Prehospital Emergency Care最新文献

{"title":"Interventions Targeting Resistance and Resilience Among Emergency Medical Service Clinicians: A Systematic Review.","authors":"Ian J Saldanha, Allen Zhang, George S Everly, Enid Chung Roemer, Edbert B Hsu, Genie Han, Ritu Sharma, Emmanuel Asenso, Drew Bidmead, Eric B Bass, J Lee Jenkins","doi":"10.1080/10903127.2025.2465712","DOIUrl":"https://doi.org/10.1080/10903127.2025.2465712","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the effectiveness and harms of interventions to promote resistance and resilience regarding mental health and occupational stress issues among emergency medical service (EMS) clinicians.</p><p><strong>Methods: </strong>We registered the systematic review prospectively on PROSPERO (CRD42023465325). We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites for studies published from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant abstracts. We included studies of EMS clinicians in high-income countries that evaluated interventions targeting resistance or resilience regarding mental health or occupational stress issues. We assessed the risk of bias and evaluated strength of evidence (SoE) using standard methods.</p><p><strong>Results: </strong>We included 7 studies (1 randomized controlled trial, 1 controlled trial with a waitlist control, 4 pre-post studies, and 1 prospective cohort [single group] study) that evaluated a total of 425 EMS clinicians. We deemed 5 of the 7 studies to have high risk of bias, 1 moderate risk, and 1 low risk. No meta-analysis was feasible because of heterogeneity in the interventions evaluated across studies. Mindfulness-building interventions targeting resistance and resilience among EMS clinicians were associated with reduced burnout at up to 6 months of follow-up (low SoE). The evidence was insufficient regarding the impacts of interventions targeting both resistance and resilience on anxiety and depression. No conclusions are possible for resistance-only or resilience-only interventions. No studies reported on the effectiveness of any interventions in reducing hospitalizations, post-traumatic stress disorder, substance use, suicidality, or withdrawals from the workforce. No studies reported on unintended harms of interventions.</p><p><strong>Conclusions: </strong>Given the sparse evidence identified in this systematic review, evidence-based options to improve mental health outcomes for EMS clinicians are very limited. Future research is urgently needed to inform strategies to address the many mental health and occupational stress issues that face the EMS clinician workforce.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-31"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-analysis.","authors":"Ian J Saldanha, Enid Chung Roemer, Edbert B Hsu, George S Everly, Genie Han, Allen Zhang, Ritu Sharma, Emmanuel Asenso, Drew Bidmead, Eric B Bass, J Lee Jenkins","doi":"10.1080/10903127.2025.2465715","DOIUrl":"https://doi.org/10.1080/10903127.2025.2465715","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.</p><p><strong>Methods: </strong>We searched Medline, Embase, CENTRAL, and CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full-texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).</p><p><strong>Results: </strong>We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. <u>Research Question 1</u> (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). <u>Research Question 2</u> (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.</p><p><strong>Conclusions: </strong>The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-23"},"PeriodicalIF":2.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Pediatric Severe and Inflicted Trauma - A Position Statement and Resource Document of NAEMSP.","authors":"Mark X Cicero, Kathleen Adelgais, Melissa C Funaro, Kathryn Schissler, Angela Doswell, Matthew Harris, Ruchika M Jones, Janice Lester, Christian Martin-Gill","doi":"10.1080/10903127.2025.2457141","DOIUrl":"10.1080/10903127.2025.2457141","url":null,"abstract":"<p><p>Pediatric trauma patients have unique physiology and anatomy that impact the severity and patterns of injury. There is a need for updated, holistic guidance for Emergency Medical Services (EMS) clinicians and medical directors to optimize prehospital pediatric trauma guidelines based on evidence and best practice. This is especially pertinent to pediatric severe and inflicted trauma, where prehospital evaluation and management determine the overall quality of care and patient outcomes. This position statement addresses the prehospital evaluation and management of pediatric severe and inflicted trauma and is based on a thorough review and analysis of the current literature.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EMS Agency Characteristics and Adverse Events in Pediatric Out-of-Hospital Cardiac Arrest Among 49 U.S. EMS Agencies.","authors":"Matthew L Hansen, Grace Walker-Stevenson, Nathan Bahr, Tabria Harrod, Garth Meckler, Carl Eriksson, Ahamed Idris, Tom P Aufderheide, Mohamud R Daya, Ericka L Fink, Jonathan Jui, Maureen Luetje, Christian Martin-Gill, Steven Mcgaughey, Jonathan H Pelletier, Danny Thomas, Jeanne-Marie Guise","doi":"10.1080/10903127.2025.2461284","DOIUrl":"10.1080/10903127.2025.2461284","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric out-of-hospital cardiac arrest (OHCA) impacts 15,000-25,000 children annually in the U.S. The objective of this study was to determine if specific Emergency Medical Services (EMS) agency factors, such as pediatric volume and preparedness factors, including hours of required pediatric training, pediatric emergency care coordinator (PECC), or pediatric informational resources are associated with improved quality of care or adverse events for pediatric OHCA.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of EMS clinical records and EMS agency survey among five agencies in the Portland OR, Pittsburgh PA, Milwaukee WI, San Bernardino CA, Atlanta GA, and Dallas TX regions. We reviewed medical records of children who experienced an EMS-treated OHCA between 2013 and 2019 using a validated structured chart review tool to identify adverse safety events (ASEs). Agencies who contributed medical records completed a survey that described elements of pediatric preparedness and organizational structure relevant to pediatric care. We first conducted a descriptive analysis of agency and patient characteristics, followed by an evaluation of the association of agency factors that we hypothesized could improve pediatric care and reduce the occurrence of ASEs.</p><p><strong>Results: </strong>Twenty-two agencies with a total of 659 OHCA patient encounters completed the survey. The Broselow system was used by 81% of agencies, local protocol guides were used in 86% of agencies. Forty-five percent of agencies had a designated pediatric emergency care coordinator (PECC). Agencies reported a similar number of hours for pediatric and neonatal simulation (1.3 and 1.5 h, respectively) and skills training (2.0 and 2.5 h, respectively) annually. We found that younger patient age significantly increased the risk of an ASE. In both univariate and multivariate analyses, several hypothesized variables were not associated with decreased risk of an ASE, including pediatric and neonatal skills/simulation training hours, conducting pediatric-specific quality reviews, and having an identified PECC.</p><p><strong>Conclusions: </strong>In this large medical record review of EMS-treated pediatric OHCA cases, pediatric training, pediatric care coordination, and conducting pediatric quality reviews were not associated with reduced ASEs. Additional research is needed to understand how EMS agencies can improve the quality of care for pediatric OHCA, especially for infants.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest Compressions Synchronized to Native Cardiac Contractions are More Effective than Unsynchronized Compressions for Improving Coronary Perfusion Pressure in a Novel Pseudo-PEA Swine Model.","authors":"Keith A Marill, James J Menegazzi, Jorge A Gumucio, Rameen Forghani, David D Salcido","doi":"10.1080/10903127.2025.2463633","DOIUrl":"https://doi.org/10.1080/10903127.2025.2463633","url":null,"abstract":"<p><strong>Objectives: </strong>Pulseless electrical activity (PEA) arrest, which includes pseudo-PEA, is increasingly common and survival remains dismal. We hypothesized that mechanical chest compressions synchronized to native cardiac contractions improve coronary perfusion pressure (CPP) during pseudo-PEA resuscitation.</p><p><strong>Methods: </strong>We developed a model of pseudo-PEA by infusing high dose esmolol intravenously into anaesthetized, intubated, and central arterial and venous catheterized swine to a goal of 45 mm Hg mean arterial blood pressure (MAP). We performed a randomized unblinded repeated crossover trial by administering alternating synchronized and unsynchronized chest compressions for 52 seconds preceded by 8 second breaks consecutively 4 times. We repeated the protocol approximately 4 times with 1 minute breaks. Synchronized compressions were provided 1:1 with native contractions during systole and unsynchronized compressions were provided at 100 beats per minute (BPM). We measured average CPP, MAP, and heartrate (HR) for 5 beats immediately preceding the chest compression onset and for 30 seconds 10 seconds after compression onset. We computed the difference in continuous CPP during compressions compared to the immediately preceding baseline for each interval. We developed a mixed linear model with outcome average CPP during compressions minus baseline, fixed variable compression type, and random variable animal.</p><p><strong>Results: </strong>We included 6 animals. Mean baseline HR was 76.0 BPM, MAP 49.9, and CPP 36.2. Chest compressions increased CPP from baseline an average 1.7 mm Hg when unsynchronized and 5.6 mm Hg synchronized. The adjusted difference was 4.0 mm Hg (95% CI 2.4-5.5).</p><p><strong>Conclusions: </strong>Synchronized chest compressions increased CPP 4.0 mm Hg (135%) more than unsynchronized compressions despite a lower compression rate in medication-induced pseudo-PEA. Further refinement and eventual application to patients suffering pseudo-PEA arrest appear warranted.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of 67,975 emergency deployments in a major German city - criteria for more efficient dispatching of emergency physicians.","authors":"Yacin Keller, Anne Schrimpf, André Gries","doi":"10.1080/10903127.2025.2460071","DOIUrl":"https://doi.org/10.1080/10903127.2025.2460071","url":null,"abstract":"<p><strong>Objectives: </strong>Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.</p><p><strong>Methods: </strong>Rescue service deployments in the city of Dresden, Germany (01/01/2021-12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site - such as airway, breathing, circulation, and disability - based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.</p><p><strong>Results: </strong>In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.</p><p><strong>Conclusions: </strong>The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EMS clinician perceptions on prehospital buprenorphine administration programs.","authors":"Wesley R Wampler, Mirinda Ann Gormley, Sarah F Griffin, Jose CorreaIbarra, Parker Bailes, Daniel L Schwerin, Keri Queen, Katy Jones, Sarah B Floyd, Gerald Wook Beltran, Alain H Litwin, Phillip Moschella","doi":"10.1080/10903127.2025.2462774","DOIUrl":"https://doi.org/10.1080/10903127.2025.2462774","url":null,"abstract":"<p><strong>Objectives: </strong>Personal attitudes amongst emergency medical services (EMS) clinicians could influence successful implementation of prehospital buprenorphine administration programs (PBAPs), yet few studies have investigated EMS clinician perceptions concerning these innovative programs. This mixed-methods study assessed EMS clinician perceptions and concerns about PBAPs.</p><p><strong>Methods: </strong>Emergency Medical Technicians (EMTs), advanced EMTs and paramedics were recruited for focus groups from Upstate South Carolina. Researchers moderated groups of 12 or fewer and field personnel were interviewed separately from EMS training officers and leadership. Participants took a survey assessing demographic, employment, and contextual information on EMS-led interventions addressing the opioid epidemic. Moderators asked participants to provide confidential responses to four open-ended questions. Thematic analysis was applied to all responses using the framework method. A codebook was modeled using deductive themes from previous literature, while inductive themes and subthemes were added through researcher consensus. Final coding of themes and subthemes was constructed independently by two researchers with disagreements resolved by a third. Descriptive statistics summarized demographic, employment, and contextual information collected from the survey.</p><p><strong>Results: </strong>The 107 participants were predominantly male (69.2%) and White (96.3%) with an average age of 38.4 years (SD = 11.4). Half were paramedics and 35.5% were EMTs with EMS experience ranging from 3 months to 39 years, median of 10 years. Most (70.2%) heard of buprenorphine and 28.9% received education on medication for opioid use disorder (MOUD). Describing initial reactions to an overdose, themes included overdoses as a routine part of EMS and naloxone distribution changing overdose dynamics. Themes included opioid withdrawal is not a medical emergency, buprenorphine negatively affecting EMS operations, and PBAPs requiring culture shift. Themes surrounding concerns included EMS clinician perceptions of individuals with opioid use disorder (OUD), PBAPs increasing substance misuse, and buprenorphine increasing EMS clinician liability. At the end of the session 45.8% stated they would want their EMS agency to participate in a PBAP, 44.9% would not want their agency to participate, and 8 (7.5%) did not answer.</p><p><strong>Conclusions: </strong>Emergency medical services clinicians' perceptions towards prehospital buprenorphine administration could influence adoption of PBAP protocols. Findings may inform PBAP educational initiatives which mitigate these concerns and knowledge gaps.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Conventional and Telemedicine Medical Services to Reduce the Burden on Emergency Medical Services in Rural Areas: A Retrospective Cohort Study.","authors":"Ryota Inokuchi, Ayaka Sakamoto, Yu Sun, Masao Iwagami, Nanako Tamiya","doi":"10.1080/10903127.2025.2460205","DOIUrl":"10.1080/10903127.2025.2460205","url":null,"abstract":"<p><strong>Objectives: </strong>During the COVID-19 pandemic, the number of ambulance calls increased sharply, and ambulances could not be dispatched due to unavailability, especially in rural areas. This study assessed the integration of traditional emergency care systems in rural areas with online medical services from urban areas.</p><p><strong>Methods: </strong>In this retrospective observational cohort study, patients recovering from mild COVID-19 at home who called an ambulance (November 2022 to January 2023) in Asahikawa, Japan were included. When an emergency call was received, the fire department control center initiated an online medical consultation to ascertain the necessity of ambulance transport while conventionally dispatching an ambulance. We compared chief complaints and patient characteristics between those who were transferred to hospitals and those who were not transferred, considering the time from the beginning of the 1-1-9 call to the start of the online service, and the duration of the online consultation for each group. The statistical significance of the differences between groups was analyzed by the Mann-Whitney U-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables with statistical significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Among the 136 patients, 73 (53.7%) were transferred to a hospital <i>via</i> ambulance. The median age of the transferred patients was significantly higher, at 83 years (interquartile range (IQR): 57-90), compared with 37 years (IQR: 26-60) for those not transferred (<i>p</i> < 0.001). A significantly higher number of transferred patients had hypoxemia (17, 23.3%; vs. non-transferred, 2, 3.2%; <i>p</i> < 0.001). The time from the start to the end of the online consultation was shorter for the transferred patients (13 min (IQR: 8-20) compared to non-transferred patients (15 min (IQR: 13-22); <i>p</i> < 0.001). There were no significant differences between groups in terms of sex, medical history, other chief complaints, or the time from the start of the 1-1-9 call to the start of the online service.</p><p><strong>Conclusions: </strong>Online medical services have the potential to optimize medical resource allocation and utilization in rural areas.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medical Services-Led Outreach Following Opioid-Associated Overdose: Frequency, Modality, and Treatment Linkage.","authors":"Alexander J Ulintz, Christopher B Gage, Jonathan R Powell, Jacob C Kamholz, Michael S Lyons, Jennifer L Brown, Henry E Wang, Soledad Fernandez, Robert A Lowe, Andrew J Murphy, Janine E Curcio, Ashish R Panchal","doi":"10.1080/10903127.2025.2462211","DOIUrl":"https://doi.org/10.1080/10903127.2025.2462211","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) post-overdose outreach programs expand beyond traditional 9-1-1 response to offer overdose survivors linkage to substance use treatment and other related harm-reducing interventions. Although intuitive and increasingly popular, evidence to define expected outcomes is exceedingly limited. We evaluated process and patient outcomes of one large Midwestern post-overdose outreach program to describe outreach characteristics and linkage to substance use treatment.</p><p><strong>Methods: </strong>This retrospective cohort study used clinical program records of individuals referred to a multidisciplinary post-overdose outreach program following a non-fatal presumed opioid overdose with emergency response. Measures included (i) number of outreach attempts, (ii) modalities of outreach attempts (in-person visit, text message, letter, phone call, or electronic mail), (iii) outcome of outreach (i.e., if the individual was contacted), (iv) interventions provided including linkage to substance use treatment with coordinated admission and transportation. We used descriptive statistics to report patient characteristics, outreach frequency, outreach modality, successful contact, and treatment linkage through the program.</p><p><strong>Results: </strong>From 2020-2022, the program attempted outreach to 3,437 individuals. The median age was 37 years (interquartile range, IQR, 30-47). Most individuals were white/non-Hispanic (n = 2,077, 63.1%) and male (n = 2,084, 61.2%). Few were unhoused at the time of outreach (n = 246, 7.2%). The program made a total of 7,935 outreach attempts with a median of 2 outreach attempts (IQR 1-3) per individual. The most common outreach modalities were in-person visit (n = 3,300, 41.6%) and text message (n = 2,776, 35.0%), though phone calls and in-person visits most often resulted in successful contact (52.6% and 23.7%, respectively). Outreach attempts resulted in 743 (21.6%) successful contacts and the program linked 304 individuals (40.9% of all contacted individuals, 8.8% of all attempted outreach) to treatment. Notably, 160 (52.6%) of the 304 individuals linked to treatment required 3 or more outreach attempts before treatment linkage occurred.</p><p><strong>Conclusions: </strong>Post-overdose outreach initiated by EMS can successfully find and link individuals to substance use treatment following a non-fatal opioid overdose. However, this intervention may be resource intensive, often requiring multiple attempts at outreach and several modalities of interaction to facilitate treatment linkage.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Prehospital Administration of Antibiotics in Trauma Patients - an NAEMSP Resource Document.","authors":"Whitney J Barrett, Kevin A Kaucher, Ross E Orpet, Christopher B, Colwell, John W Lyng","doi":"10.1080/10903127.2025.2460203","DOIUrl":"https://doi.org/10.1080/10903127.2025.2460203","url":null,"abstract":"<p><strong>Objectives: </strong>To conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds.</p><p><strong>Methods: </strong>We performed a literature search and summarized the evidence following the methodology established for the NAEMSP Prehospital Trauma Compendium. We searched PubMed from inception to 23 December 2022 for articles relevant to Emergency Medical Services, trauma, and antibiotics. Due to resource limitations, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was not used during review of the evidence, and no formal assessment of bias or strength of evidence was performed.</p><p><strong>Results: </strong>Of 105 articles identified in the initial search, 13 articles were included in the final evidence review and synthesis. Prehospital administration of antibiotics in combat and civilian trauma patients consists of mostly observational, retrospective studies that describe use as likely safe, but with uncertainty as to its effect on important clinical outcomes. Both combat and civilian analyses of protocol adherence and inter-rater reliability for recognition and treatment of injuries have also produced variable and inconsistent results. These results pose a challenge for implementation and highlight the inherent limitations and external validity of efficacy outcomes published to date.</p><p><strong>Conclusions: </strong>Prehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}