Paramedics in the West Midlands are taking part in a clinical trial that could result in thousands fewer patients with heart complaints being taken to hospital; instead being treated at home.

The study, titled PRESTO (the Pre-hospital Evaluation of Sensitive Troponin), is part of the NHS’ ambition to find new ways of delivering healthcare more efficiently without the need for hospital treatment.

West Midlands Ambulance Service is working with three other ambulance services in the trial which is led by the University of Manchester and Manchester University NHS Foundation Trust and is funded by the National Institute for Health Research. Consultant Paramedic, Matt Ward, said:

“Chest pain is the second most common reason why people call 999. However, it doesn’t always mean the patient is having a heart attack; the symptoms are often similar for non-cardiac conditions.

“What this trial is aiming to do is to allow paramedics to carry out a test at scene which would allow them to know which are which. 

“If the research is positive it could result in ambulance staff being able to provide reassurance much sooner to patients with chest pain while also reducing the number of patients ambulance crews take to A&E departments.”

The trial will be run in Coventry and Warwickshire; the Trust will work with Warwick Hospital and University Hospital Coventry and Warwickshire.

For patients willing to take part, they will continue to get exactly the same treatment as they do now except for the paramedic taking a small vial of blood at the scene.  In total, it is hoped 100 patients will take part locally; 700 nationally.

Researchers have already developed a system called the ‘Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid’ to avoid unnecessary hospital admissions from A&E and enable earlier specialist treatment to those that need it.  Over a third of all patients having the test do not need to be admitted to hospital. 

The PRESTO study is now assessing whether this decision aid is suitable for use before patients are taken to hospital. WMAS Research Paramedic, Imogen Gunson, added:

“If the trial is successful it could be possible to provide all ambulances with a portable blood testing device which would allow ambulance staff to run these important tests without patients having to be taken to the hospital.

“The impact would be huge; clinicians would be able to make more informed decisions about the best patient care with more in-depth tests at the patient’s side at scene.  

“As well as providing those patients with non-cardiac related chest pain with reassurance, it would mean those that are having acute coronary problems would receive treatment more quickly resulting in better treatment and potentially saving lives.”

The study is supported by the NIHR Clinical Research Network: Greater Manchester and receiving in kind support from Abbott Point of Care, LumiraDx and Roche Diagnostics International Ltd.