Discussion
trauma
SECONDARY
This study has highlighted a number of challenges and some opportunities for consideration by trial teams conducting pre-hospital trauma trials. These challenges and opportunities exist across health care systems and include individual (e.g. motivation/beliefs), organisational (e.g. research culture) and broader societal (e.g. legal/legislative) considerations. There were considerable areas of overlap between the pre-hospital trial researchers (who identified overarching challenges across the field) and the P-PRO clinical investigators (who provided more detailed challenges for a case study pre-hospital trauma trial), providing further validation across the data sets. The approach we used provides a behavioural diagnosis of the key challenges across the system that impact on the successful delivery of pre-hospital trauma trials.For the pre-hospital trial researchers, the lack of an established research culture within the pre-hospital environment was identified as a key challenge to the conduct of pre-hospital research. Research activity was regarded as secondary to immediate patient care, and often difficult to factor in due to operational pressures. Indeed, paramedics have reported that their involvement in pre-hospital research is not featured as part of their professional responsibilities, and that time pressures/constraints often limit their participation [The additional ‘work’ of trials was also identified in both of our interview cohorts in relation to trial conduct. The importance of designing pre-hospital trials with minimal paperwork to reduce the participation burden for pre-hospital staff was identified in our study, both directly and indirectly (i.e. limited bandwidth) and has been highlighted in other pre-hospital trials, as well as the logistical challenges related to handover procedures with regards to data collection [We used behavioural frameworks (COM-B and TDF) to facilitate our understanding of the barriers and enablers to conducting pre-hospital trials. Although this approach is gaining traction in the field of trial methodology [