Understanding public perspectives of prehospital trauma research: A qualitative community engagement study on consent and blood transfusion.

Abstract

Background: Unintentional injuries are a major cause of death worldwide. Modern trauma systems have reduced morbidity and mortality through rapid prehospital care, yet trauma research faces challenges obtaining informed consent during emergencies. Because patients are often incapacitated and substitute decision makers are unavailable, studies commonly rely on deferred or waived consent. Despite their use, little is known about public perspectives on these models or on prehospital interventions such as paramedic-administered blood transfusion.

Objective: To explore Canadian public perspectives on trauma research, alternative consent models, and prehospital blood transfusion.

Methods: A multi-methods community engagement study, including a national survey and 96 in situ interviews in four rural Ontario communities. Survey and interview questions assessed trust in healthcare, views on research consent, and acceptance of prehospital blood transfusion. Quantitative data were summarized descriptively; qualitative data underwent thematic analysis.

Results: Survey respondents reported strong trust in the healthcare system (75%) and support for clinical trials (80%). Acceptance of alternative consent was mixed, with only 40% finding it acceptable. Most agreed that data collected before withdrawal of consent should remain usable. Support for paramedic-administered blood transfusion was high (70%), grounded in urgency and trust in paramedic expertise, though concerns included safety and autonomy. Interviews reinforced these themes, emphasizing conditional acceptance of deferred consent, preference for timely communication, and strong trust in paramedics during life-threatening emergencies.

Conclusion: Canadians support prehospital blood transfusion and recognize the need for trauma research, but acceptance of alternative consent models depends on transparency, perceived necessity, and respect for autonomy.