karl Charlton1,
  2. John Franklin2,
  3. Rebekah McNaughton2
  1. 1 R&D Department, North East Ambulance Service NHS Trust, Newcastle Upon Tyne, UK
  2. 2 School of Health & Social Care, Teesside University, Middlesbrough, UK
  1. Correspondence to Karl Charlton, Research Paramedic, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK; Karl.charlton{at}


Objectives We set out to investigate paramedics’ views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA).

Methods An interpretative phenomenological approach was adopted. A purposive sample of paramedics (n=6) from North East Ambulance Service NHS Foundation Trust were invited to a semi-structured, in-depth interview.

Results Three superordinate themes emerged: (1) morality, (2) emotion and (3) equipoise. Some viewed Paramedic-2 as an opportunity to improve OHCA outcomes for the many, viewing participation as a moral obligation; others viewed the study as unethical, equating participation with immoral behaviour. Morality was a motivator to drive individual action. Positive and negative emotions were exhibited by the paramedics involved reflecting the wider view each paramedic held about trial participation. Those morally driven to participate in Paramedic-2 discussed their pride in being associated with the trial, while those who found participation unethical, discussed feelings of guilt and regret. Individual experience and perceptions of epinephrine guided each paramedic’s willingness to accept or reject equipoise. Some questioned the role of epinephrine in OHCA; others believed withholding epinephrine was synonymous to denying patient care.

Conclusion A paucity of evidence exists to support any beneficial role of epinephrine in OHCA. Despite this, some paramedics were reluctant to participate in Paramedic-2 and relied on their personal perceptions and experiences of epinephrine to guide their decision regarding participation. Failure to acknowledge the importance of individual perspectives may jeopardise the success of future out-of-hospital trials.

  • ethics
  • paramedics
  • research, clinical
  • pre-hospital
  • cardiac arrest

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  • Contributors This study was conducted solely by the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethical approval was sought and received from Teesside University research ethics committee, 198/17, and the Health Research Authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators All work has been completed by the authors without support from any collaborators.

  • Patient consent for publication Not required.