“It took 18 months to get our findings published; it was one of the hardest things I’ve done.”
For somebody used to dealing with stressful situations daily as a paramedic, this may be a surprising quote to hear from Michelle Waddington.
Research Paramedic Michelle, of North West Ambulance Service (NWAS) NHS Trust, completed a 12-month Data Science Internship with ARC NWC in 2023 which identified inequalities faced by end-of-life patients receiving paramedic care.
It led to not only a successful publication but a new promotion to help drive forward research for the service.
Hospital admissions of patients who are terminally ill can be associated with poor experiences and unwanted outcomes, such as dying away from home. While area deprivation is associated with emergency hospital admissions in the last year of life, few studies have explored the relationship between deprivation and ambulance clinicians’ decisions to convey a patient to the hospital.
At the core of her internship was a study to investigate this further.
The North West region, which has a population of over seven million people, requires NWAS to cover over 5,500 square miles – the communities of Cumbria, Lancashire, Greater Manchester, Merseyside, and Cheshire.
To enable Michelle’s research, a dataset for end-of-life patients was extracted from the 1.3 million 999 calls the Ambulance Service receives per year, which equates to 16% of the national 999 calls received.
The number of calls attended by ambulance clinicians for terminally ill patients included in the analysis was 1737 between March 2021 to February 2022. Ten per cent of these calls resulted in the patient being taken to the hospital.
Findings suggested the odds of being taken to hospital were 1.51 times greater for patients living in the 20% most deprived areas compared with those in less deprived areas, in the final model adjusted for age, gender, place of residence and the initial coded reason for the call.
Michelle, who has been working for NWAS for over twenty years, said:
“Our study findings suggested that patients with terminal illnesses living in the most deprived areas are more likely to be taken to hospital by ambulance clinicians, compared with those in less deprived areas. Overall, however, a small proportion of patients classed as terminally ill in all areas were taken to hospital. This implies that most end-of-life care provided by ambulance clinicians in this region will be in a patient’s place of residence, with implications for time, resources, and training.”
The findings were backed up by evidence from ARC South London which helped collate the Marie Curie Better End of Life Report 2024, that looked at the palliative care experiences of patients and their family members. It found that many people are dying without the support they need.
From her base in East Lancashire, Michelle helps provide emergency cover to communities in both Blackburn and Preston and since the data internship with ARC NWC, has been promoted to a Research Paramedic, meaning two days a week of her job are spent on research while her remaining shifts still take place in the ambulance cab.
Michelle stresses that securing her Research Paramedic post was only possible due to her internship with ARC NWC.
“The position came up after COVID, but I did not apply as I had no experience of research. I done the internship and the post became vacant again, I applied and got it as I could talk about my experience in research.
“The internship was a massive opportunity as I was still getting paid, part of my salary was backfilled, and you have the support of academics and other experts in data management. The value of data from emergency calls in ambulance services is immense.”
Feeling grateful for the support through her internship journey, Michelle is keen to flag up her support system of new colleagues across The University of Liverpool, Lancaster University and NWAS.
“I had a direct link with Dr Pete Dixon, theme manager at ARC NWC in Liverpool, who met with me every week and he guided me through the processes of research. We went through the process of collecting the 999 data from NWAS and once we received it, we then cleaned it up so that it was suitable for analysis.
“Professor Nancy Preston from Lancaster and Dr Maddy French from Lancaster University were instrumental in navigating me through my research journey and I had strong support from colleagues Sandra Igbodo, Research Manager, and Kieran Potts, Regional Lead for Palliative and End-Of-Life Care within NWAS, who offered unwavering support in my development.
Kieran said: “Michelle has put huge trust in the internship and in ourselves as a team, and it is certainly paying significant dividends, both to her own knowledge and to our collective organisational knowledge and relationship development.”
Now that the findings have been peer-reviewed and formally published, Michelle is sharing the results with teams in the service and further afield to influence how paramedic approaches to end-of-life care can be improved and her ambitions have not stopped there.
“I have joined the Principal Investigator Pipeline Programme (PIPP) with the NIHR, a 12-18-month programme providing theoretical learning and practical experience for research delivery staff to develop as principal investigators (PIs). It has been quite the journey.”
Those 18 months of peer review were worth the wait.
Michelle’s research can be cited as: French M, Waddington M, Dixon P, Potts K, Igbodo S, Simpson J, Preston N. Deprivation is associated with hospital conveyance among patients who are terminally ill. Emerg Med J. 2025 Aug 19;42(9):565-571. doi: 10.1136/emermed-2023-213742.