Prehospital Emergency Care最新文献

{"title":"Prehospital Trauma Compendium: Management of Suspected Femoral Shaft Fractures - A Position Statement and Resource Document of NAEMSP.","authors":"John W Lyng, Joshua G Corsa, Philip S Nawrocki, Brad D Raetzke, Josh Nackenson, Nichole Bosson","doi":"10.1080/10903127.2025.2493846","DOIUrl":"10.1080/10903127.2025.2493846","url":null,"abstract":"<p><p>Emergency medical services (EMS) clinicians encounter patients with suspected femoral shaft fractures due to both blunt and penetrating trauma. Traction splinting is commonly used by many EMS systems on the premise that it might reduce the perceived risk for hemorrhage and can help reduce pain. It has been called into question whether femoral shaft fractures are truly causative of hemorrhagic shock. Additionally, traction splinting has been associated with iatrogenic injuries, especially if applied to patients with co-morbid lower extremity and pelvic injuries. The application of a traction splint is also an infrequent EMS intervention, raising concerns about skill decay and maintenance of competency. Non-traction splinting, or static splinting, is also a therapeutic option in the field management of suspected femur fractures. Because the benefits of traction splinting versus static splinting of suspected femur fractures in the EMS setting are uncertain, the National Association of EMS Physicians (NAEMSP) performed a review of the evidence regarding EMS management of femoral shaft fractures and developed the following recommendations and summarization of the evidence.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020681","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":"Sex and Age-Based Disparities in Bystander Interventions for Out-of-Hospital Cardiac Arrest in Texas.","authors":"Ryan Huebinger, Fei Shao, Audrey L Blewer, Kevin Schulz, Christopher Root, Janet Page-Reeves, Bryan McNally, Bentley Bobrow","doi":"10.1080/10903127.2025.2498014","DOIUrl":"10.1080/10903127.2025.2498014","url":null,"abstract":"<p><strong>Objectives: </strong>Prior studies identify disparities in bystander interventions for female out-of-hospital cardiac arrest (OHCA) patients, particularly for those of reproductive age. We sought to evaluate for sex and reproductive age-based disparities in bystander interventions in Texas.</p><p><strong>Methods: </strong>We retrospectively studied the 2013-2023 Texas Cardiac Arrest Registry to Enhance Survival OHCA registry, excluding OHCAs that occurred in healthcare facilities and nursing homes or were witnessed by 9-1-1 responders. We stratified OHCAs by sex and defined our outcomes at bystander cardiopulmonary resuscitation (BCPR) (in public and private locations), and bystander automated external defibrillator placement (BAED). We evaluated the association of sex on bystander interventions using logistic regression. Models were adjusted for race/ethnicity and bystander witnessed arrest. We performed sub-analyses comparing OHCAs that were and were not reproductive age (15-49 years old).</p><p><strong>Results: </strong>We included 50,484 OHCAs that met inclusion criteria; 18,602 were female, and 31,882 were male. Including patients of all ages, BCPR rates were similar for females compared to males in public (50.7% vs 51.2%, aOR 0.98 95% CI 0.87-1.07) and private (42.2% vs 42.1%, aOR 1.02 95% CI 0.98-1.06) locations. There were also no differences comparing patients of reproductive and non-reproductive age. Compared to males and including patients of all ages, odds of BAED was lower for females (5.2% vs 6.7%, aOR 0.76 95% CI 0.60-0.96). Odds of BAED was also lower for adult female OHCA patients of non-reproductive age (4.8% vs 7.4%, aOR 0.62 95% CI 0.46-0.82). However, BAED was similar for female OHCA patients of reproductive age.</p><p><strong>Conclusions: </strong>Although we identified lower rates of bystander AED placement for female patients of non-reproductive age, we did not identify consistent sex and age-based disparities in bystander CPR.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079874","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":"Out-of-Hospital Neck of Femur Injury: An Eight-Year Observational Analysis.","authors":"Richard Hartley, Ziad Nehme, Brendan Schultz, Emily Nehme","doi":"10.1080/10903127.2025.2500717","DOIUrl":"10.1080/10903127.2025.2500717","url":null,"abstract":"<p><strong>Objectives: </strong>Pain management for patients with neck of femur fractures is a challenge for out-of-hospital clinicians. This study aimed to describe (1) the characteristics of patients presenting to emergency medical services (EMS) with suspected neck of femur injuries, (2) clinically meaningful pain reduction, and (3) ongoing moderate to severe pain in the out-of-hospital setting.</p><p><strong>Methods: </strong>A retrospective cohort study of adult patients with suspected neck of femur injuries attended by EMS in Victoria, Australia, between 01 July 2015 and 30 June 2023. Multivariable logistic regression was used to examine factors associated with clinically meaningful pain reduction and moderate to severe pain upon final EMS assessment.</p><p><strong>Results: </strong>In total, 15,937 patients were included. The median age was 84 (Interquartile Range 76-89) years, 70% were female, and 92% occurred because of a fall. Clinically meaningful pain reduction was achieved for 13,136 (82%) patients, however, 4,859 (30.5%) patients reported moderate to severe final pain. According to adjusted analysis, increasing age (Adjusted Odds Ratio (AOR) = 1.026, 95% Confidence Interval (CI): 1.021, 1.031), paramedic attendance (relative to basic life support-trained personnel, AOR = 3.471 (95%CI 2.921, 4.125)), increasing initial pain score (AOR = 1.705 (95%CI 1.665, 1.747)), application of a splint (AOR = 1.272 (95%CI 1.147, 1.411)) and analgesia administration including opioids and methoxyflurane were associated with clinically meaningful pain reduction. Factors associated with reduced odds of moderate to severe final pain included paramedic attendance (AOR = 0.298 (95%CI 0.251, 0.354)) and splint application (AOR = 0.788 (95%CI 0.730, 0.850)).</p><p><strong>Conclusions: </strong>Although most patients with neck of femur fractures reported a clinically meaningful reduction in pain, 30.5% of patients reported moderate to severe pain upon conclusion of out-of-hospital treatment. Expansion of analgesic options available to basic life support-trained patient transport officers and educating prehospital clinicians on the safety and efficacy of analgesics and splinting practices represent future opportunities for improvement.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044891","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":"Physician Directed Prehospital Treatment in Psychostimulant Induced Hyperthermia: A Case Series.","authors":"Dorothy A Habrat, William S Dukes, Michael M Neeki, Shira A Schlesinger","doi":"10.1080/10903127.2025.2508788","DOIUrl":"https://doi.org/10.1080/10903127.2025.2508788","url":null,"abstract":"<p><strong>Objectives: </strong>Psychostimulant induced hyperthermia is a high mortality condition encountered at mass gatherings such as music festivals. Early, rapid resuscitation and cooling may improve outcomes. This case series describes the use, and patient outcomes of a physician directed medical resuscitation guideline including on-scene sedation, intubation and ice-water submersion in the prehospital setting, followed by transport to non-specialized emergency departments (EDs).</p><p><strong>Methods: </strong>We performed a retrospective chart review of hyperthermia cases treated at electronic dance music festivals by physician-led prehospital resuscitation teams using ice-water bath submersion. Initial prehospital and ED core body temperatures were recorded as were initial ED vital signs, laboratory values, imaging studies and hospital outcome.</p><p><strong>Results: </strong>Twenty-one cases of hyperthermia were identified that were treated using emergency resuscitation and ice-water submersion. All were presumed to have involved the recreational use of psychostimulant drugs. Median initial rectal temperature was 42.2˚C (107.9˚F) (IQR 41.8-42.4˚C). All patients underwent sedation, intubation, and attempted cooling per the event-medicine specific guideline. Eighteen patients were cooled using ice-water submersion and on arrival to the ED the measured mean core temperature was 35.89˚C (96.65˚F) (SD 2.39 ˚C). Three patients did not complete the cooling process as they developed cardiac arrest before or during cooling, necessitating removal from the submersion tank, cardiopulmonary resuscitation (CPR), acute resuscitation led by the physician and transport to the closest hospital. On arrival to the ED mean rectal temperature was 35.89˚C (96.65˚F) (SD: 2.39 ˚C). Of the twenty-one patients that met study inclusion, nineteen survived to hospital admission, of which eighteen were discharge from the hospital neurologically intact.</p><p><strong>Conclusions: </strong>A prehospital physician-directed guideline, including ice-water submersion after sedation and intubation, was used in mass gatherings to reduce body temperature in patients with psychostimulant induced hyperthermia. In this case series we present the largest series of patients treated by physician directed guideline in the out of hospital environment at music festivals. Our outcomes suggest that a physician-directed guideline incorporating ice-water immersion on site before transfer to an emergency department can be used to decrease the mortality risk of psychostimulant induced hyperthermia in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182507","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":"Quality Improvement Intervention Targeting Ventilator Management Ground & Air Medical qUality in Transport (GAMUT) Metric Improves Documentation and Patient Care Practices.","authors":"Kellan K Doberstein, Andrew D Cathers, Craig F Tschautscher, Ryan K Newberry, Brittney Bernardoni","doi":"10.1080/10903127.2025.2499104","DOIUrl":"10.1080/10903127.2025.2499104","url":null,"abstract":"<p><strong>Objectives: </strong>The object of this study was to evaluate the effect of a bundled quality improvement (QI) intervention targeting implementation of the Ground & Air Medical qUality in Transport (GAMUT) metric plateau pressure (Pplat) < 30 mmHg on the incidence of Pplat documentation and rate of lung protective ventilation (LPV).</p><p><strong>Methods: </strong>A QI-bundle encompassing education, spaced repetition, and signposting was implemented in a university affiliated, physician/nurse-staffed critical care transport (CCT) program. Our primary aim was to improve the rate of LPV during CCT with the secondary aim of improving the documentation rate of Pplat. Statistical analysis was performed pre- and post-QI intervention using a Pearson chi-square, 95% confidence intervals (CI), nonparametric tests of medians, and two-sample t-test as appropriate. Cohen's effect size was calculated to evaluate the magnitude of difference. Control charts assess changes over time.</p><p><strong>Results: </strong>Before QI bundle implementation, Pplat was documented in 11.8% of charts compared to 96.2% post-implementation (<i>p</i> ≤ 0.001, difference 84.4%, 95% CI [49.1%, 66.2%]). There was a statistically significant increase in the proportion of patients ventilated with both Pplat < 30 mmHg and driving pressure (DP) < 15 mmHg post-QI bundle implementation (<i>p</i> ≤ 0.001, difference 20.9%, 95% CI 3.20%, 38.6% and <i>p</i> ≤ 0.001, difference 45.3%, 95% CI 14.8%, 57.8%, respectively).</p><p><strong>Conclusions: </strong>To our knowledge, this is the first report of a QI initiative targeting implementation of a GAMUT metric to improve both documentation and patient care practices. Our findings indicate that our QI intervention improved documentation of Pplat by nearly nine-fold. We also demonstrated sustained improvement in patient care with higher rates of LPV as defined by Pplat < 30 mmHg and DP < 15 mmHg post-implementation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995014","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 FAST-ED Score Item Agreement with Corresponding In-Hospital NIHSS Item Scores.","authors":"Mark T Baumgarten, Rahul R Karamchandani, Dale E Strong, Lauren Y Macko, Jeremy B Rhoten, Tsai-Wei Wang, Hongmei Yang, Douglas R Swanson, Andrew W Asimos","doi":"10.1080/10903127.2025.2508780","DOIUrl":"10.1080/10903127.2025.2508780","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) can shorten time to endovascular treatment by transporting large vessel occlusion (LVO) acute ischemic stroke (AIS) patients directly to thrombectomy centers. The standard prehospital strategy for identifying LVO AIS is performing an LVO screen, such as the Field Assessment Stroke Triage for Emergency Destination (FAST-ED), which our county EMS adopted in 2019. We aimed to assess agreement of the FAST-ED score items performed by paramedics in the field with the corresponding National Institutes of Health Stroke Scale (NIHSS) score items obtained by neurologists for patients discharged with an AIS diagnosis.</p><p><strong>Methods: </strong>We conducted a retrospective study utilizing a prospectively maintained registry of \"Code Stroke\" patients. We identified patients ≥ 18 years old transported to 1 of 4 hospitals in our system with a FAST-ED score documented. We included patients diagnosed with AIS for whom the Code Stroke protocol was activated and NIHSS recorded in the registry. As each patient was assessed by 1 paramedic from an EMS clinician pool and 1 neurologist from a hospital pool, we measured corresponding item score agreement using unweighted Fleiss Kappa for the dichotomized measure of facial palsy and quadratic Fleiss Kappa for the other ordinal measures.</p><p><strong>Results: </strong>From September 2019 to March 2024, we identified 829 patients meeting our inclusion criteria. There was substantial agreement between FAST-ED and NIHSS for arm weakness (Kappa = 0.68, 95% confidence interval (CI) 0.63-0.72) and speech changes defined as dysarthria and/or aphasia (Kappa = 0.61, 95% CI 0.56-0.67). Moderate agreement was found for eye deviation (Kappa = 0.60, 95% CI 0.54-0.66) and speech changes not including dysarthria (Kappa = 0.48, 95% CI 0.43-0.54). There was fair agreement for facial palsy (Kappa = 0.25, 95% CI 0.19-0.32) and denial/neglect (Kappa = 0.33, 95% CI 0.26-0.40).</p><p><strong>Conclusions: </strong>We found a range of agreement for items of FAST-ED prehospital scores to corresponding items of in-hospital NIHSS, including only fair agreement for facial palsy and denial/neglect. Our findings suggest EMS clinicians may benefit from targeted education in assessing denial/neglect and facial palsy, as well as how to score the speech component in cases of isolated dysarthria.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127669","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":"Ventilation Rates and Capnography in Pediatric Out-of-Hospital Cardiac Arrest with Advanced Airways.","authors":"Kelsey Stanton, Annabella Mershad, Chelsea Kadish, Andrew Murphy, Robert Lowe, Imanol Ania, Andoni Elola, Elisabete Aramendi, Matthew Hansen, Ashish R Panchal, Henry E Wang, Michelle M J Nassal","doi":"10.1080/10903127.2025.2496756","DOIUrl":"10.1080/10903127.2025.2496756","url":null,"abstract":"<p><strong>Objectives: </strong>Ventilation is important in out-of-hospital cardiac arrest resuscitation; however, few studies describe ventilation rates during pediatric out-of-hospital cardiac arrest (pOHCA). Our objective was to characterize ventilations and end-tidal capnography (EtCO₂) after advanced airway placement by emergency medical services (EMS) during pOHCA resuscitation.</p><p><strong>Methods: </strong>This was a retrospective cohort study that included pediatric (age < 18 years) non-traumatic OHCA treated by an urban fire-based EMS system (Columbus Division of Fire, Columbus, Ohio) from April 2019 to December 2020. We identified ventilations delivered during resuscitation by manual review of continuous EtCO₂ recorded by cardiac monitors. We also identified ventilations using automated detection algorithms previously validated in adult resuscitation. Mean ventilation rate and EtCO₂ were summarized in one-minute (min) epochs from advanced airway insertion through end of resuscitation efforts. We compared return of spontaneous circulation (ROSC) vs non-ROSC ventilation rates using Student's t-tests. Cochran-Armitage test of trend was used to evaluate EtCO₂ temporal trends. Associations between ROSC and EtCO₂ were tested using a regression model.</p><p><strong>Results: </strong>We identified 38 pOHCA cases and 30 cases were included for ventilation analysis. Cases were primarily infants (0.7 years, IQR 0.17-2), male (52.6%), and African-American race (63.1%). Most pOHCAs were unwitnessed (65.8%) with non-shockable rhythms (94.8%) and infrequent bystander cardiopulmonary resuscitation (31.2%). Eight patients achieved ROSC (21.2%) and two patients survived (5.3%). Advanced airway attempts included supraglottic airway devices (71.1%), endotracheal intubation (7.8%), or both (7.8%). Ventilation rates ranged from 0-23 per minute. Automated ventilation detection algorithms performed well in pediatric ventilation detection where the mean standard error was 3.7 mmHg in EtCO₂ values and 1.3 per minute in ventilation rates. Ventilation rates differed between ROSC and non-ROSC groups (9.2 vs 6.9 per min, <i>p</i> < 0.001). Ranges of EtCO₂ values included 0-100 mmHg during resuscitation. The EtCO₂ trends over time differed between ROSC and non-ROSC groups (59.82 mmHg to 75.9 mmHg vs 20.7 mmHg to 19.0 mmHg, <i>p</i> < 0.01). EtCO₂ was significantly associated with ROSC (OR 1.0 95% CI 1.00-1.01, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>These results offer one of the first perspectives of ventilation in pOHCA. Differences were observed in ventilation rates and EtCO₂ trends between ROSC and non-ROSC cases.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111820","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":"Identifying the Local Emergence of Medetomidine Through Prehospital Collaborations.","authors":"Brian Rettger, Brittany P Chapman, Alex Krotulski, Ronald Gigliotti, Jyothi Polackal, Deborah Olabisi, John Nguyen, Brian Cotoni, Michael Hunter, Roland Clayton Merchant, Sara Walton, Barry K Logan, Patricia Mae Martinez, Stacy N Weisberg, John P Broach, Kavita M Babu","doi":"10.1080/10903127.2025.2491752","DOIUrl":"10.1080/10903127.2025.2491752","url":null,"abstract":"<p><strong>Objectives: </strong>Medetomidine, an alpha-two receptor agonist, has been recently detected as an adulterant of the illicit opioid supply in multiple states and observed to complicate clinical management of opioid overdoses through sedation, hypotension, and/or bradycardia. Our goal is to describe the process through which a novel adulterant of illicit opioids was identified in our community, and describe the process through which this information was disseminated to key stakeholders, including emergency medical services, emergency medicine and internal medicine providers, local and state departments of health, harm reduction advocates, people who drugs, and lay media.</p><p><strong>Methods: </strong>After a paramedic from Worcester Emergency Medical Services described an increase in overdose alert activity, we were able to obtain blood specimens from two patients during a cluster of overdoses. These blood specimens were sent to a research laboratory for analytical toxicology testing.</p><p><strong>Results: </strong>Analyses of the two patient blood samples identified the presence of fentanyl, xylazine, and medetomidine. These patients were noted to be bradycardic and hypotensive on presentation to care, an observation that did not reflect the use of fentanyl alone. We subsequently reviewed our findings with local and state departments of health, local harm reduction agencies lay media, and patients presenting to our mobile addiction clinic.</p><p><strong>Conclusions: </strong>Medetomidine, an emerging adulterant, further complicates the clinical care of exposed patients in overdose and magnifies features of xylazine exposure. In this case, prehospital data and clinical observation led to the identification of medetomidine in our community. With appropriate analytical toxicology resources, pre-hospital providers can translate clinical observation into new drug or adulterant identification, improving clinical care and public health.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040717","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":"Social Vulnerability and Pediatric EMS Behavioral Health Activations: Trends in Utilization and Sedation Practices.","authors":"Hayes Stancliff, Christopher Buresh, Garrett Cavaliere, Susan Boehmer, Stephen M Sandelich","doi":"10.1080/10903127.2025.2506525","DOIUrl":"https://doi.org/10.1080/10903127.2025.2506525","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the growing instances of pediatric patients presenting to emergency medical services (EMS) with a behavioral health emergency (BHE), these encounters remain an understudied phenomenon from a medical and social perspective. This study aims to characterize pediatric BHEs and to understand how social determinants of health impact BHE frequency and sedation rates.</p><p><strong>Methods: </strong>We conducted a retrospective observational analysis of the National Emergency Medical Services Information System (NEMSIS) database and the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) between 2018 and 2021. Pediatric EMS encounters were filtered based on age (<18 years old) and behavioral health International Classification of Diseases-10 (ICD-10) codes. Descriptive statistics and Poisson regression assessed the association between SVI scores and BHE frequency and sedation rates.</p><p><strong>Results: </strong>Our study analyzed 344,896 BHE activations out of 3,382,719 total pediatric EMS calls. The SVI score was inversely correlated with both BHE rates and sedative medication administration, conveying that higher levels of social vulnerability were associated with lower BHE rates and lower sedative medication administration. Census tracts with an SVI score in the 1st quartile (least vulnerable) had a pediatric BHE activation rate of 15.79% whereas the 4th quartile (most vulnerable) was 11.51% (OR: 1.443 (95% CI: 1.427-1.459), p < 0.0001). For sedation rates, census tracts with an SVI score in the 1st quartile had a sedative administration rate of 2.53% whereas the 4th quartile was 1.90% (OR: 1.345 (95% CI: 1.254-1.442), p < 0.0001).</p><p><strong>Conclusions: </strong>The prehospital management of pediatric BHEs is correlated to social vulnerability across multiple metrics, pointing to a need to modify care practices and address gaps in care. Tailored EMS protocols or bolstered EMS resources may be necessary to address the needs of vulnerable populations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-27"},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111817","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":"Quality of Care and Opportunities for Improvement in Prehospital Care of Critically Ill Pediatric Patients: An Observational, Simulation-Based Study.","authors":"Mark X Cicero, Kate Schissler, Janette Baird, Linda Brown, Marc Auerbach, Nicole Irgens-Moller, Natasha Pavlinetz, Kathleen Adelgais","doi":"10.1080/10903127.2025.2500715","DOIUrl":"10.1080/10903127.2025.2500715","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians infrequently care for infants or children. Simulation allows assessment of EMS at the individual, team, and agency level. Standardized tools to evaluate EMS team performance provides educators and EMS clinicians information on the quality of clinical skills performed in pediatric prehospital scenarios, providing opportunities for reinforcement or relearning. This study utilizes skills checklists to describe EMS team performance during three pediatric emergencies and describes skill performance within each simulation. As secondary objectives we evaluated performance differences among three states, and for teams whose agency had a pediatric emergency care coordinator (PECC) compared to those that did not.</p><p><strong>Methods: </strong>This was a prospective cohort study of EMS clinician team performance, across three standardized pediatrics simulations: Respiratory (child asthma/respiratory arrest), Cardiac (infant cardiopulmonary arrest, and Neurological (sepsis/seizure). Simulations were conducted with 11 EMS agencies in three states, video-recorded and evaluated using standardized tools. Video recordings were evaluated if they included the complete simulation and the audio was intelligible. The primary outcome was mean percent of actions performed correctly in each simulation. Using a series of ANOVAs, comparisons were made among the three simulation types, states, and, whether there was an EMS PECC in participating agencies.</p><p><strong>Results: </strong>There were 166 simulations conducted over 30 months of which 140/163 (84.3%) were evaluated. The mean percent of actions performed correctly by teams in the Respiratory simulation was higher than for Cardiac and Neurological simulations (Respiratory = 60.9%, SD = 8.9, range = 40-78.6%; Cardiac 58.7% (SD = 11.8, range = 26.0.1-81.0%); Neurological = 54.9%, SD = 9.9, range = 34.1-72.3%; <i>p</i> = 0.02), and no significant difference between Cardiac and Neurological simulation performance. There were differences by participating states in the Respiratory simulation performance (<i>p</i> = 0.04) and Neurological simulations (<i>p</i> = 0.03). The study was underpowered to determine if PECC presence was associated with improved performance.</p><p><strong>Conclusions: </strong>In high acuity pediatric simulations, EMS teams demonstrated better resuscitation performance for children with child asthma/respiratory arrest than for infants with cardiopulmonary arrest or sepsis/seizure. The gaps noted in EMS quality of care can be used to guide educational and quality of care improvement interventions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050711","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}