Prehospital Emergency Care最新文献

{"title":"Utilization and Metrics Associated with Paramedic Treat and Discharge Medical Directives for Paramedic Services and Emergency Departments: A Retrospective Cohort Study.","authors":"Ryan P Strum, Shawn Mondoux, Tim Dodd, Andrew Costa, Brent McLeod, Katie Turcotte, Paul Miller","doi":"10.1080/10903127.2026.2666857","DOIUrl":"10.1080/10903127.2026.2666857","url":null,"abstract":"<p><strong>Objectives: </strong>An emerging strategy to alleviate health care system pressures are prehospital treat and discharge directives, allowing paramedics to manage patient care in the community without transporting to an emergency department (ED). In Ontario, Canada, three discharge directives apply to patients with resolved seizures, resolved hypoglycemia, and resolved supraventricular tachycardia. Our objective was to describe how these directives were utilized in practice and to characterize associated operational metrics and downstream ED utilization among eligible patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using paramedic records from southwestern Ontario between June 1, 2023, and November 15, 2024. All 9-1-1 calls were screened using objective criteria in the medical directives to identify patients who may have been eligible for paramedic discharge. Patient records were categorized into groups by directive, then classified by their call outcome (transported, discharged by paramedics, patient refusal of transport). Where established linkages existed, transported patient records were linked to their ED visits. We examined paramedic scene times and call durations across groups, and ED metrics of length of stay (LOS), wait time for physician assessment, visit outcome, and visit costs.</p><p><strong>Results: </strong>Of 1,596 patients identified as potentially eligible for discharge, 1,085 (68.0%) were transported to an ED, 474 (29.7%) patients refused transport, and 35 (2.2%) were discharged by paramedics. Paramedic discharged patients had half the median call duration (45 min) of ED transported patients (87 min). Patients with hypoglycemia had a high rate of transport refusal (58.9%), while the cohort of patients with seizure had the highest rate of transport (72.0%). Among 494 patients with linked ED data, the mean ED LOS was 6 h and 20 min. Most were discharged (70.2%) or left before completing care (13.4%). The average ED visit cost was $461 in Canadian dollars (not including physician billing), and the mean wait time for physician assessment exceeded 1.5 h.</p><p><strong>Conclusions: </strong>Paramedic-initiated discharge was used infrequently, but cases in which it was applied were associated with shorter call durations and avoided subsequent ED utilization. These descriptive findings suggest potential operational advantages worthy of further evaluation, though additional research is needed to determine safety, and system-level impact.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medical Services Responses at a Large Immigration Detention Facility in Rural Georgia: A Descriptive Analysis.","authors":"Pierre-Carole Tchouapi, Amy Zeidan, Esther Hwang, Trupti Patel, Jasmin Strong, Vega Walke, Annette M Dekker","doi":"10.1080/10903127.2026.2661802","DOIUrl":"10.1080/10903127.2026.2661802","url":null,"abstract":"<p><strong>Objectives: </strong>As the number of individuals in Immigration and Customs Enforcement (ICE) detention facilities increases, there is concern for increased utilization of local Emergency Medical Services (EMS) that serve these facilities. With multiple ICE detention facilities located in rural areas of the United States, this can create operational challenges for EMS agencies. In this study, we explored EMS activations resulting in transport to acute care centers originating from Stewart Detention Center (SDC), one of the largest ICE detention facilities located in Stewart County, Georgia. Stewart County Fire and EMS is the primary EMS service in Stewart County and responds to the majority of EMS activations, including SDC.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of all EMS activations that led to transport from April 1, 2018 to August 31, 2021 at SDC using data obtained through state and county open-records requests. Demographics, dispatch complaints, vital signs, and disposition were analyzed descriptively.</p><p><strong>Results: </strong>During the study period, there were 345 EMS-reported activations that required transport for offsite medical care. The most common symptoms were chest pain, abdominal pain, and shortness of breath. Approximately 38% of individuals had at least one abnormal vital sign during their encounter. Forty-three percent of individuals required transfer to a tertiary hospital located approximately 40 miles away. EMS activations at SDC comprised 13% (544 of 4148) of the local EMS agency's responses during the study period.</p><p><strong>Conclusions: </strong>EMS activations from SDC represented a substantial share of the call volume often requiring long-distance transfer of high acuity presentations. As medical emergencies in ICE detention facilities are likely to increase with expanding detention, continued research is needed to better understand the operational and clinical implications for EMS systems and local public health infrastructure.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147778956","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 Estimated Benefit of Lights and Sirens During Ambulance Transport.","authors":"Michael F Spigner, Megan Gussick, Manish N Shah","doi":"10.1080/10903127.2026.2659958","DOIUrl":"10.1080/10903127.2026.2659958","url":null,"abstract":"<p><strong>Objectives: </strong>The use of lights and sirens triples the odds of ambulance collisions, which are most common during patient transport. The time benefit of lights and sirens is reportedly small, though many studies were limited by small sample sizes and potential methodologic biases. The objective of this study was to estimate the effect of lights and sirens on trip duration and trip pace using a modern transportation model.</p><p><strong>Methods: </strong>We conducted an observational study of actual trip durations <i>versus</i> predicted trip durations using one year of dispatch data for a mid-sized emergency medical system in the United States. We obtained predictions of non-emergent trip duration between each incident location and destination hospital using Google's transportation model. To validate the model, we fit a linear regression model with actual non-emergent trip durations <i>versus</i> the model's predictions. Next, we subtracted actual emergent trip durations from predictions of their non-emergent duration to estimate the effect of lights and sirens on trip duration (min) and trip pace (min/km). We used the Mann-Whitney U test to assess differences in trip duration and trip pace between emergent and non-emergent groups and reported the median differences with bootstrapped confidence intervals. We repeated our analysis using a spatially aggregated approach with the median trip duration and trip pace per 1 km² area to minimize bias from high incident densities.</p><p><strong>Results: </strong>We analyzed 25,902 incidents, of which 21.0% were transported using lights and sirens. The Google model fit non-emergent study data well (<i>R</i>² = 0.78, <i>F</i>-statistic 70,130). Lights and sirens were associated with a shorter trip duration and faster trip pace of 3.0 min (95%CI, 2.9-3.1) and 0.3 min/km (95%CI, 0.3-0.3), respectively. In the spatially-aggregated analysis, lights and sirens were associated with a shorter trip duration and faster trip pace of 3.3 min (95%CI, 2.9-3.6) and 0.3 min/km (95%CI, 0.2-0.3), respectively.</p><p><strong>Conclusions: </strong>Using a modern transportation model, we estimated the median benefit of lights and sirens to be 18 s/km, or 3.0-3.3 min per trip in our system. Considering the well-documented risks of emergency driving, additional work is needed to identify the conditions when this benefit outweighs risk.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729677","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":"Can a Large Language Model Grounded in Text-Based Agency-Specific Prehospital Protocols Provide Accurate Care Recommendations?","authors":"Colin G Wang, Nichole Bosson, Rombod Rahimian, Shira Schlesinger, Denise Whitfield, Jake Toy","doi":"10.1080/10903127.2026.2668008","DOIUrl":"https://doi.org/10.1080/10903127.2026.2668008","url":null,"abstract":"<p><strong>Objectives: </strong>Large language models (LLMs) using a retrieval-augmented generation (RAG) approach have the ability to respond to user queries with answers grounded in specific sources. We conducted an exploratory evaluation of the accuracy of a RAG-based LLM to provide care recommendations for prehospital scenarios based on the emergency medical services (EMS) policies and treatment protocols (TPs).</p><p><strong>Methods: </strong>We conducted a non-human, simulation-based experimental study by uploading all text-based policies/TPs from a single large EMS system into Google's NotebookLM platform, which uses a RAG-based LLM (Gemini 2.5 Flash) framework to generate grounded responses. We developed six clinical scenario prompts, including adult patient scenarios (i.e., ventricular fibrillation out-of-hospital cardiac arrest [OHCA], blunt head trauma, stroke, hazardous materials exposure mass-casualty incident) and pediatric patient scenarios (i.e., pulseless electrical activity OHCA, traumatic penetrating extremity hemorrhagic shock). For each scenario, we used all relevant policies/TPs to create a specific set of expected patient care actions. We categorized actions as procedures/interventions, medications, and destination guidance. Medication grading included dose/route for all patients and weight-based dosing for pediatrics. After providing the LLM with the prompts, two investigators independently graded the LLM responses and evaluated for LLM \"hallucinations\". Missing actions were categorized by investigators based on applicability to the case and potential safety risk (e.g., 'non-applicable,' 'minor miss,' 'major miss'). The primary outcome was model recommendation accuracy, defined as the percentage of all actions correctly provided in the model's response. We reported descriptive statistics.</p><p><strong>Results: </strong>The LLM recommended 127 (75%) of 169 patient care actions across all cases. There were 42 missed actions. Nine of the 169 actions (5%) were categorized as 'major misses,' 13 (8%) as 'minor misses', and 20 (12%) as non-applicable to the specific case. Five of nine major misses occurred during the pediatric OHCA case; the majority of these resulted from failure to prompt for evaluation of secondary treatable causes. We identified 12 hallucinations; none were judged to endanger patient safety.</p><p><strong>Conclusion: </strong>We found that a RAG-based LLM demonstrated 75% accuracy across various prehospital scenarios when providing responses grounded in the policies/TPs of a single large EMS agency.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841929","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":"Intranasal Versus Intramuscular Midazolam in Pediatric Seizure Control: A Systematic Review and Meta-Analysis.","authors":"Jonathan D Mohnkern, Ayesha Khalid, Marwa Ibrahim, Vedanti Dave, Pietra Peterlini Chierighini, Alexandra Salazar Riaño, Tolulope Ajibade, Thaís S Martins Shehan","doi":"10.1080/10903127.2026.2658592","DOIUrl":"10.1080/10903127.2026.2658592","url":null,"abstract":"<p><strong>Objectives: </strong>Rapid termination of pediatric seizures is a critical determinant of neurological outcomes. Benzodiazepines are the established first-line therapy, yet intravenous (IV) access is frequently unavailable at initial presentation, necessitating reliance on non-IV routes. However, the optimal non-IV route remains controversial. We aimed to perform a meta-analysis comparing intranasal (IN) and intramuscular (IM) midazolam administration to determine which route is associated with more rapid and reliable seizure control in pediatric patients.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane Library for studies comparing IN and IM midazolam in pediatric patients with seizures. Pooled risk ratios (RR) and mean differences (MD) were calculated using a random-effects model, with heterogeneity quantified using the I² statistic. Subgroup analyses were performed by administration setting and benzodiazepine dose. The prospective protocol was registered with PROSPERO (CRD420251237948).</p><p><strong>Results: </strong>Five studies comprising 3,933 pediatric patients requiring pharmacological intervention for seizures were included, of whom 97.9% were managed in the prehospital setting. IM midazolam was associated with a lower likelihood of requiring rescue therapy overall (RR 1.29; 95% CI 1.15-1.45; <i>p</i> = 0.004; <i>I</i>² = 5%) and in the out-of-hospital setting (RR 1.30; 95% CI 1.11-1.51; <i>p</i> = 0.01; <i>I</i>² = 0%). The association persisted when the analysis was restricted to studies using the recommended 0.2 mg/kg dose (RR 1.26; 95% CI 1.10-1.43; <i>p</i> = 0.01; <i>I</i>² = 6%). IM midazolam was also associated with a shorter time to seizure termination (MD 23.60 s; 95% CI 2.31-44.89; <i>p</i> = 0.03; <i>I</i>² = 0%).</p><p><strong>Conclusions: </strong>Among pediatric patients with acute seizures managed in settings where IV access is not established, particularly the prehospital environment, IM midazolam was associated with more rapid seizure termination and lower rescue therapy use than IN midazolam and represents a reasonable first-line option in these settings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717449","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 Management of Suspected Spinal Cord Injuries: How Much Evidence Does It Take to Change Practice?","authors":"Seth C Hawkins, Jason Williams, Brad L Bennett, Arthur Islas, Robert H Quinn","doi":"10.1080/10903127.2026.2655989","DOIUrl":"10.1080/10903127.2026.2655989","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691924","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":"Manual versus Automated Ventilation with an i-gel^® Airway During Short-Haul Helicopter Operations.","authors":"Wade E Quilter, Theodore A Hartridge, Jared Katz, Albert R Wheeler, Eric R Swanson, Emad Awad, Scott E McIntosh","doi":"10.1080/10903127.2026.2651924","DOIUrl":"10.1080/10903127.2026.2651924","url":null,"abstract":"<p><strong>Objectives: </strong>Short-haul rescue involves evacuating a patient from a backcountry environment while suspended beneath a helicopter. Airway management may be required for head injuries or other critical transports. These missions may compromise airway security and ventilation quality. The objective of this study was to compare manual and automated ventilation performance during simulated static and live short-haul scenarios using a mid-fidelity manikin with an i-gel^® airway.</p><p><strong>Methods: </strong>We used a prospective simulation-based, non-randomized crossover study design. The study included two scenarios: simulated static and live helicopter short-haul scenarios. An i-gel^® airway was pre-inserted into a mid-fidelity Laerdal Quality Cardiopulmonary Resuscitation manikin. The primary outcome was achievement of target minute ventilation (MV; 5-7.2 L/min). Stretcher attendants performed two short-haul tests for each scenario. The first test utilized a pocket bag-valve-mask for manual ventilation (MV) of the manikin and for the second an automatic ventilator was used. Tidal volumes, breaths per minute, and MV were measured. Additionally, post-test i-gel^® movement was documented and each stretcher attendant completed a post-simulation operational usability survey. Paired comparisons between manual and automated ventilation were analyzed using McNemar's exact test for the primary outcome and Wilcoxon signed-rank tests for secondary outcomes.</p><p><strong>Results: </strong>Nine attendants completed both methods in the static scenario; six completed both in the live scenario. Target MV was achieved in 67% of tests via MV compared to 100% with automated during the static tests. In live scenarios, target MV was achieved via manual in 33% of tests while automated achieved 100%. This difference, while substantial, did not reach statistical significance (static: <i>p</i> = 0.25; live: <i>p</i> = 0.12) likely due to low number of tests with all discordant outcomes favoring the automated ventilator. Manual ventilation resulted in greater i-gel^® movement and resulted in four ventilation disconnects (two static, two live) while no disconnects were observed during automated ventilation; participants also reported greater preference for automated ventilation.</p><p><strong>Conclusions: </strong>Automated ventilation consistently achieved target MV, minimized i-gel^® movement and was preferred by attendants. Rescue teams should consider automated ventilation for short-haul airway management with an i-gel^® airway.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594072","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":"Paramedics' Decisions to Withhold Resuscitation in Traumatic Cardiac Arrest: Accuracy of Paramedic Assessments Compared with Autopsy Findings.","authors":"Ritesh Koyya, Ciara O'Brien, Ian R Drennan, Sheldon Cheskes, Johannes von Vopelius-Feldt","doi":"10.1080/10903127.2026.2655289","DOIUrl":"10.1080/10903127.2026.2655289","url":null,"abstract":"<p><strong>Objectives: </strong>Trauma remains the leading cause of death among Canadians under 45, with over 70% of these deaths occurring in the prehospital setting. In Ontario, Canada, paramedics' decision to initiate or withhold resuscitation in traumatic cardiac arrest (TCA) is governed by basic life support (BLS) and advanced life support (ALS) patient care standards. This study explores paramedics' decisions to withhold cardiopulmonary resuscitation (CPR) in cases of prehospital TCA.</p><p><strong>Methods: </strong>We conducted a retrospective review of case files relating to coroner investigations of prehospital TCA across two emergency medical services (EMS) covering a mixed urban/suburban region in Ontario, Canada, with a population of approximately 4.3 million people, from January 2018 to July 2022. We reviewed all deaths where EMS records were available in the death investigation files and where paramedics did not provide CPR. Paramedics' documentation of reasons to withhold CPR was reviewed and compared to postmortem findings. Descriptive statistics were used to describe the findings.</p><p><strong>Results: </strong>We identified 90 cases of prehospital TCA where no CPR was provided by paramedics. Of these, 55 cases (61%) had documented, injuries incompatible with life (decapitation, open head or torso wounds with visible outpouring of brain or abdominal contents) or signs of irreversible death (rigor mortis, lividity, decomposition). Postmortem examination confirmed paramedics' findings of injuries incompatible with life in 29 cases (89%). For the remaining 35 cases (39%), CPR was withheld due to a combination of prolonged time from TCA to EMS contact, severity of injuries deemed non-survivable, significant external blood loss, and following remote physician agreement in 31 (89%) cases. Of these, 29 (83%) had postmortem findings demonstrating anatomical injuries that made the TCA irreversible.</p><p><strong>Conclusions: </strong>The majority of decisions to withhold CPR in prehospital TCA cases are based on signs that are clearly incompatible with life, identified by paramedics with high specificity. In the absence of such findings, paramedics consider factors like prolonged time intervals, overall injury severity, and seek guidance through remote physician supervision before deciding whether to withhold resuscitation efforts.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639635","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":"Avoiding Pitfalls from the Past: The Tourniquet Dilemma.","authors":"Ricky C Kue","doi":"10.1080/10903127.2026.2646948","DOIUrl":"10.1080/10903127.2026.2646948","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582015","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":"Law Enforcement Officer Placed Tourniquets: An Important Tool with Opportunities to Improve - A Multi-Center Study.","authors":"Dhara Shukla, Anthony Buzzetta, Anne Lehmann, Mary Matecki, Catherine Zwemer, Kurt Edwards, Stefan Leichtle, Geoff Shapiro, E Reed Smith, Stephen Varga, Erik Teicher, Paula Ferrada, Margaret Vercruysse, Will Retz, Vladimir Faustin, Nick Bedrin, Kate Dellonte, Mark Gestring, Babak Sarani, Michael W Dailey","doi":"10.1080/10903127.2026.2646950","DOIUrl":"10.1080/10903127.2026.2646950","url":null,"abstract":"<p><strong>Objectives: </strong>A previous single center study suggested that both law enforcement officers (LEO) and emergency medical services (EMS) clinicians over-utilize tourniquets (TQs), which has the potential to result in over triage and even harm patients. The aim of this study was to assess the differences in utilization of TQs by LEO versus EMS in a multi-center, multicity review to see if the findings of the previous study are generalizable to the LEO and EMS communities at-large.</p><p><strong>Methods: </strong>This was an 11-year retrospective, multi-center study of adult patients who had a prehospital TQ placed by LEO or EMS. Data were stratified by responder type. Patient demographics, extremity location where the TQ was placed, location where the TQ was removed, incidence of recurrent bleeding, need for operative control of bleeding, and name of injured vessel were recorded. Data were analyzed using Student's t and χ² tests.</p><p><strong>Results: </strong>In total, 956 patients had TQs placed (LEO, 333 (35%); EMS, 623 (65%)). Most were placed on the thigh. There was no difference in body mass index, but the EMS cohort had a higher Injury Severity Score (9.5 vs. 7.3, <i>p</i> < 0.0001) and extremity Abbreviated Injury Scale severity score (2.0 vs. 1.8, <i>p</i> = 0.002). LEO-placed TQs were less likely to involve a major (named) vessel injury (27% vs. 35%, <i>p</i> = 0.02). There were no patient complications clearly attributable to TQ use.</p><p><strong>Conclusions: </strong>The LEO-applied TQs were less likely to have a major vascular injury, and removal was less likely associated with recurrent bleeding compared to TQs applied by EMS. Protocols that allow for TQ conversion by EMS may decrease over-triage and trauma resource utilization.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582073","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}