Pesticide PoisoningFAST-AIDNCT07581301
Administering Atropine Through Autoinjectors Within Ambulance Services for Poisoning Patients in Sri Lanka's North Central Province
An observational study of Pesticide Poisoning, run by University of Edinburgh at 1 site in Sri Lanka.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Pesticide Poisoning
- What is being tested?
- Pre-hospital Atropine Autoinjector Administration
- Type of treatment
- Medical device
- How many people
- 30 participants
- Where
- 1 siteSri Lanka
- Study dates
- 1 Dec 2026to 1 Dec 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: The study will involve three participant groups drawn from the Anuradhapura District in the North Central Province of Sri Lanka: * Ambulance staff (Emergency Medical Technicians, drivers, and support staff) working within the Suwa Seriya 1990 ambulance service who administer atropine autoinjectors during the pilot period. * Hospital staff (doctors and nurses) working in Emergency Treatment Units (ETUs) of the hospitals in two geographical clusters, one densely populated and one more remote, that receive pesticide poisoning patients treated with atropine autoinjectors. * Pesticide poisoning patients (men and women aged 18 years and above) who have received atropine via autoinjector from ambulance staff during the pilot period. 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.
Who may be able to join
- Participants over the age of 18 who are willing and able to provide written informed consent will be asked to participate in the study.
- Ambulance staff directly involved in the management and response to pesticide poisoning cases during the intervention period in the selected two geographical clusters.
- Doctors and nurses from selected hospitals in the two geographical clusters who managed pesticide poisoning patients that received atropine via autoinjectors administered by ambulance staff during the intervention period.
- Pesticide poisoning patients managed by Suwa Seriya ambulances in the selected two geographical clusters of the Anuradhapura district during the intervention period.
Who cannot join
- Participants who are unwilling or unable to provide written informed consent will not be included in the study.
- Participants who do not speak Sinhala.
- Participants under the age of 18 years.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Sri Lanka1 site
South Asian Clinical Toxicology Collaboration
Anuradhapura, North Central Province, 50000
Indika Gawarammana, PhD, +94 81 222 4125, indikagaw@gmail.com
About this study
Official title: Feasibility of Using Ambulance Services to Administer Atropine Using Autoinjectors in Farming Communities in the North Central Province, Sri Lanka
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.
Read more
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:
- Operational data from ambulance and hospital records (e.g., response times, use of autoinjectors, patient outcomes).
- Geographic mapping (GIS) of ambulance coverage to assess accessibility and response patterns.
- Focus group discussions with ambulance and hospital staff to explore training, practical challenges, and perceptions of the intervention.
- Semi-structured interviews with patients to understand their lived experience of emergency care.
- Participant observation in ambulances and hospitals to capture the everyday realities of emergency response.
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.
- Conditions
- Pesticide Poisoning
- Being tested
- Pre-hospital Atropine Autoinjector Administration
- Keywords
- Pesticide Poisoning, Pre-Hospital Care, Atropine, Autoinjectors
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Pre-hospital Atropine Autoinjector AdministrationDevice
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.
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: Device: Pre-hospital Atropine Autoinjector Administration |
What is being measured
The primary outcome is the main question the study is designed to answer.
Time from ambulance arrival to atropine administration
Measured in minutes from ambulance arrival at the scene to administration of atropine via autoinjector.
Measured: 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.
Measured: From ambulance arrival at scene until atropine administration or hospital admission, whichever occurs first (typically within 0-2 hours)
Secondary outcomes (4)
Ambulance response time
Time from emergency call dispatch to arrival at the scene.
Measured: 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)
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.
Measured: 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.
Measured: 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.
Measured: At hospital admission
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 May 2026
- Study start1 Dec 2026 (estimated)
- Primary completion31 May 2027 (estimated)
- Study completion1 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Pesticide PoisoningStudies of the same condition, open and under way.
- More trials run by University of EdinburghThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case only
- Time perspective
- Prospective
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Edinburgh
- Sponsor type
- University, hospital or other
- Collaborators
- University of Peradeniya
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07581301
- Sponsor's protocol ID
- AC25185
- Other IDs
- NIHR203140
- Acronym
- FAST-AID
- Status last verified
- Sep 2026
- First submitted
- 16 Apr 2026
- Last updated
- 9 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 9 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Feasibility of Using Ambulance Services to Administer Atropine Using Autoinjectors in Farming Communities in the North Central Province, Sri Lanka
- ClinicalTrials.gov ID
- NCT07581301
- Acronym / sponsor ID
- FAST-AID / AC25185
- Conditions
- Pesticide Poisoning
- Keywords
- Pesticide Poisoning, Pre-Hospital Care, Atropine, Autoinjectors
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 30 participants (estimated)
- Lead sponsor
- University of EdinburghUniversity, hospital or other
- Collaborators
- University of Peradeniya
- Study start
- 1 Dec 2026 (estimated)
- Primary completion
- 31 May 2027 (estimated)
- Study completion
- 1 Dec 2027 (estimated)
- First posted
- 12 May 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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:
- Operational data from ambulance and hospital records (e.g., response times, use of autoinjectors, patient outcomes).
- Geographic mapping (GIS) of ambulance coverage to assess accessibility and response patterns.
- Focus group discussions with ambulance and hospital staff to explore training, practical challenges, and perceptions of the intervention.
- Semi-structured interviews with patients to understand their lived experience of emergency care.
- Participant observation in ambulances and hospitals to capture the everyday realities of emergency response.
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.
Study design
- Observational model
- Case only
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with suspected pesticide poisoning attended by ambulance services | – | Device: Pre-hospital Atropine Autoinjector AdministrationThe 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. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- The study will involve three participant groups drawn from the Anuradhapura District in the North Central Province of Sri Lanka: * Ambulance staff (Emergency Medical Technicians, drivers, and support staff) working within the Suwa Seriya 1990 ambulance service who administer atropine autoinjectors during the pilot period. * Hospital staff (doctors and nurses) working in Emergency Treatment Units (ETUs) of the hospitals in two geographical clusters, one densely populated and one more remote, that receive pesticide poisoning patients treated with atropine autoinjectors. * Pesticide poisoning patients (men and women aged 18 years and above) who have received atropine via autoinjector from ambulance staff during the pilot period. 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.
Key inclusion criteria (4 listed)
- Participants over the age of 18 who are willing and able to provide written informed consent will be asked to participate in the study.
- Ambulance staff directly involved in the management and response to pesticide poisoning cases during the intervention period in the selected two geographical clusters.
- Doctors and nurses from selected hospitals in the two geographical clusters who managed pesticide poisoning patients that received atropine via autoinjectors administered by ambulance staff during the intervention period.
- Pesticide poisoning patients managed by Suwa Seriya ambulances in the selected two geographical clusters of the Anuradhapura district during the intervention period.
Key exclusion criteria (3 listed)
- Participants who are unwilling or unable to provide written informed consent will not be included in the study.
- Participants who do not speak Sinhala.
- Participants under the age of 18 years.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Pre-hospital Atropine Autoinjector AdministrationAdministration 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. | Device | Patients with suspected pesticide poisoning attended by ambulance services |
Primary outcome
Time from ambulance arrival to atropine administration
Time frame: From ambulance arrival at scene until hospital admission (typically within 0-2 hours)
Measured in minutes from ambulance arrival at the scene to administration of atropine via autoinjector.
Proportion of eligible patients receiving atropine via autoinjector
Time frame: From ambulance arrival at scene until atropine administration or hospital admission, whichever occurs first (typically within 0-2 hours)
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.
4 secondary outcomes
Ambulance response time
Time frame: 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)
Time frame: From estimated time of exposure to atropine administration, assessed up to 6 hours
Adverse events related to atropine administration
Time frame: From time of atropine administration to hospital admission, assessed up to 2 hours
Glasgow Coma Scale (GCS) score at hospital arrival
Time frame: At hospital admission
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Sep 2026.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Pesticide Poisoning, run by University of Edinburgh at 1 site in Sri Lanka.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sri Lanka. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Michael Eddleston, PhD (+44-131-242-1383, M.Eddleston@ed.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Time from ambulance arrival to atropine administration (time frame: From ambulance arrival at scene until hospital admission (typically within 0-2 hours)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2026.