Challenges of the pre-hospital environment (TDF environmental context and resources)
All of the barriers outlined above were compounded by the challenges associated with operating in a pre-hospital environment. This included difficulties associated with deploying REBOA when the weather was poor, the lighting was dim and there were multiple people present (e.g. such as police and other members of the public). These barriers could deter effective randomisation or the delivery of the intervention in a future trial. Furthermore, their distance from the hospital often influenced decisions to recruit. The distance from a hospital was predicted to determine decisions to randomise patients, namely due to the trajectory of the patient’s status.…we go on a helicopter and we sometimes get to people in ten, 15, 20 minutes and they’re almost dead, it’s harder to look at that person and say… if it tells me not to put a balloon in I’m happy with the next 40 minutes, or even if I’m unbelievably quick and it’s 20 minutes, am I really happy with that without intervening? That doesn’t necessarily mean we shouldn’t do an RCT, but I think we might find that the alternative is quite invasive in those patients, i.e. maybe a thoracotomy or something like that. But the time does have an effect because when we get there quicker and they’re that sick, that’s a very different patient to an hour down the line and they’re that sick. Consultant, participant 6.