Prehospital Emergency Care最新文献

{"title":"Prehospital Blood Transfusion for Medical Causes of Hemorrhage: A Case Series.","authors":"Angela P Cornelius, Jeffrey Siegler, Melissa Kroll, Brian L Miller, Betty Y Yang, Daniel Verna, Allison Scanlon, Jeff Jarvis","doi":"10.1080/10903127.2026.2726541","DOIUrl":"https://doi.org/10.1080/10903127.2026.2726541","url":null,"abstract":"<p><strong>Objectives: </strong>Much attention has been given to prehospital blood use for trauma, but evidence is lacking for non-traumatic hemorrhage. Therefore, we sought to evaluate the epidemiology of patients receiving prehospital whole blood for nontraumatic hemorrhage.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients receiving prehospital blood transfusions for non-traumatic hemorrhagic shock within two fire-based emergency medical services (EMS) systems, between February 20, 2024, and April 23, 2026. Patients were included if blood products were administered for a non-traumatic cause of hemorrhagic shock. Exclusion criteria included cardiac arrest and blood transfusion prior to EMS arrival. Data collected from electronic patient care records included demographics, scene type, blood product administered, operational time intervals, and physiologic parameters. Shock index was calculated at patient-level by dividing heart rate (HR) by systolic blood pressure (SBP) at initial EMS assessment, immediately prior to transfusion, and emergency department (ED) arrival.</p><p><strong>Results: </strong>Of 163 blood transfusions, 50 (30.7%) were administered for non-traumatic hemorrhagic shock. After exclusions, 47 patients were included. Mean age was 66 years, and 55% were male. Gastrointestinal bleeding (GI) was the most common source (49%), followed by unspecified hemorrhagic shock (43%) and obstetric/gynecologic hemorrhage (4.3%). Most encounters occurred in private residences (57%) or rehabilitation/skilled nursing facilities (32%). Mean heart rate decreased from 102 at initial EMS assessment to 96 on ED arrival, while mean systolic blood pressure increased from 83 mmHg to 106 mmHg. Mean shock index decreased from 1.34 to 1.01.</p><p><strong>Conclusions: </strong>Our two-system observational study found just under a third of patients received blood for non-traumatic reasons, with the majority being for GI bleeding. Further work is needed to better understand the impact of blood for medical patients on patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850803","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":"Feasibility and Acceptability of Mobilizing Community Paramedics to Provide the Standard of Care for Pediatric Concussion: Mobile Integrated Health Programming for Pediatric Patients.","authors":"Rory A Marshall, Paige V Swanson, Benjamin L Michaels, Kelsy M Stenger, Daniel Corwin, Jonathan Lifshitz, James T Eckner, Nathaniel R Hunt, Betsy McDavid, Alexander Rogers, Mark X Cicero","doi":"10.1080/10903127.2026.2680993","DOIUrl":"10.1080/10903127.2026.2680993","url":null,"abstract":"<p><strong>Objectives: </strong>Community Paramedics (CPs) have not yet been engaged in pediatric concussion management. This study aimed to assess the feasibility and acceptability of building and delivering HeadStrong Community (a Mobile Integrated Health (MIH) program utilizing CPs) to provide pediatric concussion care in the community.</p><p><strong>Methods: </strong>This was an experimental mixed-methods study. Physicians, CPs, and scientists used the Knowledge-to-Action cycle to co-develop the program in response to the knowledge to practice gap for CPs around recovery and rehabilitation for pediatric concussion. Patients aged 3-17 years who had sustained a concussion were eligible. Patients were recruited through the emergency department. The program consisted of a visiting clinician model where trained CPs assessed, helped manage, and provided anticipatory guidance and education for concussion. Feasibility was assessed by primary outcomes related to MIH agency uptake, CP uptake, patient enrollment, and modified Post-Concussion Symptoms Scale (PCSS) scores (0 = no symptoms, 48 = most severe symptoms). Feasibility was analyzed by description of uptake and enrollment, and pre-post symptom scores. Acceptability was assessed by primary outcomes of patient, parent, and CP satisfaction scores (5-point Likert scale). Qualitative surveys of CPs were also conducted and thematically analyzed.</p><p><strong>Results: </strong>HeadStrong Community recruited and trained 15 CPs from 2 MIH agencies. Of 156 potentially eligible patients, 19% (30/156) enrolled and completed 28 home visits. PCSS scores improved pre- versus post-visit as reported by patients (pre-visit mean = 15.2 ± 10.4, post-visit mean = 8.8 ± 7.6, <i>p</i> < 0.001) and parents (pre-visit mean = 12.0 ± 8.1, post-visit mean = 7.8 ± 7.6, <i>p</i> < 0.001). High levels of program satisfaction were reported by patients (mean = 4.3 ± 1.2; median = 5(1-5); <i>n</i> = 23), parents (mean = 4.4 ± 0.8; median = 5(2-5); <i>n</i> = 23) and CPs (mean = 4.0 ± 0.7; median = 4(1-5); <i>n</i> = 28). The CPs reported success in learning and implementing new assessments as well as engaging with concerned families, but encountered challenges integrating with the broader health care system, particularly with other specialized concussion care.</p><p><strong>Conclusions: </strong>The expansion of MIH programming to pediatric concussion patients was feasible and acceptable. HeadStrong Community is a novel and innovative model for management of pediatric concussion and may serve as a template for adaptable MIH programming to address other health care needs. Further research is needed to validate clinical utility and continuously improve the program and model.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199712","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":"Predicting Prehospital Blood Transfusion After Motor Vehicle Trauma.","authors":"Amanda Pope, Jonathan Zadra, Kent Page, Benjamin Fisher, Jonathan Race, N Clay Mann","doi":"10.1080/10903127.2026.2713132","DOIUrl":"10.1080/10903127.2026.2713132","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital blood transfusion (PHBT) improves outcomes among patients with traumatic hemorrhagic shock, yet the epidemiology and geographic distribution of patients likely to require PHBT remain poorly characterized. We sought to develop predictive models for PHBT among motor vehicle crash (MVC) patients using National Emergency Medical Services Information System (NEMSIS) data and to estimate the national distribution of patients with a high predicted probability of receiving PHBT.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2024 and 2025 NEMSIS data. Eligible encounters included 9-1-1 EMS responses for MVCs among patients aged 8-100 years. A derivation cohort was constructed from EMS agencies with active PHBT programs and at least 10 documented transfusions. Candidate predictors included demographic, physiologic, clinical, and operational variables. Random forest and ridge-penalized logistic regression models were developed to identify covariates associated with PHBT. Variables selected through machine learning approaches were subsequently evaluated in multivariable logistic regression models. Model performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration metrics. Final models were applied to the remaining national cohort to estimate patients with a high predicted probability of PHBT.</p><p><strong>Results: </strong>Among 2,078,452 eligible EMS activations, 303,383 comprised the derivation cohort. The random forest-selected logistic regression model demonstrated strong discrimination with an AUC of 0.901, sensitivity of 75.3%, and specificity of 96.5%. The ridge-selected logistic regression model achieved an AUC of 0.942, sensitivity of 63.9%, and specificity of 97.7%. Both models identified composite physiologic measures, critical hemorrhagic shock designation, and unspecified traumatic shock as significant predictors of PHBT. Application of the final models to the national cohort identified 73,754 and 70,599 predicted PHBT recipients, representing 3.6% and 3.4% of the evaluated population, respectively.</p><p><strong>Conclusions: </strong>Predictive modeling applied to NEMSIS data accurately identified patients with a high probability of receiving PHBT following MVC trauma. These findings provide a framework for estimating geographic demand for prehospital blood products and may inform data-driven expansion of PHBT programs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707342","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":"Public Acceptance, Trust, and Self-Efficacy Related to Drone-Assisted Emergency Medical Response in Louisiana.","authors":"Benjamin A Swig","doi":"10.1080/10903127.2026.2724534","DOIUrl":"https://doi.org/10.1080/10903127.2026.2724534","url":null,"abstract":"<p><strong>Objectives: </strong>Drones can deliver automated external defibrillators and other emergency supplies to bystanders before an ambulance arrives, but their public-health value depends on whether the public accepts, trusts, and feels able to use them. This study examined public acceptance of drone-assisted emergency medical response in Louisiana, including trust in drone systems and self-efficacy for using drone-delivered medical supplies, and identified demographic, experiential, and attitudinal predictors of acceptance, trust, and self-efficacy among Louisiana adults.</p><p><strong>Methods: </strong>Cross-sectional, observational online survey of 586 Louisiana adults recruited through the Dynata panel and administered via the Research Electronic Data Capture platform. Participants reviewed a standardized educational sequence describing a drone-assisted emergency response scenario before completing validated composite measures of acceptance, trust, and self-efficacy (Cronbach's alpha = .89-.91). Descriptive statistics, independent-samples t tests, paired-samples t tests, one-way analyses of variance, Pearson correlations, hierarchical multiple regression, and thematic analysis of open-ended responses were conducted.</p><p><strong>Results: </strong>Overall attitudes were favorable: mean acceptance 4.1 (standard deviation [SD] = 1.0), trust 3.8 (SD = 1.0), and self-efficacy 4.0 (SD = 0.9). Trust and self-efficacy were the strongest predictors of acceptance (R² = .57), and trust was the strongest predictor of self-efficacy, indicating that modifiable attitudinal factors, rather than fixed demographic characteristics, drive adoption. Telecommunicator guidance increased self-efficacy versus independent action for both family members and strangers (Cohen's d = 0.41-0.44, p < .001), with no difference by recipient type. Younger and Black or African American respondents reported lower acceptance and self-efficacy. Concerns centered on reliability, navigation accuracy, and user competency; confidence was associated with demonstrated reliability, normalization, telecommunicator support, and training.</p><p><strong>Conclusions: </strong>Public acceptance is driven primarily by trust and self-efficacy, modifiable factors amenable to targeted implementation. Programs emphasizing operational reliability, telecommunicator integration, public education, and clear user guidance may accelerate adoption. These findings suggest that equity-focused outreach by emergency medical services agencies and public health partners, particularly toward younger adults and Black or African American respondents, who reported lower acceptance and self-efficacy, may help narrow demographic gaps in the public's readiness to use drone-assisted emergency response.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-19"},"PeriodicalIF":2.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831991","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 Use of Capnometry in Prehospital Intubation and Association with 30-Day Mortality: A Nationwide Registry Study.","authors":"Pelle Harris Krog, Tim Alex Lindskou, Torben Anders Kløjgård, Jakob Friis Schmidt, Jacob Steinmetz","doi":"10.1080/10903127.2026.2717533","DOIUrl":"10.1080/10903127.2026.2717533","url":null,"abstract":"<p><strong>Objectives: </strong>Capnometry is the gold standard for confirming endotracheal tube placement, yet the implementation in prehospital airway management remains inconsistent. This study aimed to investigate the use of capnometry during prehospital endotracheal intubation in Denmark, and to evaluate the association between capnometry use and 30-day mortality.</p><p><strong>Methods: </strong>We conducted an observational study design with a nationwide retrospective registry-based cohort of prehospital endotracheal intubations in Denmark using data from January 1, 2016, to December 31, 2021. Data were obtained from the Danish Prehospital Medical Record system and linked to the Danish Civil Registration System for mortality outcomes. Capnometry use was defined as at least one recorded end-tidal carbon dioxide (EtCO₂) value >0. The primary outcome was capnometry use. Secondary outcomes included 30-day mortality and EtCO₂ values categorized as eucapnic (4.0-6.0 kPa), hypocapnic (<4.0 kPa), hypercapnic (>6.0 kPa). Associations with mortality were assessed using multivariable logistic regression adjusted for age, sex, symptom category, cardiopulmonary resuscitation, and time of day.</p><p><strong>Results: </strong>A total of 8,720 intubations in 8,625 patients were identified, and only the first intubation per patient was included. Capnometry was used in 6,926 of 8,625 cases (80.3%) and increased from 75.4% in 2016 to 82.6% in 2021 (IRR 1.014, 95% CI 1.0004-1.0284; <i>p</i> = 0.04). Thirty-day mortality was 62.6%. Capnometry use was more frequent among survivors (87% vs. 76%, <i>p</i> < 0.001) and was independently associated with lower mortality (adjusted OR 0.52, 95% CI 0.46-0.60). Unadjusted 30-day mortality was higher for patients without capnometry use (74.8% vs. 59.6%; 1,270/1,699 vs. 4,131/6,926; <i>p</i> < 0.001). Abnormal EtCO₂ values were common: hypocapnic in 38.3%, hypercapnic in 19.0%, both in 22.6%, and only 10.1% had values within the normal range. Mortality was highest in patients with recorded hypocapnic values (70.4%; adjusted OR 2.67, 95% CI 2.20-3.24) and lowest in those with normal values (36.7%).</p><p><strong>Conclusions: </strong>Capnometry use during prehospital intubation increased over time but remained incomplete and was independently associated with lower 30-day mortality. Abnormal EtCO₂ values were frequent and associated with worse outcomes, particularly low EtCO₂ values. These findings support adherence to current recommendations for routine EtCO₂ monitoring in prehospital airway management.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797243","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":"Outcome-Informed Emergency Medical Services Response Planning: A Systematic Review.","authors":"Richard Ferron, Jasdeep Brar, Lauren E Griffith, Iwona A Bielska, Gina Agarwal","doi":"10.1080/10903127.2026.2705415","DOIUrl":"https://doi.org/10.1080/10903127.2026.2705415","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) commonly use standardized call interrogation systems to determine response strategies. The findings of caller interrogation are typically combined with local clinical and operational guidelines to determine EMS response plans. These plans dictate assigned resource type and response priority, often with associated response time targets. It is unclear whether EMS response plans have been prospectively aligned with patient outcomes and evaluated in terms of diagnostic accuracy or predictive performance measures. This review examines evidence on the prospective alignment of EMS response plans with linked patient outcomes and the effects of implemented system-level changes.</p><p><strong>Methods: </strong>A systematic review was conducted following preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Electronic databases were searched for studies evaluating ambulance dispatch response assignment informed by linked patient outcomes. Eligible studies (1) prospectively aligned EMS response plans with linked patient outcomes and (2) evaluated the impact of implemented system-level changes utilizing linked patient outcomes <i>via</i> diagnostic accuracy or predictive performance measures. Studies were excluded if they were a single-priority system, did not evaluate fully implemented plans or evaluated single condition changes only. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal for Quasi-Experimental Studies.</p><p><strong>Results: </strong>Of the 2677 identified studies, only three studies met the inclusion criteria, representing a combined total of 2,956,071 EMS responses. All three were non-randomized and quasi-experimental. Outcome measures included short-term mortality, response time performance for high-acuity calls, emergency department presentation, lights-and-sirens utilization, and dispatch accuracy. Narrative synthesis was performed. Directional findings across the three different study interventions were consistent. The evaluated outcome-informed EMS response plans were associated with reduced high-priority responses and improved system efficiency, with no clear evidence of harm. Certainty of evidence was unable to be assessed. Substantial heterogeneity in the study design, outcomes assessed, and analytic approaches used precluded data synthesis, and limits the certainty and generalizability of the findings.</p><p><strong>Conclusions: </strong>Evidence evaluating linked patient outcome-informed optimization of EMS response plans remains limited and heterogenous but offers preliminary insight into the feasibility of such approaches. Additional research is needed to evaluate the effectiveness, reproducibility, and generalizability of system-level response plan optimization.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813815","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":"Harm Reduction on Campus: A National Survey of Collegiate-based EMS Agencies.","authors":"Patryk A Dabek, Tenzin Dhondup, Felix J Fein, Ava Ospina, Laura Hanson, Gail D'Onofrio, Katherine Couturier, David Yang, Robert Heimer","doi":"10.1080/10903127.2026.2724039","DOIUrl":"https://doi.org/10.1080/10903127.2026.2724039","url":null,"abstract":"<p><strong>Objectives: </strong>While collegiate-based emergency medical services (CBEMS) agencies have traditionally been focused on acute emergency response, their integration within student life uniquely positions them to support public health initiatives and prevent emergencies. The purpose of this study was to explore the current role of CBEMS agencies in substance use harm reduction efforts and identify the strategies and barriers that impact implementation.</p><p><strong>Methods: </strong>We conducted an observational study with a cross-sectional online survey of CBEMS agency leaders using the National Collegiate Emergency Medical Services Foundation database. Eligible agencies demonstrated recent operational activity; those agencies outside the continental United States were excluded. The survey was distributed between May 16 and September 12, 2024 with two follow-up reminders. Quantitative data were analyzed descriptively, and qualitative responses underwent inductive thematic analysis.</p><p><strong>Results: </strong>The survey achieved a 33% response rate (41/124). Among respondents, 93% stocked naloxone for emergency overdose response, 46% offered public naloxone education, and 7% distributed fentanyl test strips. Additionally, 85% offered cardiopulmonary resuscitation (CPR) training to the public. Qualitative analysis identified three primary barriers to program implementation: 1) Institutional and Policy Barriers, referring to policies and administrative inefficiencies that delay program approval; 2) Challenges in Community Engagement and Coordination and 3) Resource Constraints.</p><p><strong>Conclusions: </strong>Despite heterogeneity in operational structures, respondents demonstrated readiness for opioid overdose reversal, with naloxone stocked in nearly all agency gear bags, and established educational outreach including public CPR training and naloxone education. However, adoption of broader harm reduction strategies remained limited. Systemic barriers limited expansion of harm reduction programming. Coordinated institutional investment and standardized implementation are needed to enhance CBEMS-led CPR education and overdose preparedness.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813862","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":"Documentation of weight in pediatric 9-1-1 responses with administration of weight-based medications.","authors":"Susan J Burnett, Baruch Schwartz, Amy M Eisenhauer, Sara Moore, Jonathan R Powell, Macall Leslie Salewon, Brian M Clemency","doi":"10.1080/10903127.2026.2719957","DOIUrl":"https://doi.org/10.1080/10903127.2026.2719957","url":null,"abstract":"<p><strong>Objectives: </strong>Determining a child's weight is a critical first step in administering the appropriate dose of a medication in an emergency. The National Emergency Medical Services Quality Alliance (NEMSQA) patient safety process measure, \"Pediatrics-03b,\" calls for weight documentation in kilograms or length-based weight estimate for pediatric patients who receive weight-based medications in the prehospital setting. To date, no publication has identified compliance with this measure at a national level. The goal of this study was to describe weight documentation in pediatric 9-1-1 responses and factors associated with this quality measure.</p><p><strong>Methods: </strong>Using the ImageTrend Collaborate 2024 national dataset, we analyzed 9-1-1 responses for pediatric patients (<18 years of age) who received medication by EMS clinicians consistent with the Pediatrics-03b definition denominator. Weight documentation was obtained from eExam01 and eExam02 National EMS Information System fields. Differences in weight documentation were assessed by patient demographics, unit, and scene characteristics. Furthermore, medication type and administration routes were examined. Statistical analyses included chi-square tests for comparison of proportions and population averaged univariable logit regression models for the binary outcome of weight documentation with clustering for state.</p><p><strong>Results: </strong>Overall, 57,378 responses met inclusion criteria, and 41,963 (73.1%) had a documented weight. Weights were less likely to be documented in cases involving adolescent (age 13-17) patients (Odds Ratio [OR]: 0.87, 95% Confidence Interval [95% CI]: 0.75-0.99), patients described as Black (OR: 0.72, 95% CI: 0.61-0.85), or those with lower acuity (OR: 0.59, 95% CI: 0.50-0.71). Weights were more likely to be documented in cases managed by advanced life support units (OR: 2.02, 95% CI: 1.31-3.11) and in patients described as male (OR: 1.08, 95%: 1.03-1.14).</p><p><strong>Conclusions: </strong>Three quarters of 9-1-1 responses meeting the Pediatrics-03b case definition were compliant with the measure. Future studies should be focused on evaluating the case definition for the measure to determine how to best evaluate and improve care in this domain.Establishing a benchmark, evaluating that benchmark, and understanding barriers to optimal implementation are critical to improving prehospital care and documentation of pediatric patients by EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813803","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 Prevalence of Multiple Record Encounters in the National Emergency Medical Services Information System.","authors":"Sriram Ramgopal, Jake Toy, Rebecca E Cash, Michael Spigner, Nichole Bosson, Christian Martin-Gill","doi":"10.1080/10903127.2026.2711920","DOIUrl":"10.1080/10903127.2026.2711920","url":null,"abstract":"<p><strong>Objectives: </strong>The National Emergency Medical Services Information System (NEMSIS) is a large repository of de-identified Emergency Medical Services (EMS) data supported by the National Highway Traffic Safety Administration and is a cornerstone of large database EMS research. A known concern with large EMS datasets like NEMSIS is that multiple records may exist for a single episode of patient care. However, the extent of potentially related records is not well described. We evaluated potential EMS episodes of care contained within NEMSIS.</p><p><strong>Methods: </strong>We used an observational study design and conducted a retrospective analysis of the 2023 NEMSIS dataset. We identified hierarchical clusters of likely related episodes of care for the same patient using tiered criteria of temporal (dispatch call times of 30 s to 2 min) and Census Division, EMS agency, urbanicity, patient demographics, dispatch characteristics, clinical impression, and location type. We evaluated all possible combinations of these criteria and reported the percentage of episodes of care out of all included records overall and for five specific EMS subpopulations: cardiac arrest, trauma, stroke, airway intervention, and pediatric patients.</p><p><strong>Results: </strong>We included 36,757,562 EMS records. When applying all criteria, the final algorithm identified 36,552,901 likely episodes of care, representing 99.4% of all records. Most episodes of care (36,353,329, 99.5%) consisted of a single EMS record, with fewer episodes having 2 (195,786, 0.5%), 3 (3,088, <0.1%), 4 (428, <0.1%), and 5 or more (270, <0.1%) records. When evaluating all possible alternative combinations of the criteria, most resulted in a similar number of episodes of care. Among the subpopulations, the number of episodes of care approached the total number of encounters for that condition: cardiac arrest (89.2%-98.5%), pediatric (73.8%-99.3%), stroke (89.5%-99.3%), airway procedure (95.4%-99.4%), and trauma (84.1%-99.6%). Findings were robust to sensitivity analyses which relaxed the time- and age-based criteria.</p><p><strong>Conclusions: </strong>Nearly all included EMS records in NEMSIS appeared to represent unique patient-care episodes. Approximately 0.5% of episodes involved more than one EMS record, suggesting that related records or multi-unit documentation is uncommon but should be considered in analyses, particularly for selected clinical subgroups.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620967","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":"Identifying Quality Indicators for Prehospital Care Following Out-of-Hospital Cardiac Arrest: A Focused Scoping Review.","authors":"Petrus Malherbe, Eric Bustos, Will Dunn, Lindsey Cella, Lara Rappaport","doi":"10.1080/10903127.2026.2719960","DOIUrl":"https://doi.org/10.1080/10903127.2026.2719960","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital cardiac arrest (OHCA) has a high rate of mortality. While prehospital management of OHCA is well described, post-return of spontaneous circulation (ROSC) care in the prehospital setting is often based on in-hospital care and broadly lacks evidence-based prehospital-specific recommendations. Additionally, there are no formal standardized quality indicators to benchmark post-ROSC care in the prehospital setting. This study served to systematically identify and appraise post-ROSC documents to synthesize a set of potential quality indicators to inform the survey of a multi-stage Delphi consensus for national quality indicators for prehospital care after out-of-hospital cardiac arrest.</p><p><strong>Methods: </strong>Following PRISMA guidelines, a systematic search was conducted across various databases for quality indicators and recommendations for prehospital care for post-ROSC following OHCA. Two reviewers performed title and abstract screening, full-text review, and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) independently and in duplicate. Identified quality indicators and recommendations were extracted as potential quality indicators and categorized into functional domains by the research team.</p><p><strong>Results: </strong>The search yielded 337 initial records, of which 87 underwent full-text review, and 46 studies met the <i>a priori</i> inclusion criteria. Studies from over 17 different countries were identified, of which the United States published the majority (<i>n</i> = 13). Randomized control trials represented the largest portion of the included studies (<i>n</i> = 18). The majority of study settings were in-hospital. Only five of the included studies made formal recommendations, and only two listed quality indicators. A total of 36 underwent appraisal with MMAT, of which the overall quality was generally high. A total of 16 potential quality indicators were extracted from the included studies and were grouped into five different domains.</p><p><strong>Conclusions: </strong>This focused scoping review highlights a lack of specific prehospital post-ROSC benchmarks and quality indicators. The identified potential quality indicators provide a foundational framework for a Delphi process for expert consensus on specific and measurable quality indicators. These indicators aim to standardize prehospital post-ROSC care for OHCA for national datasets like the Cardiac Arrest Registry to Enhance Survival.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797302","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}