Prehospital Emergency Care最新文献

{"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":"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":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-05-15","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":"Emergency Medicine Residents in the Prehospital Setting: Does This Augment Training?","authors":"Joshua D Mastenbrook, Philip A Pazderka, Kathryn E Redinger, Emily R Bon, Claire F Clifton, John D Hoyle, David T Overton","doi":"10.1080/10903127.2026.2666138","DOIUrl":"10.1080/10903127.2026.2666138","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medicine (EM) residency curricula are designed to prepare future physicians for independent practice. Although the Accreditation Council for Graduate Medical Education requires that EM residents have prehospital experiences, very few programs augment this experience with a dedicated resident response vehicle. There are minimal data demonstrating the utility of such an approach. Our residency program staffs a dedicated response vehicle with a PGY-2/3 resident 24/7/365 to respond to high-acuity emergency medical services (EMS) calls. Additionally, from 0800 to 2300, the on-duty resident provides on-line medical control (OLMC) for the county. Each resident averages one 24-h shift per 4-week EM block. The purpose of this study is to describe the prehospital educational experiences and curricular contributions that this program provides.</p><p><strong>Methods: </strong>We used a retrospective observational study design of administrative patient care records over a 5-year period. The primary outcomes were the number of unique encounters and patient experiences per resident per cohort year. The secondary outcomes included characterization of the prehospital experiences among all residents: physician role, patient age-group and sex, problem type, scene location, and procedures. Descriptive statistics were computed to quantify the number, type, and characteristics of the prehospital encounters.</p><p><strong>Results: </strong>Ninety unique resident users were identified in the charting system. The mean number of encounters per resident was grouped by graduation year and spanned from 28.7 (SD 15) for 2018 to 79.2 (SD 49.2) for 2022, with a range of 2-222 encounters per resident documented. Over the study period, our residents managed 1313 out-of-hospital cardiac arrests (34 pediatric), 1048 refusals, 596 death pronouncements, 172 critical trauma patients, and answered 2053 complex OLMC consults.</p><p><strong>Conclusions: </strong>This study quantified the prehospital experiences of our senior EM residents with the addition of a physician response vehicle to our longitudinal EMS curriculum. This has allowed our residents to gain valuable first-hand exposure to out-of-hospital adult and pediatric cardiac arrests, refusals of care, altered mental status, and respiratory emergencies, in addition to prehospital scenarios not likely to be seen within the hospital walls, including motor vehicle collisions with entrapment and mass casualty incidents.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819012","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":"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":"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":"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":"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":"Introduction of a Clinical Practice Guideline for Patella Reduction by Paramedics: The Effect on Pain Relief, Relocation, and Transport Decision.","authors":"James Oswald, Emily Nehme, Alexander Olaussen, Sarah Hopkins, Scott Bennetts, David Anderson","doi":"10.1080/10903127.2026.2650541","DOIUrl":"10.1080/10903127.2026.2650541","url":null,"abstract":"<p><strong>Objectives: </strong>Patella dislocation is a common and painful form of orthopedic injury cared for by paramedics. Care is typically limited to analgesia and transport to an emergency department, delaying definitive joint relocation. In November 2022, Ambulance Victoria introduced a guideline recommending out-of-hospital patella reduction by paramedics. This study aimed to evaluate the effect of the guideline on pain reduction and other clinically and service-oriented outcomes.</p><p><strong>Methods: </strong>A retrospective study was conducted using emergency medical service electronic patient care data from the state of Victoria, Australia. Consecutive patients presenting with acute patella dislocation between September 1, 2021 and August 31, 2023 were included. Interrupted time series analysis was used to evaluate the effect of the guideline on the proportion of patients with effective analgesia, defined as ≥50% reduction from the initial pain score.</p><p><strong>Results: </strong>The analysis included 1,210 patients with 622 in the pre-implementation group and 588 in the post-implementation group. Following the introduction, there was no significant step change in the proportion of patients reporting substantial analgesia (0.8%, 95%CI -6.6%, 8.1%; <i>p</i> = 0.832). There was a significant reduction in the rate of intravenous (IV) access (-17.3%, 95%CI -25.9%, -8.7 %; <i>p</i> < 0.001), transport to hospital (-38.4%, 95%CI -48.2%, -28.7%; <i>p</i> < 0.001) and case duration (-32.9 min, 95%CI -50.8, -15.0; <i>p</i> < 0.001). The success rate of reduction attempts was 91.8%. The median estimated duration of dislocation was 71 min shorter amongst patients who received a successful reduction (median minutes: 47 [IQR 32-65] versus 118 [96-157]; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The introduction of a guideline for patella reduction by paramedics was associated with similar rates of effective analgesia and significant reductions in intravenous access, transport rate, and total case duration. Future studies should examine the longer-term functional outcomes, patient experience, and safety associated with patella reduction by paramedics.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521625","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":"Digital Patient Distribution and Dynamic Capacity Management During a Vehicle-Ramming Mass-Casualty Incident in Munich, Germany.","authors":"Mark Malota, Roman Leitow, Dieter Steinbrunner, Karl Georg Kanz, Viktoria Bogner-Flatz, Dominik Hinzmann","doi":"10.1080/10903127.2026.2649293","DOIUrl":"10.1080/10903127.2026.2649293","url":null,"abstract":"<p><strong>Objectives: </strong>Urban mass-casualty incidents (MCIs) caused by deliberate violence pose a high risk of hospital overload and secondary system failure. Digital coordination platforms have been proposed as tools to enhance system resilience, yet real-world evaluations remain limited. To describe and evaluate the use of a web-based digital patient distribution system during the February 13, 2025 vehicle-ramming attack in Munich, Germany.</p><p><strong>Methods: </strong>We conducted a retrospective operational analysis using anonymized data from the Integrierter Versorgungsnachweis (IVENA) Massenanfall von Verletzten, mass-casualty incident (MANV) coordination module, integrated into the regional hospital capacity management system. Key outcomes included timelines of system activation, patient distribution, hospital capacity feedback, and continuity of routine emergency care.</p><p><strong>Results: </strong>The incident resulted in 39 casualties, including two fatalities. Early activation of the digital MANV module enabled real-time situational awareness and demand-oriented allocation of patients. All critically injured patients were distributed across multiple hospitals within 19 min of the first transport. Hospitals dynamically adjusted reported capacities throughout the incident, allowing routine emergency operations to continue largely unaffected. No single hospital experienced critical overload.</p><p><strong>Conclusions: </strong>Digital patient distribution supported rapid, adaptive coordination during a high-impact urban MCI and contributed to prevention of hospital overload. Integration of such systems into routine operations, combined with standardized preparation and training, may enhance disaster risk reduction and resilience of urban emergency medical systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147532089","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}