Prehospital Emergency Care最新文献

{"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":"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":"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), <i>p</i> < 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), <i>p</i> < 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":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","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 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":"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":"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":"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}

{"title":"Prehospital Diagnosis of Acute ST-Elevation Myocardial Infarction in a Patient with Situs Inversus Totalis.","authors":"Victoria Gordon, Jason Jones, Brad Ward, Casey Patrick","doi":"10.1080/10903127.2025.2506183","DOIUrl":"https://doi.org/10.1080/10903127.2025.2506183","url":null,"abstract":"<p><p>We report a case of a 50-year-old male who presented to emergency medical services (EMS) with acute chest pain, pallor, and diaphoresis. A prehospital diagnosis of ST-elevation myocardial infarction (STEMI) was made following electrocardiogram (ECG) lead reversal by the paramedics secondary to a reported history of situs inversus totalis, a congenital condition with complete reversal or mirroring of the thoraco-abdominal visceral organs. Paramedics initiated a STEMI alert to the emergency department (ED) from the scene, and the patient underwent emergent cardiac catheterization following transport to the hospital. A stent was placed in the left coronary artery, and the patient's symptoms resolved. He was discharged on hospital day three with no complications. This case highlights the need for pre-hospital clinicians to recognize and adapt when encountering rare conditions like dextrocardia and situs inversus.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102434","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":"Addressing the Use of Mechanical Compression Devices in Traumatic Out-of-Hospital Circulatory Arrest.","authors":"Jamie Jasti, Jeremy Levin, Jacqueline Blank, Thomas Engel, Daniel Holena, Jacob Peschman, Katie Iverson, Thomas Carver, Marshall Beckman, M Riccardo Colella","doi":"10.1080/10903127.2025.2500714","DOIUrl":"https://doi.org/10.1080/10903127.2025.2500714","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041807","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":"Implementation and Validation of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in a Rural EMS Region.","authors":"Luke Wohlford, Miles Kittell, Jackson Lyttleton, Jane G Morris, Timothy G Lukovits, Kate D Zimmerman, J Matthew Sholl, Thomas W Trimarco, Peter W Callas, Daniel Wolfson","doi":"10.1080/10903127.2025.2498012","DOIUrl":"https://doi.org/10.1080/10903127.2025.2498012","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital identification of large vessel occlusion (LVO) stroke patients is crucial for timely mechanical thrombectomy (MT). The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score effectively predicts LVOs, but its utility in rural, multi-state emergency medical services (EMS) systems remains unexplored.</p><p><strong>Methods: </strong>This prospective cohort study included ground prehospital stroke alerts in Vermont, New Hampshire, and Maine from July 2021 to December 2022. Patients with a prehospital FAST-ED score recorded were enrolled. LVO was confirmed by CT angiography. Our primary outcome was the accuracy of LVO identification with FAST-ED scores. Secondary outcomes included the predictiveness of the prehospital FAST-ED score for Thrombectomy Capable Center (TCC) appropriateness, MT, and 30-day mortality.</p><p><strong>Results: </strong>This study included 370 patients. The overall LVO prevalence was 23.2% (<i>n</i> = 86). A positive FAST-ED score demonstrated a sensitivity of 73% (95% CI, 63%-82%) and specificity of 61% (95% CI, 55%-66%) for presence of LVO. The PPV was 36% (95% CI, 29%-44%) and the NPV was 88% (95% CI, 83%-92%). Positive FAST-ED scores were associated with significantly higher rates of TCC appropriateness (46% vs 10%, <i>p</i> < 0.0001), mechanical thrombectomy (19% vs 6%, <i>p</i> < 0.001) and 30-day mortality (24% vs 6%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The FAST-ED score can be implemented by prehospital personnel to triage patients to a TCC when faced with options for hospital destination in a rural setting. This study supports incorporating FAST-ED scoring in rural protocols for potential diversions to TCCs. Further research should be done to better characterize the effects of prehospital diversion on time to thrombectomy, functional outcomes, and mortality.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025239","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 Trauma Compendium: Tranexamic Acid in Trauma- a joint position statement and resource document of NAEMSP, ACEP, and ACS-COT.","authors":"Whitney J Barrett, Kevin A Kaucher, Ross E Orpet, Eric M Campion, Jeffrey M Goodloe, Peter Fischer, Christopher B Colwell, John W Lyng","doi":"10.1080/10903127.2025.2497056","DOIUrl":"https://doi.org/10.1080/10903127.2025.2497056","url":null,"abstract":"<p><p>Prehospital use of tranexamic acid (TXA) has grown substantially over the past decade despite contradictory evidence supporting its widespread use. Since the previous guidance document on the prehospital use of TXA for injured patients was published by the National Association of Emergency Medical Services Physicians (NAEMSP), the American College of Surgeons Committee on Trauma (ACS-COT), and the American College of Emergency Physicians (ACEP) in 2016, new research has investigated outcomes of patients who receive TXA in the prehospital setting. To provide updated evidence-based guidance on the use of intravenous TXA for injured patients in the EMS setting, we performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026451","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}