The Irish Paramedicine Education and Research Network (IPERN) is dedicated to collaboratively building research culture and research capacity for out-of-hospital care in Ireland and internationally. IPERN is led by an inter-professional team of paramedics, nurses, doctors, allied health professionals and scientists. IPERN supports clinicians to bridge the theory-practice gap through involvement in research training, knowledge generation, knowledge translation, evidence implementation, policy setting, research partnerships, co-production and research leadership. The aim of this study is to quantitatively describe the activity of IPERN in the first two years of it’s foundation (2021-2022).

This is an observational study and data was collected prospectively throughout 2021 and 2022. Data on event attendance was collated via the Event management software EventBrite and supplemented with minutes from IPERN Committee meetings. Data analysis was performed in Microsoft Excel and comprised descriptive statistics.

The IPERN Team comprises 14 inter-professional members of whom nine (64%) are paramedics. To date IPERN has launched seven special interest groups; Medical, Trauma, Pediatrics, Mental Health, Human Factors, Medical Logistics and Equality Diversity & Inclusion. The network hosted 14 CPD events from March 2021 to November 2022. In terms of research capacity building, the work of IPERN has been presented at six international conferences and the IPERN Team has successfully secured four grants since the foundation of the network.

Due to the complex and multidisciplinary nature of out-of-hospital care a strategic and collaborative approach to research capacity-building is essential. Underpinning evidence-based practice is a strong research culture and it is imperative that all clinicians involved in out-of-hospital care have the opportunity to develop knowledge and expertise. IPERN takes a participatory approach to research and our events provide an open and friendly platform for members to engage in research, building a vibrant research community both in Ireland and internationally.

Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.

A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.

We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.

The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.

International reports suggest there have been prehospital delays for time-sensitive emergencies like stroke and TIA during the COVID-19 pandemic. The aim was to investigate the impact of the COVID-19 pandemic on ambulance times and emergency call volume for adults with suspected stroke and TIA in Ireland.

We conducted a retrospective cohort study of patients ≥ 18 years with suspected stroke/TIA, based on data from the National Ambulance Service. We included all cases assigned code 28 (suspected stroke/TIA) by the emergency call-taker, from 2018-2021. We compared ambulance times and emergency call volume by week, the four COVID-19 waves (defined by the Health Protection Surveillance Centre) and annually. The COVID-19 period was from March 1, 2020 - December 19, 2021 and the pre-COVID-19 period January 1, 2018 - February 29, 2020. Continuous variables were compared with t-tests and categorical variables with Pearson’s χ2 tests.

40,012 cases were included: 20,281 in the pre-COVID-19 period and 19,731 in the COVID-19 period. Mean patient age significantly decreased between the two periods, from 71 years (±16.5) to 69.8 years (±17.1); p<0.001. Mean ambulance response time increased between the two periods from 17 minutes 31 seconds to 18 minutes 59 seconds (p<0.001). The number of cases with symptom onset to emergency call time of >4 hours significantly increased from 5,581 to 6,060 during the COVID-19 period (p<0.001). Mean calls/day increased from 25.1/day to 30.1/day during the COVID-19 period.

Early findings from the study suggest an increase in call volume for stroke/TIA between the COVID-19 and pre-COVID-19 periods. An increase in response times during the same periods was also found. We concluded that longer symptom-to-call times indicate a change in healthcare-seeking behavior. Sustaining high levels of compliance with stroke code protocols is crucial during healthcare crises. Future research will involve further analysis including controlling for confounders.

The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions, like stroke and transient ischaemic attack (TIA). Thus, the aim of this study was to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA.

Following a published study protocol, a systematic search of databases was conducted up to May 31, 2022. Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic were considered for inclusion. The methodological quality of the included studies was assessed using the appropriate Joanna Briggs Institute tool. Overall pooled estimates of ambulance times (activation, response, patient care time) were calculated. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Stroke/TIA emergency call volume was reported using a narrative synthesis. Clinical stakeholders and Patient and Public Involvement Contributors were involved from research question development to dissemination of results.

Of 4083 studies identified, 56 unique articles met the inclusion criteria. Early data from 8/12 studies reporting ambulance times, suggests that patient care time increased. Furthermore, emergency call volume for stroke/TIA decreased during the COVID-19 pandemic, according to 43/56 studies that reported this outcome. Terminology for ambulance time intervals differed between studies. The majority of studies reported time from call to hospital arrival, whereas the minority of studies reported activation time.

Preliminary results from our systematic review and meta-analysis show that conflicting evidence exists on the impact of the COVID-19 pandemic on ambulance times and emergency call volume for stroke/TIA. Thus, this review synthesized available evidence on the varied effects across different countries, healthcare systems and ambulance time terminology. Review findings may inform our understanding of healthcare system resilience in response to crises on a broader level.