Prehospital Emergency Care最新文献

{"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":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","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":"Disparities in Emergency Medical Services Termination of Resuscitation Practices for Patients with Out-of-Hospital Cardiac Arrest.","authors":"C J Naas, L B Nickel, T P Aufderheide, B W Weston","doi":"10.1080/10903127.2025.2487135","DOIUrl":"https://doi.org/10.1080/10903127.2025.2487135","url":null,"abstract":"<p><strong>Objectives: </strong>There are well-described racial, ethnic, and gender-based inequities following out-of-hospital cardiac arrest (OHCA). Few studies have analyzed disparities in emergency medical services (EMS) termination of resuscitation (TOR) practices. This purpose of this study was to identify inequities in duration of prehospital resuscitation prior to TOR.</p><p><strong>Methods: </strong>A retrospective cohort of adult (≥18 years-old), non-traumatic OHCA events in a single metropolitan, fire-based EMS system was evaluated. Duration of resuscitation prior to prehospital TOR was separately evaluated among racial/ethnic (Black, Hispanic, and White) and gender (Female and Male) groups using a multivariable linear regression model. Variables in the model included bystander cardiopulmonary resuscitation (CPR) provision, arrest witnessed status, initial rhythm (shockable versus non-shockable), and patient age. Multiple imputation was used to account for missing data entries where duration of resuscitation was not documented. Incidence of hospital transport between racial/ethnic and gender groups was also assessed.</p><p><strong>Results: </strong>Between February 1, 2020 and February 28, 2023, 3700 patients met inclusion criteria, of which 1895 (51.2%) had field TOR and 1328/1895 had a documented time of TOR. When controlling for arrest witnessed status, bystander CPR provision, initial shockable rhythm, and subject age, Black race (24.1 minutes (95% confidence interval 21.2-27.0, p < 0.001)) and Hispanic ethnicity (23.7 minutes (95% CI 20.0-27.5, p = 0.03)) were associated with shorter duration of resuscitation compared to White race (25.8 minutes (95% CI 23.9-27.7)). These racial inequities persisted when using multiple imputation modeling. There was no difference in duration of resuscitation between female (24.3 minutes (95% CI 22.4-26.2)) and male gender (24.7 minutes (95%CI 21.8-27.5), p = 0.46). There were no differences in incidence of hospital transport.</p><p><strong>Conclusions: </strong>This study identified inequities in prehospital termination of resuscitation practices following OHCA. Black and Hispanic patients, as compared to White patients, received approximately 2-minute-shorter prehospital resuscitative efforts prior to TOR despite controlling for bystander CPR, witnessed status, initial rhythm, and patient age. There were no gender-based differences in prehospital duration of resuscitation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-24"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754296","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 Spector Job Satisfaction Survey: Associations of Satisfaction with Leaving EMS.","authors":"Christopher B Gage, Lakeshia Logan, Jacob C Kamholz, Jonathan R Powell, Shea L van den Bergh, Eben Kenah, Ashish R Panchal","doi":"10.1080/10903127.2025.2482100","DOIUrl":"10.1080/10903127.2025.2482100","url":null,"abstract":"<p><strong>Objectives: </strong>Detailed job satisfaction evaluations are often used to build strategies for employee retention. Despite recognizing that emergency medical services (EMS) dissatisfaction drives turnover, validated tools rigorously evaluating satisfaction have not been employed. We aim to assess the association between EMS clinician satisfaction and their likelihood of leaving the profession using the validated Spector Job Satisfaction Survey (JSS).</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of nationally certified EMS clinicians in the United States recertifying between October 2022 and April 2023. Our primary outcome was the self-reported likelihood of leaving EMS within 12 months (likely or not likely to leave). The primary exposure was job satisfaction, assessed using the 36-item JSS, scored from 36 to 216, and analyzed in two models: total satisfaction (dissatisfied [scores 36-108], ambivalent [108-144], satisfied [144-216]), and satisfaction subscales (e.g., pay, promotion, supervision). We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify key predictors of intent to leave EMS, adjusting for demographic and agency characteristics. Post-LASSO Bayesian logistic regression estimated odds ratios (OR) and 95% credible intervals (CrI).</p><p><strong>Results: </strong>Among 33,414 EMS clinicians (response rate: 26.3%), the median age was 36 years (IQR: 29,46), 74.2% were male, and 83.0% were White, non-Hispanic. Most respondents worked full-time (77.6%), primarily as EMTs (48.5%), in urban settings (89.9%). Mean satisfaction scores were higher among those not likely to leave EMS (146.7 [standard deviation: 29.0]) than those likely to leave (121.2 [28.4]). Odds of leaving decreased for more satisfied clinicians: ambivalent clinicians [0.35 (0.32-0.38)]; satisfied clinicians [0.11 (0.10-0.13)]; referent dissatisfied. Additionally, specific satisfaction subscales were associated with lower odds of leaving for those satisfied compared to those dissatisfied, including nature of work [0.32 (0.28-0.37)], pay [0.46 (0.40-0.52)], promotion opportunities [0.53 (0.47-0.61)], supervision [0.65 (0.57-0.73)] and contingent rewards [0.77 (0.67-0.88)].</p><p><strong>Conclusions: </strong>The EMS clinicians with higher satisfaction with their nature of work, pay, and promotion opportunities were less likely to report intent to leave. These findings highlight key factors that may inform workforce retention efforts.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664311","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":"Outdated & Overwhelmed: Evolving 9-1-1 for Modern Health Care.","authors":"Michael A Austin","doi":"10.1080/10903127.2025.2487136","DOIUrl":"https://doi.org/10.1080/10903127.2025.2487136","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754298","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":"Improving Bystander Response: How Long Does It Take to Retrieve an AED From Varying Distances.","authors":"Erin R Gramm, Jorge A Gumucio, Kate Flickinger, David D Salcido, James J Menegazzi","doi":"10.1080/10903127.2025.2475323","DOIUrl":"10.1080/10903127.2025.2475323","url":null,"abstract":"<p><strong>Objectives: </strong>Survival from out-of-hospital cardiac arrest (OHCA) is low, with less than 10% surviving to hospital discharge. Early defibrillation can improve survival from an OHCA with a shockable rhythm. Cell phone applications alert rescuers as to where victims are and where automated external defibrillators (AEDs) are located, but guidance on choosing between going to the victim and doing cardiopulmonary resuscitation and retrieving an AED is lacking. We sought to determine the time required to retrieve AEDs at varying distances in a real-life setting. At a distance greater than 400 meters away, that AED retrieval time will be longer than median emergency medical services (EMS) first response time of 6.9 min, based on national data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry.</p><p><strong>Methods: </strong>Thirty study participants (15 male, 15 female) performed four AED retrieval runs, separated by at least 24 h. Three runs simulated a real-life OHCA situation outdoors on a busy street in our city (in all four seasons), and one was unimpeded on an indoor track. The AED retrieval distances were 200 meters (400 roundtrip), 400 meters (800 roundtrip), and 600 meters (1,200 roundtrip) The middle distance (400/800 meters) was chosen for the track run.</p><p><strong>Results: </strong>The mean run times were 4.05 min for the 200/400 m retrieval, 6.62 min for the 400/800 m, 8.62 min for the 600/1,200 m, and 4.35 min for the 400/800 m track run, which is 2.3 min shorter than the 400/800 m real-life run and significantly different (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Barriers to mobility, like traffic lights, motor vehicles, weather conditions, and pedestrians, have significant impacts on how long it takes for an AED to be retrieved and returned to the patient's side. Using these simulation runs, we demonstrated that short AED retrieval distances are likely necessary to impact survival. When compared to our national EMS first response times, only the 200/400 m retrieval distance would likely provide sufficient time for a responder to retrieve, arrive at the patient's side and utilize an AED prior to EMS arrival.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692967","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: Transfusion of Blood Products in Trauma - A Position Statement and Resource Document of NAEMSP.","authors":"Joshua B Brown, Mark H Yazer, Joseph Kelly, Philip C Spinella, Valerie DeMaio, Andrew D Fisher, Andrew P Cap, C J Winckler, Gerald Beltran, Christian Martin-Gill, Francis X Guyette","doi":"10.1080/10903127.2025.2476195","DOIUrl":"10.1080/10903127.2025.2476195","url":null,"abstract":"<p><p>Hemorrhagic shock remains the leading cause of potentially preventable death among injured patients with life-threatening bleeding. Prehospital resuscitation has been evolving with increasing use of blood product resuscitation. The impact of blood administration on patient outcomes remains poorly defined with significant heterogeneity in the quality of literature supporting prehospital blood product resuscitation after trauma. We completed a structured search of the literature using a rapid review framework based on three distinct PICO questions to develop systematic and consensus recommendations.</p><p><p>The National Association of Emergency Medical Services Physicians (NAEMSP) recommends, in EMS agencies/systems that can support a high-quality prehospital blood transfusion program:Use of blood components over crystalloids for the first-line treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitationUse of low titer group O whole blood (LTOWB) as the first-choice blood product for treatment of patients with traumatic life-threatening bleeding in the prehospital phase of resuscitationUse of a combination or composite of prehospital transfusion indications, focused on physiologic abnormalities and/or injury patterns with obvious significant blood loss.Use of active monitoring for transfusion-related adverse events.Developing a mechanism to recycle unused blood product units nearing their expiration date to a high-use hospital facility to minimize wastage.Engaging in a comprehensive longitudinal active collaboration between EMS agencies, trauma centers, and blood suppliers to ensure the success of a prehospital transfusion program.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701327","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 Utilization of Medication for Opioid Use Disorder: A Narrative Review of the Literature and Analysis of Prehospital Buprenorphine Protocols.","authors":"Kasha Bornstein, David Rayburn","doi":"10.1080/10903127.2025.2486292","DOIUrl":"https://doi.org/10.1080/10903127.2025.2486292","url":null,"abstract":"<p><strong>Objectives: </strong>This narrative review examines the current literature and prehospital buprenorphine protocols, discusses the available outcomes data of existing protocols, identifies protocol variations, and highlights challenges and opportunities associated with prehospital medication for opioid use disorder (MOUD) initiation.</p><p><strong>Methods: </strong>PubMed was searched for articles from 1/1/2010 to 2/1/2025, using keywords \"Prehospital Buprenorphine,\" \"Emergency Medical Services Buprenorphine,\" \"EMS Medication for Opioid Use Disorder,\" and \"Prehospital MOUD.\" All EMS protocols from the website http://www.emsprotocols.org (Acid Remap, LLC) were reviewed, supplemented with internet searches. A data dictionary was developed to categorize protocol characteristics; categories of responses included minimum Clinical Opiate Withdrawal Scale (COWS) scores, initial and maximum buprenorphine dosages, adjunct medications for withdrawal symptoms, online medical control (OMC) consultation requirements, minimum age, contraindications and exclusion criteria, and post-induction follow-up.</p><p><strong>Results: </strong>Six statewide prehospital MOUD protocols were identified, along with regional protocols in 21 states and Washington, DC. Details were available for 42 state or regional protocols. Initial dosing across all protocols ranged between 4-24mg. Maximum dosing ranged between 8-48mg. Median initial and total dosage was 16mg and 24mg, respectively. Adjunctive medication for withdrawal was available in 61.9% of protocols. Treatment with MOUD was limited to mobile integrated health/community paramedicine programs in 19% of protocols. Otherwise, administration was permitted via standing order in 52.4% and required physician authorization in 26.2% of protocols. The minimum COWS scores ranged between 5-8, with 71.5% of protocols requiring a COWS score >7. Most (59.5%) protocols specified 18 years as the minimum age, while 23.8% specified 16 years. Buprenorphine was contraindicated for pregnant patients in 38% of protocols, while 9.6% of protocols required OMC consultation. Ten peer-reviewed studies evaluating EMS MOUD protocols outcomes were identified, most of which reported successful initiation, linkage to care, and retention for significant proportions of patients evaluated for opioid overdose and/or opioid withdrawal symptoms.</p><p><strong>Conclusions: </strong>Prehospital MOUD protocol design varies significantly, and best practices remain unknown, particularly regarding protocol inclusion criteria, dosing regimens, adjunctive medications, and resources to ensure continuity. The available data suggest protocols with more permissive inclusion criteria and comprehensive service provision are associated with higher rates of linkage to care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-20"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754297","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":"https://doi.org/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, p <0.001). A total of 1732 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 (p <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":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","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}

{"title":"Bystander Defibrillation and Survival According to Emergency Medical Service Response Time After Out-of-Hospital Cardiac Arrest - A nationwide registry-based cohort study.","authors":"Mathias Hindborg, Harman Yonis, Filip Gnesin, Mikkel Porsborg Andersen, Frank Eriksson, Zehao Su, Fredrik Folke, Kristian Bundgaard Ringgren, Carolina Malta Hansen, Helle Collatz Christensen, Kristian Kragholm, Christian Torp-Pedersen","doi":"10.1080/10903127.2025.2478211","DOIUrl":"https://doi.org/10.1080/10903127.2025.2478211","url":null,"abstract":"<p><strong>Objectives: </strong>The impact of emergency medical services (EMS) response times when integrating bystanders' automated external defibrillator (AED) use into established response systems remains unclear. This study aims to investigate 30-day survival probabilities for different EMS response times for bystander and non-bystander defibrillated patients and identify for which EMS response times bystander defibrillation improves 30-day survival probability.</p><p><strong>Methods: </strong>Data on patients with bystander witnessed out-of-hospital-cardiac arrest (OHCAs) with initial shockable rhythm who received bystander cardiopulmonary resuscitation were retrieved from Danish Cardiac Arrest Registry for years 2016-2022. Proportions of 30-day survival were calculated for five intervals of EMS response time for patients who received bystander defibrillation and those who did not. The causal inference framework utilizing targeted maximum likelihood estimation was used to estimate 30-day survival probability for each interval of EMS response time and when comparing cases where bystander defibrillation was performed with those where it was not. This analysis was adjusted for relevant confounding factors and conducted separately for residential and public OHCAs.</p><p><strong>Results: </strong>The study included 3,924 patients with OHCA. Bystander defibrillation was more frequent in public than in residential OHCAs (64.1% vs. 35.9%). Short EMS response times had higher 30-day survival probability. Bystander defibrillation resulted in higher probability of 30-day survival for EMS response times of 7-9 minutes (survival ratio 1.24 (95% CI: 1.03; 1.49)) in public OHCAs in the adjusted model, when compared to non-bystander defibrillated patients.</p><p><strong>Conclusions: </strong>With EMS response times of 7-9 minutes, we detected a clear 30-day survival benefit for bystander defibrillated patients in public locations. No 30-day survival benefits were seen for other EMS response time intervals or in residential locations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711081","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":"Disparities of Aspirin Administration for Prehospital Chest Pain and ST Elevation Myocardial Infarctions.","authors":"Anna Maria Johnson, Hei Kit Chan, Renee Johnson, Anastasia S Papin, Daniel C Walter, N Clay Mann, Benjamin Fisher, Larissa Myaskovsky, Ryan M Huebinger","doi":"10.1080/10903127.2025.2473684","DOIUrl":"10.1080/10903127.2025.2473684","url":null,"abstract":"<p><strong>Objectives: </strong>Although disparities exist in aspirin administration for chest pain and ST elevation myocardial infarctions (STEMI), little is known about community-based disparities in aspirin administration for prehospital patients. We evaluated disparities in prehospital aspirin using a national prehospital database.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2018-2021 NEMSIS database linked to census data, including adult prehospital encounters. We created two cohorts: dispatch reason of chest pain and identified STEMI on prehospital EKG. We stratified patients based on majority ZIP Code race/ethnicity (>50% White, Black, and Hispanic) and into quartiles based on household income. Using multivariable logistic regression, we evaluated the association between incident community characteristics and aspirin administration.</p><p><strong>Results: </strong>We included 4,881,663 chest pain encounters and 184,610 STEMIs. Chest pain encounters in majority White communities (32.3%) received aspirin more often for chest pain than Black (22.1%; aOR 0.59, [0.59-0.60]) or Hispanic (24.8%; aOR 0.66, [0.66-0.67]) communities. Compared to the top income quartile (29.0%), the lowest income quartile had lower odds of aspirin administration (4th-27.6%; aOR 0.93, [0.92-0.94]). For STEMIs, adjusted odds of aspirin administration were higher for White (53.4%) than Black (52.5%; aOR 0.81, [0.78-0.84]) or Hispanic (53.6%; aOR 0.93, [0.89-0.96]) patients. Compared to the highest income quartile (55.0%), lower quartiles had lower odds of aspirin administration (2nd-54.2%; aOR 0.95, [0.92-0.97]; 3rd-52.9%; aOR 0.93, [0.91-0.96]; 4th-52.0%; aOR 0.86, [0.84-0.89]).</p><p><strong>Conclusions: </strong>Patients from Black, Hispanic/Latino, and lowest-income communities received aspirin for chest pain at a lower rate than white or high-income patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557792","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}