Prehospital Emergency Care最新文献

{"title":"A Heterogeneous Legal Landscape Governs Community AED Use: Crowdsourced United States AED Legal Review and Gap Analysis.","authors":"David J Adriansen, Bryan L Fischberg, Keith A Marill","doi":"10.1080/10903127.2025.2490804","DOIUrl":"10.1080/10903127.2025.2490804","url":null,"abstract":"<p><strong>Objectives: </strong>Automatic External Defibrillators (AEDs) are a tremendous advance in the care of victims of out-of-hospital cardiac arrest. We sought to define and assess the legal landscape regarding Automatic External Defibrillators (AEDs) in the United States (U.S.).</p><p><strong>Methods: </strong>We performed a retrospective study of all state and federal laws relevant to the use of AEDs outside the hospital in the U.S. In the first of three phases, we searched a database of U.S. laws and regulations (\"rules\") using broad relevant search terms. Teams of two investigators reviewed all rules identified for relevance to ten realms: location, acquisition, deployment, liability, training, accessibility, maintenance, registration, interface, and reporting. We termed the application of each rule to a single realm an \"action,\" so each rule could have one or more actions. In Phase 2, a third reviewer resolved any differences or discrepancies. A separate team of investigators confirmed or identified a \"URL\" online address for each rule. In Phase 3, we performed quantitative assessments of all included rules using summary statistics and Cohen's kappa to assess reviewer reliability. We made qualitative assessments for each realm across all jurisdictions using SWOT (Strengths, Weaknesses, Opportunities, and Threats) analyses.</p><p><strong>Results: </strong>Nine hundred twenty-one rules, which included 1,987 actions, were deemed relevant to defibrillator access and use in the community, with a mean of 17.4 (SD 14.0) rules and 37.5 (SD 35.0) actions per jurisdiction, suggesting large heterogeneity in actions across states. There were 21 federal rules, including 42 actions. Qualitative analyses revealed that some states have successfully implemented AED training programs and public awareness campaigns, but uneven public awareness, cost, liability, and overly complex or stringent rules have posed barriers to successful AED deployment and use.</p><p><strong>Conclusions: </strong>We have provided a focused overview of U.S. rules governing community AEDs. We found high heterogeneity across states and a limited federal floor of rules. It is hoped this report can be used to improve legislation and resulting future successful AED use.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"258-268"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977017","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":"422-426"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","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":"Addition of Intramuscular Epinephrine to Standard of Care by Paramedics to Decrease Time-to-Initial Epinephrine Dose in Pediatric Out-of-Hospital Cardiac Arrest: A Simulation Trial.","authors":"Jay Loosley, Maysaa Assaf, Katie McKenzie, Saoirse Cameron, Katelyn Gray, Matthew Davis, Facundo Garcia-Bournissen, Michael Miller, Janice A Tijssen","doi":"10.1080/10903127.2025.2536223","DOIUrl":"10.1080/10903127.2025.2536223","url":null,"abstract":"<p><strong>Objectives: </strong>Survival rates for pediatric out-of-hospital cardiac arrest (POHCA) are low at around 10%. Paramedic services administer critical interventions including epinephrine. While typically administered via intravenous (IV) or intraosseous (IO) routes, obtaining these access points in out-of-hospital emergencies is challenging. We aimed to evaluate the time to first dose epinephrine and dosing accuracy in a simulated POHCA event.</p><p><strong>Methods: </strong>Paramedics were randomized to one of three epinephrine administration routes: 1) IV or IO; 2) intramuscular (IM) by autoinjector; or 3) IM by needle/syringe. Each participant was asked to provide resuscitation to a school-aged mannequin with asystole, including administration of epinephrine via their randomized route. Participants were not directly informed of the outcome variables. The primary outcome was time to initial epinephrine dose for each route. Our secondary outcomes were non-inferiority time to definitive dose epinephrine (i.e., by IV or IO), time to secure vascular access (either IO or IV), and administration of correct epinephrine dose (within 20% of correct dose).</p><p><strong>Results: </strong>Sixty six paramedics participated. We demonstrated a significant reduction in time to initial dose of epinephrine of 1.5 min (<i>p</i> < 0.001) by the IM route using epinephrine autoinjectors compared to standard of care by IV or IO. We also demonstrated that using a needle and syringe to administer epinephrine by the IM route offered no benefit in time to initial epinephrine dose and led to more dosing errors for the definitive dose of epinephrine (i.e., by IV or IO) (<i>n</i> = 4). We demonstrated that time to secure vascular access after IM injection with an auto-injector was delayed by 1:07 min (<i>p</i> = 0.002) compared to IV/IO.</p><p><strong>Conclusions: </strong>This is the first study to demonstrate that IM epinephrine by autoinjector is feasible in a simulated POHCA scenario and confers a significant advantage in time to initial dose of epinephrine. This study will inform future human trials of IM epinephrine for POHCA.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"354-358"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874845","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":"Association Between Immediate Defibrillation and Outcomes in Shockable Out-of-Hospital Cardiac Arrest: A Propensity Score Analysis.","authors":"Ryu Kimura, Koshi Nakagawa, Tomoya Kinoshi, Hideharu Tanaka","doi":"10.1080/10903127.2025.2558868","DOIUrl":"10.1080/10903127.2025.2558868","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to examine the association between the timing of defibrillation by emergency medical service (EMS) and out-of-hospital cardiac arrest (OHCA) patient prognosis using a nationwide database.</p><p><strong>Methods: </strong>We included patients with non-traumatic OHCA aged ≥15 years from 2010 to 2019, with an initial shockable rhythm, who received EMS defibrillation. Patients were divided into 2 groups: defibrillation within 2 min of cardiopulmonary resuscitation (CPR; immediate defibrillation) or after 2 min (delayed defibrillation). The primary outcome was 1-month survival. We set the primary exposure to immediate defibrillation and employed a 1:1 propensity score matching. Multiple logistic regression analysis estimated the adjusted odds ratio (AOR) and 95% confidence interval (CI) for exposure and outcomes.</p><p><strong>Results: </strong>After propensity score matching, 16,970 patients were included in each group. The 1-month survival were 32.5% and 29.1% for immediate defibrillation and delayed defibrillation, respectively. Immediate defibrillation was significantly associated with 1-month survival compared to delayed defibrillation (AOR [95% CI], 1.18 [1.12, 1.24]).</p><p><strong>Conclusions: </strong>Defibrillation within 2 min of starting CPR was associated with 1-month survival, emphasizing the importance of immediate defibrillation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"393-400"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034060","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":"Analysis of 67,975 Emergency Deployments in a Major German City - Criteria for More Efficient Dispatching of Emergency Physicians.","authors":"Yacin Keller, Anne Schrimpf, André Gries","doi":"10.1080/10903127.2025.2460071","DOIUrl":"10.1080/10903127.2025.2460071","url":null,"abstract":"<p><strong>Objectives: </strong>Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.</p><p><strong>Methods: </strong>Rescue service deployments in the city of Dresden, Germany (01/01/2021-12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site - such as airway, breathing, circulation, and disability - based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.</p><p><strong>Results: </strong>In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.</p><p><strong>Conclusions: </strong>The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"55-62"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365077","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":"Video-Assisted Versus Audio-Assisted Dispatcher Cardiopulmonary Resuscitation for Optimizing Compression Quality in Simulated Scenarios: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Xinyu Tan, Xiaokai Wang, Xiangmin Li, Xinbo Yin","doi":"10.1080/10903127.2025.2547651","DOIUrl":"10.1080/10903127.2025.2547651","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate video-assisted dispatcher cardiopulmonary resuscitation (V-DACPR) versus audio-assisted dispatcher CPR impacts on compression quality in simulated out-of-hospital cardiac arrest (OHCA) scenarios.</p><p><strong>Methods: </strong>Network meta-analysis of randomized controlled trials (RCTs) compared V-DACPR versus audio-assisted dispatcher CPR (A-DACPR) and control. The primary outcome was the compression rate; the secondary outcomes included compression depth, time to first compression, and interruption time. Network meta-analysis of RCTs compared dispatcher-guided CPR with video feedback versus telephone-only instructions in simulated OHCA scenarios using high-fidelity manikins. Three intervention arms were compared: video-assisted CPR, audio-assisted CPR, and unguided CPR (control). Standardized mean differences (SMD) and surface under the cumulative ranking curve (SUCRA) were calculated using Bayesian network meta-analysis methodology.</p><p><strong>Results: </strong>Fifteen trials (<i>n</i> = 1,556) were analyzed. V-DACPR showed superior compression rates versus A-DACPR (impact size: -21.37, 95% CI: -36.10, -7.41) and control (-43.04, 95% CI: -63.05, -22.52). V-DACPR demonstrated better time to first compression versus control (-42.23, 95% CI: -83.31, -1.42) and favorable trends in compression depth (-5.06, 95% CI: -12.40 to 2.12) and interruption time, though several comparisons between V-DACPR and A-DACPR did not reach statistical significance. Heterogeneity was low to moderate (I² = 12-63%). Confidence in network meta-analysis (CINeMA) assessment supported moderate to high-quality evidence.</p><p><strong>Conclusions: </strong>V-DACPR demonstrated significant advantages in compression rate in simulated scenarios, with favorable trends in other quality metrics compared to A-DACPR. These findings support the potential for video assistance technology in dispatcher-guided CPR, particularly for optimizing compression rates. However, these results were observed in simulation studies and require validation in real-world clinical settings to determine their impact on patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"383-392"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966143","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":"Wildland Fireas a Public Health and EMS Crisis: Evolving Threats and Imperatives for Out-of-Hospital Leadership.","authors":"Brian R Drury, David Baskin, Michelle M Curry, Christian M Garcia, Seth C Hawkins","doi":"10.1080/10903127.2025.2601095","DOIUrl":"10.1080/10903127.2025.2601095","url":null,"abstract":"<p><p>Wildland fire in the United States has evolved into a sustained public health emergency with direct and escalating implications for emergency medical services (EMS). Once viewed primarily as a forestry issue, modern wildfire is now driven by climate change, decades of fuel accumulation, expansion of the wildland-urban interface, and ecosystem degradation. Fire seasons have lengthened into year-round events, generating substantial health impacts and placing severe strain on out-of-hospital systems. The population health consequences of wildfire exposure are extensive. Acute smoke inhalation increases asthma exacerbations, chronic obstructive pulmonary disease presentations, cardiovascular events, and premature mortality. Repeated or chronic exposure contributes to long-term pulmonary dysfunction, elevated malignancy risk, and behavioral health morbidity. Children, older adults, individuals with preexisting conditions, and socioeconomically disadvantaged communities experience disproportionate harm. Simultaneously, wildfires cause surges in EMS call volume while disrupting communications, transportation, and access to definitive care. Prehospital clinicians and responders also face significant occupational hazards, including extreme heat, prolonged particulate exposure, musculoskeletal trauma, behavioral health stressors, and an elevated risk of sudden cardiac death. As EMS agencies are increasingly tasked with austere fireground support, extended evacuations, and prolonged operations, the role of EMS physicians becomes critical. However, despite the scale of these challenges, prehospital physicians are often underrepresented in regional wildfire mitigation, preparedness, and resilience planning. National recommendations now call for a strategic shift from reactive suppression to proactive, interdisciplinary collaboration. Prehosptial physicians are uniquely positioned to integrate clinical care, disaster medicine, occupational health, and community preparedness. Their leadership is essential to ensure EMS integration into community wildfire protection plans; to strengthen occupational and mental health support for responders; to guide wildfire-specific training, triage, and protocol development; and to inform public education efforts. Prehospital physicians must also advocate for policies that incorporate out-of-hospital perspectives into resilience funding and mitigation initiatives. In summary, wildland fire is a chronic societal crisis with expanding health and EMS implications. Meeting this challenge requires prehospital physicians to broaden their roles as clinicians, educators, advocates, and policy leaders to support a more fire-adapted and resilient future.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"436-440"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743995","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":"Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-Analysis.","authors":"Ian J Saldanha, Enid Chung Roemer, Edbert B Hsu, George S Everly, Genie Han, Allen Zhang, Ritu Sharma, Emmanuel Asenso, Drew Bidmead, Eric B Bass, J Lee Jenkins","doi":"10.1080/10903127.2025.2465715","DOIUrl":"10.1080/10903127.2025.2465715","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.</p><p><strong>Methods: </strong>We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).</p><p><strong>Results: </strong>We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.</p><p><strong>Conclusions: </strong>The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"63-77"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399795","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":"Effectiveness of Prehospital Critical Care Scene Response for Major Trauma: A Systematic Review.","authors":"Jeremy Penn, Ryan McAleer, Carolyn Ziegler, Sheldon Cheskes, Brodie Nolan, Johannes von Vopelius-Feldt","doi":"10.1080/10903127.2025.2483978","DOIUrl":"10.1080/10903127.2025.2483978","url":null,"abstract":"<p><strong>Objectives: </strong>Major trauma is a leading cause of morbidity and mortality worldwide. It is unclear if the addition of a critical care response unit (CCRU) with capabilities comparable to hospital emergency departments might improve outcomes following major trauma, when added to Basic or Advanced Life Support (BLS/ALS) prehospital care. This systematic review describes the evidence for a CCRU scene response model for major trauma.</p><p><strong>Methods: </strong>We searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL (EBSCOhost), Science Citation Index Expanded (Web of Science), Conference Proceedings Citation Index - Science (Web of Science), LILACS (Latin American and Caribbean Health Sciences Literature) for relevant publications from 2003 to 2024. We included any study that compared CCRU and BLS/ALS care at the scene of major trauma, reported patient-focused outcomes, and utilized statistical methods to reduce bias and confounding. The risk of bias was assessed by two independent reviewers, using the ROBINS-I tool. Based on our a priori knowledge of the literature, a narrative analysis was chosen. The review was prospectively registered (PROSPERO ID CRD42023490668).</p><p><strong>Results: </strong>The search yielded 5243 unique records, of which 26 retrospective cohort studies and one randomized controlled trial met inclusion criteria. Sample sizes ranged from 308 to 153,729 patients. Eighteen of the 27 included studies showed associations between CCRUs and improved survival following trauma, which appear to be more consistently found in more critically injured and adult patients, as well as those suffering traumatic cardiac arrest. The remaining nine studies showed no significant difference in outcomes between CCRU and BLS/ALS care. Most studies demonstrated critical or severe risks of bias.</p><p><strong>Conclusions: </strong>Current evidence examining CCRU scene response for major trauma suggests potential benefits in severely injury patients but is limited by overall low quality. Further high-quality research is required to confirm the benefits from CCRU scene response for major trauma.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"309-322"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701322","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":"Genre of Music Festivals as a Predictor for Medical Utilization Rate.","authors":"G D van Dijken, J S W R Hofsteede, A E Hoek, D Dekker, D W de Lange","doi":"10.1080/10903127.2025.2481143","DOIUrl":"10.1080/10903127.2025.2481143","url":null,"abstract":"<p><strong>Objectives: </strong>The medical utilization rates (MUR) can be applied to anticipate necessary medical resources at mass gatherings. The MUR describes the number of patients per thousand attendees. The aim of this observational study was to evaluate whether the type of music festival, Electronic Dance Music Festivals (EDMF) versus Mainstream, is related to the MUR and to drug-related incidents.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patient data from Event Medical Service B.V., a Dutch company, providing emergency care at many festivals in the Netherlands. Data were collected in an online database between February 2022 and August 2023. The number of patient contacts per festival type was recorded and patients requiring advanced medical care (unable to sit, potentially hemodynamically unstable, and/or requiring advanced medical care), were analyzed for drug-related causes.</p><p><strong>Results: </strong>A total of 20,829 patients presented at 518 events with a total attendance of almost 7.5 million visitors. There were 253 EDMF events with a median attendance of 12,000 and 265 mainstream events with a median attendance of 10,000 per event. The average MUR for the EDMF group was higher compared to the Mainstream group (28.8 vs. 17.8, <i>p</i> < 0.001). A total of 1,732 patients needed advanced medical care. The proportion of drug<b>-</b>related cases among the patients needing advanced medical care, mainly stimulants and combined drug use, was 74% for the EDMF group compared to 52% in the mainstream group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In this observational study we found a clear difference in MUR in Electronic Dance Music events compared to Mainstream events with a higher percentage of drug-related cases in patients with more severe conditions at EDMF events. Our findings may help to better plan scarce medical resources at mass gatherings in the music scene and suggest that EDMF need a targeted approach for more drug-related pathology.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"332-337"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721125","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}