Research

All proposed research involving London Ambulance Service staff, our patients or their data must be formally considered through our Trust Research Approval process. This application process includes a feasibility assessment of the study and consideration of whether or not the research will be of benefit to the Trust.

We welcome opportunities for collaborative research with academic, commercial and third sector organisations, as well as with other NHS Trusts.

For student research projects, we accept applications from staff who have substantive contracts with our Trust and are undertaking research as part of an educational qualification. However, we do not have the capacity to support external student’s requests for research that is below PhD level.

PhD research proposals will be considered on a case-by-case basis and may be supported if undertaken collaboratively with LAS, and if the project aligns with our research priorities and there is no overlap with our own research programme.

PhD research proposals will be considered on a case-by-case basis and may be supported if the project aligns with our research priorities and research programme, and is adequately resourced or undertaken collaboratively.

Please get in touch for further information:

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SIS

The LAS participated in the Spinal Immobilisation Study (SIS), a randomised controlled trial which aims to determine whether movement minimisation is non-inferior to triple immobilisation (hard collar, blocks and scoop) for trauma patients with suspected cervical spine injury. The study was funded by the National Institute for Health and Care Research.

Recruitment ended in January 2026 and we await publication of the results.

PROTECTeD

The PROTECTeD study, which aimed to explore and improve resuscitation decisions in out-of-hospital cardiac arrest, was run by the University of Warwick.

Background

PROTECTeD aimed to explore and improve decision-making regarding termination of resuscitation. It comprised of five work packages, including interviews with cardiac arrest survivors and their families, LAS clinicians and ED staff. By exploring the perspectives of these groups, this research project aimed to change the way we manage termination of resuscitation – developing a consensus of evidence based, ethically grounded guidelines that optimise outcomes for patients and are sensitive to the needs of relatives and the demands on NHS services.

Results

Relatives’ experiences highlight two key challenges for ambulance clinicians: being aware of the tension relatives feel between needing reassurance that the crew is doing everything to save the patient and wanting to avoid prolonged and ultimately futile resuscitation attempts; and having ongoing conversations with those present to inform clinical decision-making whilst managing the resuscitation attempt.

The study was published in BMC Emergency Medicine, and can be accessed on springer.com.

RAPID-MIRACLE

RAPID-MIRACLE aimed to develop an early pre-hospital risk stratification score for adult patients in stable Return of Spontaneous Circulation (ROSC) after a cardiac arrest, including the use of Point-of-Care (POC) venous blood gas sampling.

Background

The study recruited patients over two years, from 2022 until 2024. Patients were screened for inclusion by our LAS Critical Care Advanced Paramedic Practitioners (APP-CCs). If eligible, a small blood sample was taken and analysed using either an Abott iSTAT or Siemens epoc device. The pH value from this sample was added to other clinical variables to work out a MIRACLE2 score – similar to NEWS2, this tool is used to predict the risk of a poor neurological outcome after a cardiac arrest. The investigators proposed that MIRACLE2 score would help clinicians best identify the most appropriate destination for patients.

Results

LAS APP-CCs recruited 521 patients into the study, however issues obtaining and analysing a sample using the POC testing devices meant that pH could only be recorded for 333 patients. Whilst the score performed well, these feasibility issues would impact its use in the real world. As a result, the authors tested the performance of a scoring tool that excluded pH and the need for a blood sample, pre-MIRACLE2. This had almost equal performance to the full score including blood pH (AUC of 0.88, 95% CI 0.84–0.92).

In future, pre-MIRACLE2 may be used to aid decision making for patients in ROSC after cardiac arrest.

The study was published in the European Heart Journal: Acute Cardiovascular Care.

PARAMEDIC-3

The PARAMEDIC-3 trial, which compared different routes of administering adrenaline to patients in cardiac arrest, was run by the University of Warwick, in collaboration with the London Ambulance Service and nine other ambulance services across England and Wales.

Background

Due to the lack of high-quality evidence as to which is the most effective route of drug administration in adults in out-of-hospital cardiac arrest, the International Liaison Committee on Resuscitation (ILCOR) recommended a randomised controlled trial be conducted urgently to inform future treatment strategies. PARAMEDIC-3 aimed to understand the effect of vascular access route on patient outcomes by randomising them to receive either an intraosseous (IO) or intravenous (IV) initial access strategy.

At London Ambulance Service, 480 Fast Response Unit paramedics and Clinical Team Managers volunteered to participate in this study and were responsible for recruiting almost a third of the 6,082 patients enrolled nationally into this trial.

Results

The study found no significant difference in the time it took to administer drugs via either the IO or IV route.

Patients showed similar outcomes across both groups, with no significant differences in the rates of survival at 30 days or neurological status at discharge.

These findings indicate that the administration of adrenaline via the IO route is no more effective than IV and are expected to contribute to the evidence base used to inform future guidelines. At London Ambulance Service, we routinely use both the IO and IV routes and the results from PARAMEDIC-3 support our current practice.

The study was published in the New England Journal of Medicine, and can be accessed here.

ARREST TRIAL

The ARREST trial involved 616 London Ambulance Service clinicians, 860 of our patients and 35 hospitals across London. It took 10 years from inception to completion and was made possible thanks to a generous research grant from the British Heart Foundation. The project was coordinated by the Clinical Audit and Research Unit at London Ambulance Service with support from the London School of Hygiene and Tropical Medicine and Kings College London.

Background

ARREST was a randomised controlled trial which compared direct conveyance to a Cardiac Arrest Centre (one of the 7 Heart Attack Centres, HACs, in London) with the current standard of care (conveyance to the geographically closest Emergency Department, ED). Patients were included if they were successfully resuscitated following an out of hospital cardiac arrest with a presumed cardiac cause, and did not meet the current criteria for HAC conveyance (ST elevation on their Electrocardiogram, ECG).

ARREST was the first and only randomised trial in the world to address the question of whether patients benefit being taken by our clinicians directly to hospitals with specialist cardiac and intensive care facilities, even if that means driving past the closest Emergency Department.

Results

ARREST showed that survival amongst patients resuscitated following an Out of Hospital Cardiac Arrest, who do not have ST elevation on their ECG, was no different when they were taken to a specialist hospital compared with the local ED. These patients also had no difference in their neurological outcomes at hospital discharge or 3 months after their cardiac arrest. This is good news as it indicates that not all patients after cardiac arrest need really aggressive intervention, and what they actually need is a period of stabilisation and supportive treatment which can be delivered in any hospital in London.

For most patients without ST elevation on their 12-lead ECG following cardiac arrest, the current guidelines recommend conveyance to the nearest Emergency Department, and ARREST shows that this is safe and appropriate.

Additionally, it means our current pathway of conveying most patients quickly to the nearest ED, and reserving the specialist centres for those with specific needs such as those having a STEMI cardiac arrest is probably the best course of action.

The full results have been published in The Lancet, one of the world’s leading scientific journals.

PARAMEDIC-2

This trial, funded by the NIHR Health Technology Assessment, aimed to understand whether using adrenaline is helpful or harmful when treating someone experiencing a cardiac arrest outside of a hospital. The study ran between 2014 and 2017. PARAMEDIC-2 is officially the largest cardiac arrest drug trial in Europe, involving 8,014 patients (2,102 recruited by the LAS) and the largest randomised placebo-controlled trial examining the role of adrenaline in cardiac arrest.

Background

Adrenaline has been an integral component of advanced life support for over 50 years, but it had not previously been fully tested to see if it is beneficial for patients who have a cardiac arrest outside of hospital. This randomised controlled trial compared the clinical and cost effectiveness of adrenaline versus a saline placebo for the treatment of out-of-hospital cardiac arrest. Drugs were blinded so that paramedics were unaware of which drug they were administering. All other aspects of resuscitation practices remained unchanged.

Four other ambulance trusts also participated in the trial (South Central, North East, West Midlands and Wales). The trial was supported by the International Liaison Committee on Resuscitation, Resuscitation Council (UK), College of Paramedics and the Joint Royal College Ambulance Liaison Committee.

Results

The trial found that, after 30 days, adrenaline resulted in a slight increase in survival but much greater likelihood of severe disability.

The results were published in August 2018 in the New England Journal of Medicine. Further details can be found on the trial website.

PARAMEDIC-2 was listed in the top 100 papers for 2018 (#27) in terms of the Altmetric score.

RIGHT-2

This trial, funded by the British Heart Foundation, aimed to understand whether glyceryl trinitrate (GTN) improves outcomes for patients who experience a stroke. The study ran between 2016 and 2018.

Background

High blood pressure (BP) is common in stroke patients and generally associated with poor outcomes. This trial aimed to understand if using GTN as soon as possible after the onset of a stroke improved patients’ neurological outcome. This randomised controlled trial involved paramedics administering either GTN or placebo patches to patients within four hours of them experiencing symptoms.

Six other ambulance trusts (East Midlands, West Midlands, East of England, South West, South East Coast and Wales) also participated in the trial.

Results

The trial found that pre-hospital treatment with GTN for patients with presumed stroke does not appear to improve functional outcome.

The results were published in February 2019 in The Lancet.

PRE-HOSPITAL EMERGENCY DEPARTMENT DATA LINKING PROJECT

This mixed-methods research project, funded by the Health Foundation, aimed to determine the feasibility of and potential learning from retrospectively linking ambulance service data to Emergency Department (ED) data to create a continuous electronic record of the patient journey.

The project was run in collaboration with Swansea University, the Nuffield Trust, and Kingston University and St. George’s University of London.

Background
Historically, front line ambulance crews would take a patient to hospital and, often, would have little to no further information about the patient’s outcome during and/or following their stay in hospital. The Pre-Hospital Emergency Department Data Linking Project (PHED Data) was designed to see if linking ambulance service data to hospitals’ would lead to benefits for the patient without compromising confidentiality.

Results
PHED Data showed it is possible to link ambulance data to ED data across multiple sites, which would suggest that national implementation would also be feasible using the same method.

NHS England has since approved the bid to run this project nationally. The results of the project now form the Ambulance Data Set which will standardise and link data nationally, and will be rolled out across all ambulance services and emergency departments across England.

Here you can find a list of publications authored by CARU and also those from LAS staff and volunteers (all approved by CARU), going back to January 2022.

Clicking on a title below will take you to the article on the publisher’s website. Contributing LAS authors are in bold.

2026

Effectiveness of Multidisciplinary “Case Management” Approaches to the Management of Patients Who Make High Use of the Emergency Ambulance Service: A Quasi-experimental Evaluation Using Linked Routine Records
A Watkins, R Waseem Aslam, T Driscoll, A Edwards, B Edwards, BA Evans, T Foster, R Fothergill, P Gripper, IM Gunson, A John, A Khanom, R Petterson, A Porter, N Rees, A Rosser, Jason Scott, B Sewell, A Tee, H Snooks

Research into the Management of Cardiac Arrest in Children

Researchers at the London Ambulance Service are working with the University of Warwick to understand how ambulance staff respond when a child’s heart suddenly stops beating (cardiac arrest).

As part of this research, a researcher at London Ambulance Service will be reviewing the notes made by London ambulance staff for all children who were treated after their heart stopped beating between 2021 and 2024. They will extract anonymous information about each case which will help us to learn more about the response to these incidents. It won’t be possible to identify any child from the data that is extracted from the ambulance notes, and only anonymous data will be shared with the University of Warwick. The Health Research Authority are providing support for the use of confidential patient information without consent under ‘section 251 support’ on the advice of the Confidentiality Advisory Group, who have reviewed the planned research (24/CAG/0151). The research has also been reviewed and approved by an independent Research Ethics Committee (24/EM/0268).

If you or your child was treated by London Ambulance Service following a cardiac arrest between 2021 and 2024 and you would like to learn more about this research, or if you would prefer if information about you or your child was not included, please contact the London Ambulance Service research team on [email protected]. You may choose to opt out of the use of you or your child’s data for this study by contacting the research team. If you do so, identifiable data about you or your child will not be accessed by the research team for this study. The research team will also check for any child who has a registered NHS National Data Opt Out and will not access their identifiable data as part of this research.

CRASH-4

Intramuscular tranexamic acid for the treatment of symptomatic mild traumatic brain injury in older adults: a randomised, double-blind, placebo-controlled trial

CRASH-4 is exploring the role of intramuscular Tranexamic Acid (TXA) in older patients with mild symptomatic traumatic brain injury (TBI). Trial-trained paramedics administer the trial drug, containing either TXA or a placebo, to these patients on scene.

With increasing age, the risk of intracranial bleeding following mild TBI increases and outcomes for older patients are poorer, with more dying and fewer making a full recovery. Patients may suffer large bleeds or smaller microbleeds that are associated with the development of dementia. CRASH-4 aims to establish if TXA is a useful treatment which prevents intracranial bleeding and improves outcomes for this patient group.

More information can be found on the study website.

PROTECTeD

Exploring and Improving Resuscitation Decisions in Out of Hospital Cardiac Arrest

PROTECTeD aims to explore and improve decision-making regarding termination of resuscitation. It is comprised of five work packages, including interviews with cardiac arrest survivors and their families, London Ambulance Service clinicians and Emergency Department staff. By exploring the perspectives of these groups, this research project aims to change the way we manage termination of resuscitation – developing a consensus of evidence based, ethically grounded guidelines that optimise outcomes for patients and are sensitive to the needs of relatives and the demands on NHS services.

RAPID-MIRACLE

Developing a digital handover application for paramedics to provide a personalised approach to pre-hospital stratification for OOHCA (Out Of Hospital Cardiac Arrest)

RAPID-MIRACLE is a prospective observational study aiming to validate the MIRACLE2 score in the prehospital setting. The MIRACLE2 tool was designed by researchers at Kings College Hospital in collaboration with London Ambulance Service to predict neurological outcomes for patients in out-of-hospital cardiac arrest. The tool aims to stratify patients based on the nature of their cardiac arrest, taking account of variables like age, shockable rhythm and adrenaline administration. As blood pH is also a variable of interest, RAPID-MIRACLE will involve point-of-care blood testing. Advanced Paramedic Practitioners (Critical Care) will aim to recruit 500 patients into the study who will be followed-up to measure survival. Later, the score will be refined and integrated into a digital smartphone application that could be used on scene to predict patients outcome.

SIS

Randomised controlled trial of the clinical and cost-effectiveness of cervical spine immobilisation following blunt trauma (SIS trial)

The LAS is participating in the Spinal Immobilisation Study (SIS), a randomised controlled trial which aims to determine whether movement minimisation is non-inferior to triple immobilisation (hard collar, blocks and scoop) for trauma patients with suspected cervical spine injury.

This important study has been funded by the National Institute for Health and Care Research and will provide much-needed evidence to support our approach to managing these patients in the future. The study has been approved by an independent Research Ethics Committee.