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| ID | Type | Description | Link |
|---|---|---|---|
| NIHR203140 | Other Grant/Funding Number | National Institute of Health and Care Research, UK |
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| Name | Class |
|---|---|
| University of Peradeniya | OTHER |
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Pesticide poisoning remains one of the most serious public health challenges in rural Sri Lanka, particularly in the North Central Province (NCP), where intensive farming and heavy pesticide use have led to high rates of accidental and intentional poisoning. Although the antidote, atropine, is routinely used in hospitals, delays in receiving treatment often occur because patients must travel long distances before reaching care. Early initiation of treatment is critical, and survival depends on the speed with which atropine is administered.
The government's free 1990 Suwa Seriya ambulance service, established in 2016, provides emergency transport across Sri Lanka but currently has limited capacity for administering time-sensitive antidotes. Community consultations conducted during an earlier study revealed that people preferred life-saving treatments such as atropine to be managed through the formal health system, rather than stored in villages. This led to the idea of exploring whether ambulance staff could safely use atropine autoinjectors; simple, pre-filled devices that deliver the drug quickly and can safely be used even by non-medical professionals.
The FAST-AID study aims to assess the feasibility of introducing atropine autoinjectors into Sri Lanka's emergency ambulance system for use in pesticide poisoning cases. The main question is:
How feasible is it to integrate atropine autoinjectors into the ambulance service to provide earlier treatment for pesticide poisoning patients? Secondary questions explore (1) how ambulance coverage and travel routes affect timely administration; (2) how ambulance and hospital staff experience the use of the devices; and (3) how patients perceive the care they received.
The study will be carried out in the Anuradhapura District of the NCP, in collaboration with the Suwa Seriya ambulance service and selected hospitals. Two geographical clusters, one densely populated and one more remote, have been chosen to compare different service conditions. Around 30 pesticide poisoning patients will receive atropine using autoinjectors during ambulance transport, under guidance from an on-call emergency physician.
Data will be collected through several complementary methods:
Participants will be adults (aged 18 or above) who either work in the ambulance or hospital system or who have experienced pesticide poisoning and received atropine during the study period. All participants will provide written informed consent.
The research team will include Sri Lankan and UK collaborators from the University of Edinburgh and the South Asian Clinical Toxicology Research Collaboration (SACTRC).
By assessing the operational and social feasibility of using atropine autoinjectors in ambulances, this study aims to strengthen Sri Lanka's emergency response system and provide a foundation for a larger trial that could ultimately help save lives of those experiencing pesticide poisoning.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with suspected pesticide poisoning attended by ambulance services | The cohort includes individuals with suspected pesticide poisoning attended by participating Suwa Seriya 1990 ambulances in the North Central Province of Sri Lanka. Cases are identified at the pre-hospital stage based on reported exposure and clinical presentation, reflecting real-world emergency conditions where diagnostic confirmation is often unavailable at first contact. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Pre-hospital Atropine Autoinjector Administration | Device | Administration of atropine via pre-filled autoinjector by trained ambulance staff of the Suwa Seriya 1990 for patients with suspected pesticide poisoning in the pre-hospital setting. Selected ambulances will be equipped with atropine autoinjectors, and staff will receive training on identification of poisoning cases, indications for atropine use, dosing, and safe administration. The intervention is implemented during routine emergency response, with atropine administered when clinically indicated prior to hospital arrival. This intervention aims to enable earlier delivery of atropine and improve initial management within the emergency care pathway. |
| Measure | Description | Time Frame |
|---|---|---|
| Time from ambulance arrival to atropine administration | Measured in minutes from ambulance arrival at the scene to administration of atropine via autoinjector. | From ambulance arrival at scene until hospital admission (typically within 0-2 hours) |
| Proportion of eligible patients receiving atropine via autoinjector | Defined as the number of suspected pesticide poisoning cases attended by participating Suwa Seriya 1990 ambulances who receive atropine via autoinjector, divided by the total number of eligible cases. | From ambulance arrival at scene until atropine administration or hospital admission, whichever occurs first (typically within 0-2 hours) |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulance response time | Time from emergency call dispatch to arrival at the scene. | From emergency call dispatch to ambulance arrival at scene (typically within 0-60 minutes) |
| Time to atropine administration (minutes) from reported pesticide exposure (ambulance records) |
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Inclusion Criteria:
Exclusion Criteria:
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The study will involve three participant groups drawn from the Anuradhapura District in the North Central Province of Sri Lanka:
The total expected sample size is approximately 30 pesticide poisoning patients, and all ambulance and hospital staff directly involved in these 30 cases will also be invited to participate in focus group discussions.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Michael Eddleston, PhD | Contact | +44-131-242-1383 | M.Eddleston@ed.ac.uk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| South Asian Clinical Toxicology Collaboration | Anuradhapura | North Central Province | 50000 | Sri Lanka |
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Measured as the time interval in minutes between the estimated time of pesticide exposure (as reported by the patient or bystanders and documented by emergency medical technicians) and the time of atropine administration via autoinjector recorded in ambulance patient care records of the Suwa Seriya 1990. This measure will be recorded only for cases where both time points are available. |
| From estimated time of exposure to atropine administration, assessed up to 6 hours |
| Adverse events related to atropine administration | Defined as the number of participants with any documented adverse reactions following atropine administration via autoinjector, as recorded in ambulance and hospital records. | From time of atropine administration to hospital admission, assessed up to 2 hours |
| Glasgow Coma Scale (GCS) score at hospital arrival | Measured using the Glasgow Coma Scale (GCS), a standardized clinical assessment of level of consciousness ranging from 3 to 15, as recorded at the time of hospital admission following transport by Suwa Seriya 1990. | At hospital admission |