Prehospital Emergency Care最新文献

{"title":"Low-Titer O + Whole Blood Implementation in the EMS System for Metropolitan Oklahoma City and Tulsa: Significance, Success, & Sharing Lessons Learned.","authors":"Anna M Bailey, Curtis L Knoles, David S Howerton, Duffy McAnallen, Matthew L Cox, Patrick Cody, Jeffrey M Goodloe","doi":"10.1080/10903127.2026.2747040","DOIUrl":"https://doi.org/10.1080/10903127.2026.2747040","url":null,"abstract":"<p><strong>Objectives: </strong>Over 300 emergency medical services (EMS) organizations across the United States have implemented transfusion programs for traumatic injuries using packed red blood cells, platelets, plasma, or whole blood before hospital arrival. Beginning in December of 2022, the EMS System for Metropolitan Oklahoma City (OKC) and Tulsa began carrying low-titer O-positive whole blood (LTOWB) for adult patients in traumatic hemorrhagic shock, specifically those exhibiting elevated shock indexes. We aim to describe establishing our prehospital LTOWB program and its first two years of operations across OKC and Tulsa.</p><p><strong>Methods: </strong>We used an observational study design and retrospective descriptive analysis of patients receiving LTOWB by paramedic transfusion from the Emergency Medical Services Authority Ambulance Service, Oklahoma City Fire Department, or Tulsa Fire Department between December 1, 2022, and February 1, 2025. Descriptive analysis and univariate logistic regression quantify the relationship of patient characteristics against survival to hospital arrival and survival to hospital discharge outcomes.</p><p><strong>Results: </strong>Penetrating trauma was the most common mechanism of injury recorded for patients receiving EMS LTOWB (71.6%). Following LTOWB transfusion, prehospital vital signs (systolic blood pressure, heart rate, and shock index) significantly improved (p < 0.05). Systolic blood pressure improvement conferred 9.7 times greater odds of survival to hospital arrival (95% CL 1.6-58.6). Occurrence of prehospital traumatic circulatory arrest was significantly related to lower odds of survival to hospital arrival and survival to hospital discharge (OR 1.01 and OR 1.04, respectively).</p><p><strong>Conclusions: </strong>Transfusion of LTOWB in a large, urban EMS system in the Southwestern United States confers a positive benefit to patients with measurable improvement in median systolic blood pressure, heart rate, and shock index. Continuous review of cases and misses empowered our system in dynamic protocol adjustments to best meet our population's needs. Patients often had secondary deterioration during transit, illustrating that blood transfusion \"bought\" temporary time during transport of critically injured patients to definitive care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224821","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":"Factors Associated with Low-Acuity EMS Transport to the Emergency Department: An Observational Study Guided by the Andersen Behavioral Model.","authors":"Hannah C Muthersbaugh, James E Winslow, Joseph M Grover, Chris M Gillette","doi":"10.1080/10903127.2026.2747036","DOIUrl":"10.1080/10903127.2026.2747036","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) demand is increasing, with a growing proportion of low-acuity encounters. Prior studies are limited by regional sampling, inconsistent definitions, narrow observation periods, and limited theoretical grounding. The objective of this study was to identify predisposing, enabling, and need-based factors associated with EMS transport among low-acuity emergency department (ED) patients, guided by Andersen's Behavioral Model of Health Services Use.</p><p><strong>Methods: </strong>We conducted a secondary, retrospective observational study using a 10% random sample of multicenter electronic health record data from 21 EDs in the southeastern United States. Eligible visits included: (1) patient age >17 years, (2) occurred between January 1, 2016, and April 29, 2025, (3) triaged as Emergency Severity Index 4 or 5, and (4) ended in a final visit disposition of discharge. The primary outcome was arrival at the ED by EMS. We categorized independent variables as predisposing, enabling, or need-based factors according to Andersen's model. We used multivariable logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 41,761 low-acuity ED encounters, 3,232 (7.7%) arrived by EMS. Higher odds of EMS use were observed for older age (per 10-year increase; aOR 1.33, 95% CI = 1.30-1.36), male sex (aOR 1.20, 95% CI = 1.12-1.30), being retired or disabled (aOR 3.60, 95% CI = 3.15-4.10), being unemployed (aOR 2.26, 95% CI = 2.04-2.52), having a nighttime presentation (aOR 1.63, 95% CI = 1.51-1.76), and mental health diagnosis (aOR 1.76, 95% CI = 1.62-1.90). Lower odds of EMS arrival were observed for white race (aOR 0.89, 95% CI = 0.83-0.96), established primary care (aOR 0.57, 95% CI = 0.53-0.62), weekend presentation (aOR 0.91; 95% CI = 0.84-0.99), and visits during (aOR 0.63, 95% CI = 0.55-0.71) or after (aOR 0.54, 95% CI = 0.48-0.61) the COVID-19 period. Rurality, insurance, and primary language were not associated with EMS use.</p><p><strong>Conclusions: </strong>Among low-acuity ED patients, EMS arrival was associated with older age, unemployment or disability, no established primary care clinician, and a previous mental health diagnosis. These characteristics identify a population that may be served by alternatives to ambulance transport, such as treat-in-place and alternative destination pathways, when paired with expanded access to primary care and behavioral health resources.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167909","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":"Missed Opportunities for Prehospital Transfusion in Pediatric Trauma.","authors":"Jane M Hayes, Gregory A Peters, Jingya Gao, Rebecca E Cash","doi":"10.1080/10903127.2026.2742418","DOIUrl":"10.1080/10903127.2026.2742418","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital blood transfusion has been associated with improved outcomes among pediatric trauma patients, but its utilization nationally remains poorly understood. We recently conducted a similar study that builds upon the findings of the investigation by Ramgopal et al. to identify potential missed opportunities for prehospital transfusion in pediatric trauma.</p><p><strong>Methods: </strong>We utilized the National EMS Information System dataset from 2018-2023 to identify emergency medical services (EMS) responses for pediatric (<18 years of age) trauma patients. We identified trauma patients using the CDC Injury Mortality Diagnosis Matrix related ICD-10 codes. We identified patients at increased risk of benefiting from a transfusion using age-adjusted positive shock index thresholds. The outcome of interested was prehospital blood or blood product transfusion.</p><p><strong>Results: </strong>We found there were 1,663,601 total 9-1-1 EMS activations to a scene for pediatric trauma. There were 363,844 patients with a positive shock index who were considered to be at increased risk of benefiting from a prehospital transfusion, but only 287 (0.1%) of these patients received a prehospital transfusion. Only 10 (2%) of the 468 patients who experienced a cardiac arrest after the arrival of EMS to the scene received a hospital transfusion.</p><p><strong>Conclusions: </strong>Together, our results indicate prehospital transfusion rates ranging from 0.1% to 1.01% among potentially eligible pediatric trauma patients. Although positive shock index does not confirm hemorrhagic shock, these findings suggest underutilization of prehospital blood transfusion among pediatric trauma patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114159","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 Risk Stratification for Early Transfusion in Pediatric Trauma: A National Trauma Data Bank Analysis.","authors":"John Su, Joelle J Donofrio-Odmann, Francis X Guyette, Jonathan Studnek, Christyn Magill, Kathryn M Kothari, Lorin R Browne, Bella Triolo, Manish I Shah","doi":"10.1080/10903127.2026.2750457","DOIUrl":"https://doi.org/10.1080/10903127.2026.2750457","url":null,"abstract":"<p><strong>Objectives: </strong>Pediatric criteria remain limited for identifying injured children who may benefit from early blood transfusion for hemorrhagic shock. This study evaluated whether emergency medical services (EMS)-observable variables in a national trauma registry could identify children at risk for early hospital blood transfusion.</p><p><strong>Methods: </strong>We conducted an observational retrospective cohort study using the National Trauma Data Bank (2017-2020). Among 391,126 records for patients aged 1-15 years, we included children transported by EMS directly from the scene to a participating trauma center after excluding burn injuries, interfacility transfers, and missing pre-identified EMS variables (systolic blood pressure, heart rate, or Glasgow Coma Scale [GCS]). The primary outcome was any blood product administered within 4 hours of emergency department arrival. Five prespecified EMS-observable predictors composed the model: age-adjusted hypotension, age-adjusted tachycardia, GCS ≤14, penetrating mechanism, and prehospital traumatic cardiac arrest. We fit a multivariable logistic regression and a classification and regression tree (CART) using an 80/20 stratified train-validation split. Missing data sensitivity analyses included multiple imputation and CART refitting in the broader eligible cohort.</p><p><strong>Results: </strong>Among 79,764 children, 2,634 (3.3%) received early transfusion in the hospital. All five predictors were independently associated with early transfusion, led by GCS ≤14 (adjusted odds ratio [aOR] 8.38; 95% confidence interval [CI], 7.61-9.22), penetrating mechanism (aOR 5.87; 95% CI, 5.28-6.51), and age-adjusted hypotension (aOR 5.39; 95% CI, 4.74-6.13). In the validation cohort, CART analysis stratified patients into low-, intermediate-, and high-risk tiers comprising 77.0%, 19.7%, and 3.3% of patients, respectively. Early-transfusion rates were 1.2%, 6.1%, and 36.7% across these tiers. The high-risk tier accounted for 36.8% of all early transfusion events. Using the high-risk tier as a decision threshold, sensitivity was 36.8%, specificity 97.8%, positive predictive value 36.7%, and negative predictive value 97.8%.</p><p><strong>Conclusions: </strong>Five EMS-observable features, including age-adjusted hypotension, age-adjusted tachycardia, GCS ≤14, penetrating mechanism, and prehospital traumatic cardiac arrest, identified a small subgroup of pediatric trauma patients with substantially elevated risk of early hospital transfusion. This parsimonious framework may inform prospective validation of prehospital transfusion criteria.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207780","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":"Decreasing response phase lights and siren use through modification of dispatch priority response for 9-1-1 responses to personal emergency response system activations: an interventional study.","authors":"Lori L Boland, Diana Jin, Joey L Duren, Nicholas J Maleska, Marc W LeVoir, Ashish R Panchal","doi":"10.1080/10903127.2026.2751025","DOIUrl":"https://doi.org/10.1080/10903127.2026.2751025","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) responses to personal emergency response systems (PERS) activations predominantly involve low-acuity patients. Recent evidence demonstrates that while most PERS calls are dispatched lights and siren (L&S), only 1% result in L&S transport. Reduction of L&S use through modified dispatch priority response for PERS calls has not been evaluated. Our objective was to evaluate the efficacy of modifying dispatch priority response mode for PERS calls to non-L&S response, the resulting reduction in response phase L&S use, and potential impact on time critical interventions.</p><p><strong>Methods: </strong>We conducted a retrospective observational pre-post analysis comparing PERS responses in two 11-month periods before (January-November 2023) and after (January-November 2024) revising the dispatch priority response for PERS calls to non-L&S in December 2023. We evaluated response mode and transport mode. The primary outcome was total hours/month of response phase L&S use, with L&S duration computed as the interval between unit dispatched and arrival (patient contact) or call cancellation. Descriptive statistics were computed followed by interrupted time series analysis (ITSA) to assess the impact of the intervention on the primary outcome and maintenance of the effect across the post-intervention period (p for post-intervention linear trend).</p><p><strong>Results: </strong>Analysis included 3,262 PERS calls (pre-intervention = 1,634; post-intervention = 1,628). L&S response occurred in 98% (n = 1,601) of pre-intervention calls and 12% (n = 192) of post-intervention calls (p < 0.001). The prevalence of L&S transport was similar in both periods (0.9% vs 0.9%, p = 0.99). The ITSA revealed an immediate 13.8-hour/month decrease in response phase L&S use (95% confidence interval: -16.2 to -11.3) that was sustained across the post-intervention period (p > 0.05). Total response phase L&S hours decreased 86%, from 172 hours in the pre-intervention period to 24 hours during the post-intervention period. Importantly, only four post-intervention calls (0.2%) involved a non-L&S response followed by L&S transport, with just one of these requiring advanced life support interventions.</p><p><strong>Conclusions: </strong>Modifying dispatch priority response for PERS calls reduced L&S responses and yielded a marked decrease in hours of L&S use which was maintained overtime. As the industry advocates for safer, more judicious L&S use, additional low-acuity call types should be identified for similar dispatch priority response revision.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207822","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":"The Cost-Effectiveness and Health Equity of Prehospital Treatment Strategies for Out-of-Hospital Cardiac Arrest Patients: A Systematic Review.","authors":"Kyumin Jang, Rachael L Morton, Mark Dennis, Jessica Nikolovski, Xin Zhan, Yuling Ke, Brian Burns, Anh D Tran","doi":"10.1080/10903127.2026.2741269","DOIUrl":"10.1080/10903127.2026.2741269","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge, associated with substantial mortality and significant costs for health care system. This systematic review aimed to (i) synthesize economic evaluations of prehospital treatment strategies for OHCA from ambulance attendance through to hospital discharge; (ii) assess the methodological quality and reporting of the included studies; and (iii) evaluate the reporting of health equity-relevant data.</p><p><strong>Methods: </strong>We searched Medline, Embase, Scopus, EconLit, and CINAHL databases for records from database inception to 12 June 2026. The QHES and CHEERS checklists were used to assess the quality and reporting standards of included studies, and the review was reported according to the PRISMA checklist. The completeness of reporting health equity outcomes was reviewed using the PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status and Social capital) - Plus framework.</p><p><strong>Results: </strong>Ten economic evaluations met eligibility criteria. Most studies were cost-utility analyses (<i>n</i> = 8, 80%) and used Markov models (<i>n</i> = 6, 60%). Most evaluations were 'very good quality' (<math><mrow><mo>≥</mo></mrow></math>80%) (<i>n</i> = 6, 60%). Early defibrillation and advanced life support (ALS) delivered by trained emergency medical technicians were cost-effective compared with no intervention, emergency physician-led ALS, standard emergency medical services or paramedic care (ICER range from £11,407 to USD $56,700 per QALY gained). Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) was more cost-effective than in-hospital ECPR strategies (ICER range from AUD $27,323 to $44,000 per QALY gained). Termination-of-resuscitation (TOR) strategies were cost-effective compared with no TOR or other TOR strategies, including basic life support and ALS TOR, with estimates of $110,554 saved per QALY lost and USD $23,851 per QALY gained. Survival rate and neurological outcomes influenced cost-effectiveness results. Equity reporting was limited: almost all included studies addressed less than 40% of the PROGRESS-Plus equity criteria.</p><p><strong>Conclusions: </strong>Most strategies that increased prehospital treatment intensity, avoided futile transport, or enabled earlier advanced care were cost-effective; however, the certainty of evidence, particularly for sub-groups, was limited by heterogeneous comparators and sparse equity reporting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-30"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081869","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 Care of Older Adults Following Perceived Low-Acuity Falls and Related \"Lift Assist\" Encounters: An NAEMSP Position Statement and Resource Document.","authors":"Maia Dorsett, Tom Wen-Han Su, Andra M Farcas, Jenna White, Tony Rosen, Jeffrey E Rollman, Kevin Joles, Christopher Colwell, Anjni Joiner","doi":"10.1080/10903127.2026.2748380","DOIUrl":"https://doi.org/10.1080/10903127.2026.2748380","url":null,"abstract":"<p><p>Older adults who present as low-acuity falls requiring mobilization assistance, commonly referred to as a \"lift assist\", represent a common reason for EMS activation. These encounters often involve underlying medical conditions or injuries that are not immediately apparent, and missed or delayed diagnosis is associated with adverse outcomes. At the same time, some patients are transported to the emergency department when it is not necessary, exposing them to potential harms and contributing to increased healthcare utilization. These encounters are therefore complex clinical presentations and represent important opportunities for thorough assessment and higher-order clinical decision making, supported by systems that enable appropriate disposition and follow-up. However, there is a system-level bias, beginning in initial education and reinforced through dispatch, policy, and protocol, that frames these encounters as uniformly low-acuity, non-medical, minor traumas leading to underassessment and limiting clinical decision-making. Therefore, NAEMSP recommends:EMS systems should recognize calls for falls or \"lift assists\" as patient encounters that warrant an assessment, including evaluation for underlying medical causes, traumatic injuries, and safety, and frame these encounters as opportunities for higher-order clinical decision-making within the broader context of geriatric syndromes rather than isolated low-acuity events.EMS systems should support transport decisions based on a thorough assessment and patient-centered discussion, recognizing that not all patients require ED transport and that safe alternatives may include non-transport or referral to appropriate follow-up pathways.EMS systems should track the assessment of patients encountered during \"lift assist\" responses and older adults following perceived low acuity falls as a system-level quality measure to monitor performance and drive improvement.Policymakers and payers should implement sustainable reimbursement structures that support EMS assessment and care even when transport does not occur.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-40"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183918","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":"Response to \"Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature\".","authors":"Thomas Lardaro, L Anthony Cirillo","doi":"10.1080/10903127.2026.2745170","DOIUrl":"10.1080/10903127.2026.2745170","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114076","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":"Supporting Mental Health in EMS Clinicians: A NAEMSP Position Statement and Resource Document.","authors":"Al Lulla, Remle Crowe, Elizabeth A Donnelly, S Marshal Isaacs, Erin Lincoln, Lauren Maloney, Diane L Miller, Brandon Morshedi, Bridgette Svancarek, Maia Dorsett","doi":"10.1080/10903127.2026.2740139","DOIUrl":"10.1080/10903127.2026.2740139","url":null,"abstract":"<p><p>Emergency medical services (EMS) clinicians operate in environments characterized by repeated trauma exposure, operational unpredictability, shift work, moral distress, and cumulative occupational stress. A substantial body of evidence demonstrates elevated rates of post-traumatic stress symptoms, depression, anxiety, substance use, sleep disturbance, burnout, and suicide among EMS clinicians and other public safety professionals compared to the general public. The implications extend beyond individual well-being, affecting workforce sustainability, clinical performance, and high quality patient care. Mental health in EMS is therefore not solely an individual concern, but a systems issue. Therefore, the National Association of EMS Physicians (NAEMSP) recommends that:Organizational leadership should recognize EMS clinician mental health as foundational to workforce sustainability and safe patient care.EMS clinician mental health awareness, management, and treatment options should be a core part of EMS education.EMS systems should take a multi-faceted approach to mental health, with an emphasis on ensuring access to confidential and culturally competent resources for EMS clinicians and other public safety professionals including telecommunicators, law enforcement officers and firefighters.EMS systems should engage in quality improvement to identify and improve practices affecting EMS clinician mental health.EMS systems should achieve meaningful and sustainable improvements in EMS clinician mental health through legislative advocacy and building strong partnerships with local, regional and national agencies including public health and research institutions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114154","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":"Bystander AED Effectiveness Despite Low Utilisation in OHCA.","authors":"Youdong Sohn, Gyuchong Cho, Youngsuk Cho, Taejin Park","doi":"10.1080/10903127.2026.2743854","DOIUrl":"10.1080/10903127.2026.2743854","url":null,"abstract":"<p><strong>Objectives: </strong>Observational estimates of bystander automated external defibrillator (AED) effectiveness are inconsistent in settings with mature public-access defibrillation infrastructure but low utilization, partly because the conventional reference group pools emergency medical services (EMS)-shocked with non-defibrillated patients. We estimated bystander AED effectiveness against a partitioned no-defibrillation reference, tested effect modification by location, and quantified the deployment-utilization gap.</p><p><strong>Methods: </strong>Retrospective analysis of a prospectively collected multicenter out-of-hospital cardiac arrest (OHCA) registry (Korea, October 2015-June 2025; 23,918 adults of presumed medical etiology). A three-tier prehospital defibrillation-provider variable was defined: bystander AED applied (<i>n</i> = 383); EMS-delivered shock without preceding bystander AED (<i>n</i> = 5,975); and no prehospital defibrillation (reference; <i>n</i> = 17,560). Primary outcomes were survival to discharge and good neurological outcome (Cerebral Performance Category 1-2), analyzed by multivariable logistic regression with propensity-score, inverse-probability-weighting and location-stratified secondary analyses.</p><p><strong>Results: </strong>Bystander AED application was associated with improved survival (adjusted odds ratio [aOR] 1.60; 95% CI 1.19-2.14) and good neurological outcome (2.31; 1.65-3.23), comparable to that of EMS-delivered shock; the pooled-control specification attenuated estimates to non-significance (survival 1.09; neurological 1.14). Shock-delivered applications significantly exceeded EMS-delivered shock for neurological outcome (aOR 1.43; <i>p</i> = 0.03). Effectiveness did not differ by location (interaction <i>p</i> ≥ 0.15). Bystander AED was applied in 8.5% of Public-area versus 1.9% of Nonpublic AED-opportunity cases-a 4.5-fold gap.</p><p><strong>Conclusions: </strong>Bystander AED was associated with improved outcomes when applied, comparable to or exceeding EMS-delivered shock; the dominant constraint was the deployment-utilization gap, greatest in residential settings. Residential rapid-activation infrastructure warrants policy priority alongside, not instead of, continued device placement.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114106","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}