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The Brain Biomarker after Trauma Cohort Study (BBATS) investigates potential biomarkers in traumatic brain injury, for guiding diagnosis, prognosis and treatment of brain injury. It has been running for 19 months. Blood samples must be obtained within 60 minutes (i.e. the ‘Golden Hour’) of traumatic injury. The National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC) trauma research team recruit patients at the scene of injury. This requires extensive collaboration with the ambulance service in order to achieve maximum recruitment in this cohort of patients.


Medical Emergency Response Incident Team (MERIT) training was conducted at the Queen Elizabeth Hospital, Birmingham (QEHB) and the West Midlands Ambulance Service by means of audio-visual presentations and group discussions. Awareness of the study in the Emergency Department (ED) of QEHB was ensured by regular training sessions with relevant staff. Ready-made blood bottle packs were delivered to the MERIT air ambulance base. The trauma research nursing team were available 24 hours a day, attending all trauma activations in ED. Delivery of quarterly interim results and recruitment progress is fed back to the ambulance team and ED staff.


Trauma research nurses screened 481 patients for eligibility into BBATS. 72 (15%) were recruited within the first 19 months and of these only 42% were recruited during working hours, Monday to Friday 09:00–17:00. 409 patients did not meet inclusion criteria. Only 3 patients declined enrolment.


Pre-hospital enrolment of trauma patients into BBATS has been successfully undertaken through coordinated activity between the SRMRC trauma research nursing team and pre-hospital practitioners. However a large proportion of screened trauma patients are not recruited due to lack of blood sample during the ‘Golden Hour’. Achieving research in the pre-hospital setting is possible with clear infrastructure and collaboration established from the outset.

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