Ethical and practical problems in blood sampling for research purposes during pre-hospital emergencies

Research in the pre-hospital phase of emergencies involves certain ethical and practical challenges. Severely ill or injured patients are not able to give informed consent in the immediate stressful situation. The aim of this pilot study was to find an ethically acceptable method to carry out research in acutely ill or injured patients before any treatment was given in order to be able to study the acute and unmodified systemic inflammatory response to trauma.

Younger physicians were assigned to the mobile emergency care unit (MECU) on a volunteer basis. They drew blood samples 'at the scene' from patients exposed to accidental injury or from patients with acute medical emergencies. The ethical committee accepted that informed consent to blood analyses could be postponed until later or given by relatives. Pro- and anti-inflammatory cytokines, catecholamines and cortisol were measured.

During 6 months, the study group accompanied the MECU on approximately 500 call-outs. Blood samples were drawn from 42 patients. Consent to the analysis of blood samples was obtained in 30 cases. In 20 cases, it was not possible to draw the blood sample before medication.

This pilot study showed that it was possible to conduct blood sampling from acutely ill patients 'at the scene'. However, the present legislation on informed consent makes this type of research very time consuming. When patients die in hospital and no relatives can be found, consent cannot be obtained, and information from these severely affected patients is lost.