Prehospital Emergency Care最新文献

{"title":"Rapid Discharge Following Air Transport in Children.","authors":"Vishal Naik, Pranshu Bhardwaj, Sriram Ramgopal","doi":"10.1080/10903127.2025.2531074","DOIUrl":"10.1080/10903127.2025.2531074","url":null,"abstract":"<p><strong>Objectives: </strong>Air transport can play a crucial role in the care of critically ill or injured children. Use of air emergency medical services (EMS) can be subject to both over- and undertriage, with prior work suggesting that some air transports in children may be unnecessary. Our objective was to evaluate the association of pediatric air transport with emergency department (ED) discharge and short (<48 h) hospitalization.</p><p><strong>Methods: </strong>We performed a multicenter retrospective study of children's hospitals participating in the Pediatric Emergency Care Applied Research Network Registry between 2012 and 2021, including encounters for children (<18 years) transported to the ED by air EMS. Our outcomes were (1) ED discharge and (2) hospitalization with short admission (length of stay <48 h). We evaluated clinical, demographic, and diagnostic factors associated with each outcome using multivariable logistic regression.</p><p><strong>Results: </strong>We included 7722 encounters [60.9% male, median age 5.9 years (IQR 1.9-12.3 years)]; with 35.8% having a trauma-related principal diagnosis (with 38.4% of reporting encounters based on ED and admission codes, and the remainder as ED diagnosis codes only). Overall, 1545 (20.0%) encounters were discharged from the ED. Among admitted patients (<i>n</i> = 6139), 3548 (57.8%) had a short admission. Discharge from the ED was associated with Black non-Hispanic race/ethnicity, other payer status relative to private payer status, and lower triage acuity relative to Emergency Severity Index (ESI) level 1. Certain traumatic, musculoskeletal, neurological, psychiatric, toxicologic, and gastrointestinal diagnoses were also associated with ED discharge. Conditions associated with lower odds of admission for <48 h included genital/reproductive diseases, toxicologic emergencies, brain/skull trauma, facial and dental trauma, contusions, otolaryngological diseases, neurological diseases, and psychiatric, behavioral, and substance abuse disorders.</p><p><strong>Conclusions: </strong>More than two-thirds of children transported to the ED by air are either discharged from the ED or within 48 h of admission. Race, ethnicity, payer status, low triage acuity, and missing vital sign information were associated with ED discharge. While this dataset lacks information on the rationale for initiating air transport, these findings emphasize the need for additional research into the decision-making processes surrounding pediatric air EMS to support optimal resource utilization and patient care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609181","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 Technicians Can Administer Nitrous Oxide for Effective Analgesia in an Urban Multi-Tiered EMS System.","authors":"Emiliano Costilla, Bradley Teasley, Xingpei Zhao, Daniel Schwerin, Mirinda Ann Gormley, Michael Troise, Martin Lutz, Matthew Cobb, Stella Self, Thomas Blackwell","doi":"10.1080/10903127.2025.2531546","DOIUrl":"10.1080/10903127.2025.2531546","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effectiveness of self-dosed nitrous oxide administration by emergency medical technicians (EMTs) in treating medical and traumatic pain in the prehospital setting, to quantify the incidence and type of adverse events associated with this intervention, and to identify characteristics associated with subjective improvement following prehospital pharmacologic analgesia.</p><p><strong>Methods: </strong>We performed a state-approved 365-day pilot study in which EMTs administered patient-dosed inhaled nitrous oxide (premixed 50% nitrous oxide and 50% oxygen) to patients in pain in the prehospital setting. We conducted a retrospective cohort analysis of all patients who received pain management following an abnormal pain assessment performed by an EMT. Using paired t-tests and multivariable logistic regression, we analyzed the qualified responses (improved, worsened, or unchanged) and quantified responses (ten-point pain scale) of patients with abnormal pain assessment findings to prehospital treatments.</p><p><strong>Results: </strong>Of the 165 patients who received nitrous oxide, 125 (75.76%) demonstrated an improved response and zero demonstrated a worsened response in the judgment of the attending EMT. Nitrous oxide reduced pain scores by 2.29 (<i>p</i> < 0.01) after five minutes and 2.46 (<i>p</i> < 0.01) at hospital. Two minor adverse events occurred (asymptomatic hypotension and dizziness). An EMT's categorization of a patient's response to nitrous oxide as \"unchanged\" predicted an 89% increase in the need for a paramedic response to the scene (<i>n</i> = 10). Paramedics administered parenteral analgesia to 11 patients, three of whom did not receive nitrous oxide.</p><p><strong>Conclusions: </strong>Nitrous oxide self-dosing, when supervised by trained EMTs, could effectively relieve pain in most out-of-hospital patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659995","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":"Current Emergency Medical Services Systems Approaches to Refusal of Assessment, Treatment, or Transport: Examination of Statewide Protocols.","authors":"Rana Barghout, Joshua Lachs, William Haussner, David Hancock, Alyssa Elman, Emily Benton, Douglas Kupas, Ronald Strony, Dennis Rowe, Cory Henkel, Bess White, Phylise Banner, Mark Lachs, Tony Rosen","doi":"10.1080/10903127.2025.2537861","DOIUrl":"https://doi.org/10.1080/10903127.2025.2537861","url":null,"abstract":"<p><strong>Objectives: </strong>Many emergency medical services (EMS) 9-1-1 activations result in patients declining evaluation, treatment, or transport to the emergency department (ED). Assessment of a patient's decision-making capacity to refuse and taking appropriate actions based on that are critical elements of EMS practice. However, EMS clinician approaches in this area are under-studied, and variation may exist. As EMS practice is highly protocolized, our goal was to examine all publicly available United States (U.S.) state protocols and describe their guidance around refusals.</p><p><strong>Methods: </strong>We used a structured, multi-step content analysis and published expert recommendations on managing refusal of care in health care settings to identify 35 specific elements within five domains of prehospital refusal management: decision-making capacity assessment, risk assessment, persuasion, escalation to medical oversight, and documentation. We systematically and comprehensively reviewed 34 state protocols and a U.S. national protocol for the presence of these elements.</p><p><strong>Results: </strong>Among 34 state protocols examined, 24% (8) had no guidance on refusal, with 18% (6) including at least some guidance in all domains. Among states with any guidance on refusal, we found a median of 15, a mean of 15, and a range of 5-25 elements included. Three states (9%) discussed all four components of decision-making capacity. Seven (21%) emphasized assessing risk of a severe medical emergency when considering refusal. Guidance on persuasion for high-risk patients was included in 13 (38%). Escalation to direct medical oversight was present in 20 (59%). Only 21 (62%) of protocols provided specific documentation guidelines. Notably, guidance was identified in state protocols that is inconsistent with expert recommendations for management of refusal in the ED. Checklists were included in 4 (12%).</p><p><strong>Conclusions: </strong>Substantial variability exists among state protocols regarding patient refusal guidance. Few protocols address high-risk patients, provide strategies for persuasion, or include checklists for proper management. Standardizing and expanding protocols may enhance EMS care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699345","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":"Nebulized Nitroglycerin Improves Carotid Blood Flow During Cardiopulmonary Resuscitation in a Swine Model of Cardiac Arrest.","authors":"Christopher Kelly, Helen Palatinus, Russell Johnson, Taryn Hunt-Smith, Nicole Ewer, Laurence Saint-Pierre, Guillaume L Hoareau, M Austin Johnson, Scott T Youngquist","doi":"10.1080/10903127.2025.2537862","DOIUrl":"https://doi.org/10.1080/10903127.2025.2537862","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary vasodilators have shown promise in reducing pulmonary vascular resistance during CPR. Most are not currently available outside of an intensive care unit (ICU) setting. Nitroglycerin is widely used by emergency medical services to treat chest pain. If beneficial, the inhalation route of nitroglycerin administration could be implemented by basic life support personnel at the scene of a cardiac arrest. The aim of this investigation was to assess the hemodynamic effects of nebulized nitroglycerin (NIN) in a swine model of ventricular fibrillation (VF)-induced cardiac arrest.</p><p><strong>Methods: </strong>Seventeen Mixed breed Yorkshire swine (54 + 5 kg) were anesthetized. Ventricular fibrillation was then induced by connecting a 9-volt battery to a pacing catheter in the right ventricle. After 7 minutes of untreated VF, mechanical chest compressions were initiated. Three minutes later, mechanical ventilation was resumed at pre-arrest settings with 100% FiO2. Two minutes later, 5 mL of normal saline (NIS controls, n = 9) or with 10 mg of nitroglycerin (NIN treatment, n = 8) were randomly nebulized through a nebulizer in line with the respiratory circuit. After 4 minutes of nebulization, an intravenous dose of epinephrine (0.015 mg/kg) was administered, followed 2 minutes later by defibrillation. Standard advanced cardiac life support resuscitation was continued along with NIN or NIS until full delivery, and continued until return of spontaneous circulation or 40 minutes had elapsed since arrest. Data were analyzed using mixed effects models.</p><p><strong>Results: </strong>Prearrest arterial and right atrial pressures, chemistries and arterial blood gas values were similar between groups. There were no differences in systolic, diastolic, or coronary perfusion pressures. There was a statistically significant increase in carotid blood flow (CBF) following NIN. Before administering epinephrine, CBF in NIN-treated animals were approximately double those of NIS controls: 92.2 (95%CI 70.69-113.74) versus 41.96 (95% CI 22.28-61.63) mL/min, respectively, a mean difference of 50.26 mL/min (95% CI 24.91-75.61, p < 0.0001).</p><p><strong>Conclusions: </strong>Early nebulized nitroglycerin treatment resulted in superior CBF without decreasing systemic arterial pressures or coronary perfusion pressures in this model of cardiac arrest.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699346","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":"Distinguishing Subtypes of Unwitnessed Out-of-Hospital Cardiac Arrest by Estimated Last Seen Alive Time.","authors":"Sophia Snyder, Dalton Wesemann, Maja C Strusinska-Thayer, Jonathan Jui, Ritu Sahni, Shewit P Giovanni, Chris R Shaw, Mohamud R Daya, Joshua R Lupton","doi":"10.1080/10903127.2025.2522824","DOIUrl":"10.1080/10903127.2025.2522824","url":null,"abstract":"<p><strong>Objectives: </strong>Approximately one-half of all out-of-hospital cardiac arrests (OHCA) are unwitnessed and have a very low survival rate. Our objective was to assess if use of a bystander estimated last-seen-alive (ELSA) time could predict a subset of unwitnessed OHCA patients with outcomes resembling those with witnessed OHCA.</p><p><strong>Methods: </strong>This is a registry-based retrospective analysis of adults presenting with emergency medical services (EMS)-treated, non-traumatic OHCA from 2018 to 2023, in the Portland Cardiac Arrest Epidemiologic Registry. We excluded EMS-witnessed arrests, patients with do-not-resuscitate orders and records with incomplete data. Our primary outcome was survival with a favorable neurologic outcome at hospital discharge (Cerebral Performance Category score ≤2). We compared bystander witnessed arrests to unwitnessed arrests with ELSA times <5 min, 5-10 min, 10-15 min, ≥15 min, or unknown. ELSAs were abstracted from EMS charts using bystander estimates of when the patient was last seen, with values averaged if a range was given. We used multivariable mixed effects regression analysis to adjust for potential confounding variables. In the subset of patients where no-flow time (NFT) could be calculated, using the interval from estimated time of arrest (using ELSA and 9-1-1 call time) to initial EMS cardiopulmonary resuscitation, we performed propensity score matching by NFT and potential confounding variables.</p><p><strong>Results: </strong>There were 2067 bystander witnessed and 2755 unwitnessed patients meeting inclusion criteria. Patients with an unwitnessed arrest and an ELSA <5 min had similar adjusted favorable neurologic survival (absolute difference (95% confidence interval)) relative to witnessed arrests (-1.4%, (-6.9%, 4.2%)). Compared to witnessed arrests, neurologically favorable survival was significantly lower in unwitnessed arrests with ELSA 5-10 min (-5.3% (-9.5%, -1.2%)), 10-15 min (-6.8% ((-10.7%, -2.9%)), ≥15 min (-9.2% ((-12.7%, -5.7%))), or unknown (-5.2% ((-7.0%, -3.4%))). In our propensity matched group by NFT and covariates, there was no differences in favorable neurologic survival for unwitnessed arrests (11.4%) and bystander witnessed arrests (10.0%, <i>p</i> = 0.785).</p><p><strong>Conclusions: </strong>OHCA patients with unwitnessed arrests with an ELSA under 5 min or using ELSA to match by NFT displayed similar neurologically favorable survival as witnessed arrests. These findings suggest that the use of ELSA may help better characterize unwitnessed OHCAs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609180","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 Associated with Documentation of Prehospital Stroke Scale and Blood Glucose Level.","authors":"Anjali J Misra, Scott A Goldberg, Kori S Zachrison, Remle P Crowe, Rebecca E Cash","doi":"10.1080/10903127.2025.2528114","DOIUrl":"10.1080/10903127.2025.2528114","url":null,"abstract":"<p><strong>Objectives: </strong>Reasons for emergency medical services (EMS) agency-level variation in prehospital stroke care are poorly understood. Our objective was to identify EMS agency characteristics associated with low-, average-, and high performance for documentation of prehospital stroke scale and blood glucose to inform strategies for improving prehospital stroke care.</p><p><strong>Methods: </strong>This was a retrospective evaluation of EMS activations for patients with suspected stroke/transient ischemic attack (TIA) in the 2019 ESO Data Collaborative, a de-identified dataset of ∼8.3 million EMS activations from 1,200+ agencies who voluntarily agree to include their data for research and benchmarking. We included agencies that provided ≥10 9-1-1 responses with a field impression of stroke/TIA excluding basic life support agencies and those only responding to acute care facilities (i.e., freestanding or hospital emergency department). Agencies were categorized by mean rates of stroke scale and blood glucose documentation. Low, average, and high performance were defined as the 1st, 2nd-9th, and 10th deciles, respectively. Multinomial logistic regression models were used to calculate relative risk ratios (RRR) to compare agency characteristics (including patient demographics, agency type, and service type) between the three performance groups.</p><p><strong>Results: </strong>We analyzed 862 EMS agencies (21.6% fire department-based, 65.1% non-volunteer, 93.6% primarily providing 9-1-1 response). The mean agency-level rates by low-, average- and high-performers were 4.9% (SD 6.1%), 69.0% (SD 26.6%), and 99.6% (SD 0.6%) respectively for stroke scale, and 61.7% (SD 10.6%), 87.6% (SD 6.0%), and 98.7% (SD 1.6%) for blood glucose. There were no significant associations between agency characteristics and rates of stroke scale documentation. For blood glucose, agency characteristics associated with better performance were higher rates of urban encounters and non-volunteer providers (urban: RRR for low performance 0.53, 95% CI 0.33-0.85; non-volunteer: RRR for low performance 0.52, 95% CI 0.32-0.84).</p><p><strong>Conclusions: </strong>The wide agency-level variation in rates of stroke scale and blood glucose documentation indicates an opportunity to better standardize care. Better understanding strategies of high performers and barriers for low performers is key to designing interventions to ensure all stroke patients receive evidence-based, guideline-concordant prehospital care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592023","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":"Evaluating ImageTrend Collaborate as a National EMS Dataset: A Cross-Sectional Comparison with the National EMS Information System.","authors":"Alexander J Ulintz, Christopher B Gage, Jonathan R Powell, Jacob C Kamholz, Rebecca E Cash, Henry E Wang, Ashish R Panchal","doi":"10.1080/10903127.2025.2526160","DOIUrl":"10.1080/10903127.2025.2526160","url":null,"abstract":"<p><strong>Objectives: </strong>ImageTrend Collaborate (ITC) is a new dataset of emergency medical services (EMS) patient care events. While offering a new option for prehospital research, it is unclear if ITC data accurately reflects EMS event characteristics across the United States. Our objective was to assess the national representativeness of the ITC dataset.</p><p><strong>Methods: </strong>We performed a cross-sectional study comparing the 2022 ITC with the 2022 National EMS Information System (NEMSIS) research dataset, a federally funded national EMS data repository. We compared 9-1-1 EMS activations across call (e.g., agency level of service, urbanicity, census region), patient (e.g., age category, sex, dispatch complaint, response time, primary symptom, primary impression), and intervention (e.g., procedures) characteristics. We quantified absolute proportional differences (PD, ITC% - NEMSIS%) with 95% confidence intervals (CI) and standardized mean differences (SMD) to evaluate the effect size of observed differences.</p><p><strong>Results: </strong>We included 9,592,122 EMS events in ITC and 41,997,730 in NEMSIS. ImageTrend Collaborate included a higher proportion of fire-based agencies (PD 8.2, SMD 0.16) and Advanced Emergency Medical Technicians (PD 2.1, SMD 0.12) and lower proportion of volunteer agencies (PD -1.4, SMD -0.12). Census Region differences included West (PD 13.9, SMD 0.31), Northeast (PD -11.0, SMD -0.33), and Midwest (PD -5.2, SMD -0.14). Age, sex, dispatch complaint, and primary impression had absolute proportional differences less than 1.0% with SMD less than 0.10 (i.e., negligible) except for \"sick person\" dispatch (PD -3.0, SMD -0.08) and \"other general\" primary symptom (PD -1.5, SMD -0.11). Median response times were identical in both databases. The most common procedures were similar between the datasets, but differed in proportion, including: catheterization of vein (PD -4.8, SMD -0.12), 12 lead electrocardiogram (PD -7.9, SMD -0.22), and evaluation procedure (PD -3.8, SMD -0.15).</p><p><strong>Conclusions: </strong>ImageTrend Collaborate reflects most national EMS call, patient, and intervention characteristics. Notable and expected differences between ITC and NEMSIS include fire-based agency and census region representation, likely due to self-selection; however, differences in procedures may reflect tradeoffs between granularity of a single vendor dataset versus an aggregated national dataset. Prehospital researchers should understand the characteristics of the ITC dataset to ensure proper use and analysis.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584648","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":"Development and validation of an administrative claims measure of Emergency Medical Services (EMS) triage quality for mobile integrated health interventions.","authors":"Nicole Voll, Cameron Gettel, Shu-Xia Li, Li Qin, Yixin Li, Sarah Attanasio, Isabella Epshtein, Marvin Nichols, Alexis Lilly, Jacob Quinton, Susannah Bernheim, Hannah Stiles, Karthik Murugiah, N Clay Mann, Arjun Venkatesh","doi":"10.1080/10903127.2025.2535574","DOIUrl":"https://doi.org/10.1080/10903127.2025.2535574","url":null,"abstract":"<p><strong>Objectives: </strong>In general, Medicare pays for emergency ground ambulance services when a patient is transported to the nearest emergency department (ED) or other select facilities. As state and local agencies strive to provide high quality person-centered emergency care in locations outside the ED, there is a need for a reliable and valid prehospital quality measure to ensure patient safety. The Centers for Medicare and Medicaid Innovation Center's Emergency Triage, Treat and Transport (ET3) Model created a unique opportunity to develop a quality measure for ambulance organizations to measure safe and effective prehospital care. Our objective was to develop and validate the Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure.</p><p><strong>Methods: </strong>The measure was developed using 2021-2023 Medicare Part B fee-for-service administrative and claims data from 67 ambulance organizations that participated in the ET3 Model, triaging patients using predetermined clinical protocols. The measure cohort included patients that were either transported to an alternative destination (TAD), such as urgent care, or provided treatment in place (TIP). The measure outcome was met if the patient subsequently had an ED visit or died within three days of a TAD/TIP encounter, as an inverse measure, lower is better. We calculated a risk-adjusted measure score using a hierarchical generalized linear model approach, adjusting for patient-level variables and calculating model and measure performance. Finally, we assessed measure face validity and construct validity. To ensure measure reliability, some results were examined using a minimum case threshold of 20 TAD/TIP encounters by each ambulance organization.</p><p><strong>Results: </strong>Among the 22 ambulance organizations that met the minimum case volume threshold, the mean, SD measure score was 20.3 (5.3), ranging from 11.6 to 35.4. The mean (SD) reliability signal-to-noise ratio was 0.791 (0.124). Nine of 11 (82%) members of an interested party consensus group provided a positive vote of face validity. Construct validity was demonstrated by identifying an anticipated negative correlation with three relevant prehospital measures.</p><p><strong>Conclusions: </strong>The Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure is a reliable and valid measure that fills a critical gap in assessing patient safety in prehospital care in the United States.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675517","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":"Gender and pay gaps in paramedic services leadership in Ontario, Canada.","authors":"Dominique Arseneau-Bruneau, Justin Mausz, Sarah Salvis, Andy Tannous, Elizabeth A Donnelly","doi":"10.1080/10903127.2025.2536222","DOIUrl":"https://doi.org/10.1080/10903127.2025.2536222","url":null,"abstract":"<p><strong>Objectives: </strong>Research suggests that women are underrepresented in healthcare leadership and often earn less than men. This may be true in the emergency medical services (EMS) as well, but research on the subject is limited and specific data in Canada are scarce. This study aimed to estimate the gender and income distributions among leadership within Ontario's paramedic services.</p><p><strong>Methods: </strong>We abstracted records for leadership positions (e.g., superintendent, commander, deputy chief, chief) from the Ontario Public Sector Salary Disclosure List. Two raters independently assessed the presumed binary gender of each individual, resolving discrepancies through consensus. Interrater agreement was measured using a kappa statistic. Chi-square tests compared the proportions of men and women at different leadership levels (entry, middle, executive). Income distributions were compared using parametric and non-parametric tests, stratified by leadership level.</p><p><strong>Results: </strong>Our search yielded 863 individuals from 49 (out of 54) paramedic services. Interrater agreement on presumed gender was 95% (κ = 0.87, p < 0.001). After resolving discrepancies (n = 43), we achieved complete agreement for 855 individuals (98%). Among the sample, 655 (76%) were presumed to be men. Women held 23% of entry, 35% of middle, and 15% of executive leadership roles. Within the leadership pool and compared to men, women were twice as likely to hold a middle leadership role (Odds Ratio [OR] 2.00, 95% Confidence Interval [CI] 1.35-2.98, p < 0.001) but less likely to hold an executive leadership position (OR 0.54, 95% CI 0.33-0.87, p = 0.012). Median income distributions were comparable at the executive level (p = 0.327), but lower for women at the middle and entry leadership levels, earning $0.90 (p < 0.001) and $0.95 (p < 0.001) for every dollar earned by men, respectively. Gender accounted for 1.7% of the variance in total earnings.</p><p><strong>Conclusions: </strong>Our findings suggest the existence of both gender and pay gaps in leadership, the reasons for which are not immediately apparent and warrant further study.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675518","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":"\"On the Wall\": A Descriptive Analysis of Ambulance Patient Offload Times in the United States.","authors":"Matthew R Shaw, Eric Quinn, Jack Cheng, Sabina Pilipovic, Ali Treichel, Remle P Crowe, Jeffrey L Jarvis","doi":"10.1080/10903127.2025.2535576","DOIUrl":"https://doi.org/10.1080/10903127.2025.2535576","url":null,"abstract":"<p><strong>Objectives: </strong>Prolonged Ambulance Patient Offload Times (APOT) can lead to decreased ambulance availability and delays for subsequent patients but there is no standardized definition for this interval. We aimed to describe various APOT definitions and compare prolonged APOT intervals by agency characteristics in a large national dataset.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2024 ESO Research Collaborative dataset, including all 9-1-1 response transports. We calculated median APOT intervals using the difference between the \"Arrival at Hospital\" timestamp and \"Receiving Facility Signature\" (APOT 1), \"Transfer of Care\" (APOT 2), \"Incident Closed\" (APOT 3), and a \"Composite\" interval (APOT 4) using the \"Receiving Facility Signature\" timestamp where available and \"Transfer of Care\" timestamp where not available. Using the composite APOT interval, we described characteristics among agencies with >100 annual transports with ≥25% of transports with prolonged APOTs compared to agencies with <25%.</p><p><strong>Results: </strong>Of the 7,237,606 included records, calculable intervals were available for 1,691,745 for APOT 1; 5,613,315 for APOT 2; 7,235,713 for APOT 3; and 6,025,643 for APOT 4. Median and interquartile (IQR) time in minutes for APOT 1 was 10.9 (6.6, 17.5), APOT 2 was 6.6 (4.4, 13.1), APOT 3 was 19.7 (13.1, 30.6), and APOT 4 was 8.7 (4.4, 15.3). Among agencies with ≥100 annual transports (2,020), 3.3% (67) had ≥25% transports with a prolonged APOT of more than 30 minutes. These agencies were more urban (79.1% vs 58.9%) and had a higher median annual 9-1-1 call volume of 2,772 (IQR:1,145, 5,978) compared to agencies where <25% of transports had a prolonged APOT (1,817 (IQR:719, 4,473)).</p><p><strong>Conclusions: </strong>Overall, median APOT intervals were short, independent of the definition. A small number of EMS agencies experienced prolonged offload times for at least 1-in-4 transports, indicating that though not widespread nationally, APOT challenges are prevalent in a subset of EMS systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675516","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}