Prehospital Emergency Care最新文献

{"title":"From Conference Presentation to Publication: An Analysis of Abstracts Presented at NAEMSP Scientific Sessions, 2018-2022.","authors":"Joshua M Kimbrell, Nadia Ahmed, Jacob Stebel, Alexander O'Donnell, Albert Bouwer Monroy, Judah A Kreinbrook, Kyle Rice, Martin Pelletier, Rebecca E Cash","doi":"10.1080/10903127.2025.2568084","DOIUrl":"https://doi.org/10.1080/10903127.2025.2568084","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify the abstract-to-manuscript conversion rate of abstracts presented at the National Association of Emergency Medical Services Physicians (NAEMSP) conference by year, abstract number, and status as oral or poster abstract.</p><p><strong>Methods: </strong>We conducted a cross-sectional evaluation of all abstracts presented at the NAEMSP annual meetings from 2018 to 2022, and withdrawn abstracts were excluded. We used PubMed to identify publication status, year of publication, journal of publication, and first-author continuity from abstract to manuscript. We used a Chi-square test to assess changes in the proportion of abstracts published as manuscripts.</p><p><strong>Results: </strong>A total of 1,010 abstracts were included and 348 (34%) were published in a PubMed-indexed journal within two years of presentation. The conversion rate was higher for oral abstracts (n = 71/150, 47%) than poster abstracts (n = 277/765, 36%). The conversion rates were not different across the five years (lowest: 2018, 29%; highest: 2022, 39%, p = 0.137); however, author continuity varied across years (lowest: 2018, 64%; highest: 2021: 86% p = 0.046).</p><p><strong>Conclusions: </strong>In this cross-sectional analysis of NAEMSP conference presentations from 2018 to 2022, abstract-to-manuscript conversion rates were low and did not change over time.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244872","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":"Planning and Execution of an EMS-Based Field Hospital: A Case Report.","authors":"Michael F Spigner, Cassandra Hardy, Craig Tschautscher, Nicholas Genthe, Kiriana Morse, Michael Lohmeier","doi":"10.1080/10903127.2025.2556442","DOIUrl":"10.1080/10903127.2025.2556442","url":null,"abstract":"<p><p>Mass gathering events can produce large volumes of patients and burden local emergency medical services (EMS) systems. This is particularly true of rural communities where local EMS resources may be scarce. Field-based hospitals are one strategy that has been shown to alleviate transport-to-hospital rates. This case report describes planning and execution of an EMS-based field hospital for a rural mass gathering event. In September 2023, an outdoor country music concert was hosted on a working farm in south central Wisconsin. Approximately 20,600 patrons and staff attended this event. To help preserve local EMS resources, a field-based hospital was developed using a hybrid staffing model of EMS clinicians (e.g., emergency medical technicians, paramedics) and EMS physicians. During the 11 h of operation, 51 patients were treated by EMS personnel. Thirty-six patients were treated at the field hospital, with 30 of these patients arriving during a 90-minute surge. The median age of patients presenting to the field hospital was 29.5 years (IQR: 20.0-49.3). Seven of the patients (19.4%) were pediatric. 52.7% of patients presenting to the field hospital had abnormal vital signs at triage, most commonly tachycardia. The most common presenting problems were alcohol intoxication (41.6%), cardiac problems (16.6%), and traumatic injuries (13.9%). The median length of stay at the field hospital was 26 min (IQR: 19-55), ranging from 4 min to 115 min. Six patients were transported, and five of the six patients were transported by units that were staged at the event. It is estimated that at least 15 patients would have been transported without the field hospital due to cognitive incapacity or medical necessity. The overall patient presentation rate of the event was 2.55 per 1,000 and the transport-to-hospital rate was 0.3 per 1,000. After action evaluation noted areas for improvement related to communications and security. We concluded that the use of a field hospital staffed by physicians and EMS clinicians helped preserve local EMS resources during a rural mass gathering event. Several opportunities for improvement related to critical infrastructure and staffing were identified.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125985","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":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","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":"Opioid Epidemic Through the Lens of Prehospital Emergency Care: A 5-Year Descriptive Analysis of the Statewide Opioid Response Directive (SWORD) Surveillance Program.","authors":"Peter Canning, Daniella M Carnevale, Regina Kostyun, Richard Kamin","doi":"10.1080/10903127.2025.2559909","DOIUrl":"10.1080/10903127.2025.2559909","url":null,"abstract":"<p><strong>Objectives: </strong>The Connecticut Statewide Opioid Response Directive (SWORD), a surveillance program utilizing emergency medical services (EMS) clinician reporting to the Connecticut Poison Control Center (CPCC) on suspected opioid overdose cases, was created to collect data on the opioid overdose epidemic, monitor revealing trends, and provide early warning alerts to overdose outbreaks. This study provides a description of patient characteristics, overdose location, opioid type, disposition, and use of opioid antagonist treatment for the first five years of surveillance.</p><p><strong>Methods: </strong>This was a retrospective review of data collected from the SWORD surveillance program between June 2019 and May 2024. For each suspected opioid overdose encounter, data related to patient demographics, descriptions of the overdose event, prehospital treatments, disposition and fatality were obtained from the database. Descriptive statistics were completed for outcomes of interest.</p><p><strong>Results: </strong>Over the five-year period, EMS clinicians reported 21,281 opioid overdoses. Fentanyl or heroin was suspected in 7,208 (83.4%) cases when the drug of exposure was known (<i>n</i> = 8,641). There were 17,597 (82.7%) patients who received naloxone, and 1,151 (5.4%) patients who suffered fatal overdoses. Males represented 73.6% (<i>n</i> = 15,559) of all overdose cases. The median patient age increased from 38 in year one to 43 in year five. Patients 60 years of age and older accounted for 13.3% (<i>n</i> = 2,771) of all overdoses. Bystanders first administered naloxone in 18.9% (<i>n</i> = 2,926) of the cases where naloxone was given. The data produced 1,489 early warning notifications to local community partners to alert them to high overdose activity in their community.</p><p><strong>Conclusions: </strong>This five-year descriptive study highlights the ongoing severity of the opioid epidemic as reflected in the SWORD surveillance program. Over the years, a rising median age and an increasing percentage of overdose cases among those aged 60 and older were noted, indicating a shift in the demographic profile of affected individuals. These findings underscore the complex and evolving nature of the opioid crisis, emphasizing the need for continued monitoring, targeted interventions, and community involvement in opioid overdose response.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075929","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 Preliminary Outcomes of a Simulated Prehospital Pediatric Ventilation Scenario Using a Ventilation Feedback Device.","authors":"Joseph D Finney, Jeffrey Siegler, Jinli Wang, Elizabeth Larkin, Kavya John, Brad McClain, Sang Hoon Lee, Lauren C Riney, Lynn Babcock, Lorin R Browne, Fahd A Ahmad","doi":"10.1080/10903127.2025.2558861","DOIUrl":"10.1080/10903127.2025.2558861","url":null,"abstract":"<p><strong>Objectives: </strong>Appropriate ventilation technique is critical to support a child who isn't breathing. The inadequacies of manual ventilation in hospitalized patients are well known but the performance of this skill by emergency medical services (EMS) clinicians has not been fully evaluated. This study examined the feasibility and preliminary efficacy of implementing a ventilation feedback device (VFD) into a high-risk low-frequency pediatric simulation scenario for EMS clinicians.</p><p><strong>Methods: </strong>We enrolled EMS clinicians in a metropolitan area during active-duty shifts. Participants were randomized into one of two groups and completed two 2-min pediatric respiratory arrest scenarios sequentially, separated by a 10-minute washout period. During the first scenario, Group 1 received feedback from the VFD while Group 2 was blinded. After a 10-minute washout period, both groups crossed over and completed the scenario a second time (Group 2 unblinded and Group 1 blinded). With each breath delivered, the VFD recorded tidal volume (TV), ventilation rate (VR), and airway leak. Participants were further randomized to wear a head-mounted camera (HMC) for skill evaluation and completed a survey regarding simulation fidelity.</p><p><strong>Results: </strong>Eighty-one participants were enrolled and 75 had complete data. Feasibility outcomes were the perceived impact of the VFD and HMC on skill performance and the fidelity of the scenario. Of 74 participants who completed the post-participation survey, 98.6% believed the VFD positively impacted performance and 97.3% believed the scenario was realistic. Of the 27 participants assigned to wear the HMC, 98.6% did not believe it impacted skill performance. Unblinded participants better adhered to guidelines than blinded participants for TV (73.3% vs. 13.5%) and VR (96% vs. 57%) with lower rates of significant airway leakage (10% vs 21.2%). Findings remained significant regardless of blinded-unblinded sequence. The HMC did not impact performance.</p><p><strong>Conclusions: </strong>Enrolling EMS clinicians and capturing real-time VFD output were feasible during shifts. Using a VFD improved ventilation in a simulated pediatric respiratory arrest scenario. Our methodology offers a model for incorporating pediatric in-situ training. Use of a HMC is a potential novel skill performance assessment tool. Larger, multi-center studies and real-world application of a VFD to evaluate patient-centered outcomes are necessary.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034188","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: Management of Geriatric Trauma Patients - A Position Statement and Resource Document of NAEMSP.","authors":"William K Haussner, Amelia M Breyre, Kristen Bascombe, Whitney J Barrett, Mario A Camacho, Petter Overton-Harris, Samantha Williams, John W Lyng, Christian Martin-Gill, Christopher Colwell","doi":"10.1080/10903127.2025.2557006","DOIUrl":"10.1080/10903127.2025.2557006","url":null,"abstract":"<p><p>Trauma in geriatric patients (traditionally defined as adults aged 65 and older) is associated with high morbidity and mortality. Although older adults have lower average Injury Severity Scores (ISS) than younger patients, their mortality rates are higher. There are multiple hypotheses to explain these disparities; however, there is an incomplete consensus on how to best care for these patients in the prehospital setting. To address this issue, the National Association of Emergency Medical Services Physicians (NAEMSP) conducted a structured, rapid review of the literature to develop evidence-based guidance on the care of geriatric trauma patients in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055030","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":"\"Humans Don't Do That to People\": A Qualitative Study of the Experience of Paramedics Providing Care to a Patient Who Has Just Allegedly Committed a Violent Crime.","authors":"Abby J McCormick, James W Pearce, Hila A Dafny","doi":"10.1080/10903127.2025.2553740","DOIUrl":"10.1080/10903127.2025.2553740","url":null,"abstract":"<p><strong>Objectives: </strong>Every day across the world, paramedics make critical behavioral decisions that align with an expected standard of care, whilst also incorporating personal morals and values. The work of paramedics is inherently moral, however, the ability to do what is right can be impeded by multiple external factors. On occasion, paramedics are in the position where they are required to care for a patient who has just allegedly committed a violent crime. How does a paramedic perceive alterations to their behaviors regarding their personal morals, values and ethics, when caring for these patient types?</p><p><strong>Methods: </strong>One-on-one, semi-structured interviews were conducted with 12 registered paramedics throughout Australia who had direct experience caring for a patient who had just allegedly committed a violent crime. These paramedics were diverse in their clinical levels, years of experience and working region. Interview questions detailed the paramedic's opinions, moral and ethical conflicts, prior specific training, effects on personal wellbeing, and coping strategies. Interviews were transcribed and subjected to inductive coding and examination through the reflexive thematic analysis framework.</p><p><strong>Results: </strong>Four themes, comprising 11 sub-themes, were conceptualized: type of crime, coping strategies, impact, and support. The participants provided varying individual experiences with alleged violent crime, and thus differed in the opinions they held and the reactions and behaviors they faced. The participants were unanimous in their responses stating they received a severe lack of previous training or education pertaining to offender care. Participants referenced a desire for improvements to education, better recognition of these cases by the community and organizations, and incorporation of preventative measures for emotional distress, rather than focusing on coping with aftermath stress.</p><p><strong>Conclusions: </strong>Paramedics experience profound impacts on their emotional, professional, and mental well-being when required to care for alleged perpetrators of violent crime. The innate role identity of the paramedic predisposes them to experiencing moral injury and distress. Paramedics call for action toward a greater level of training and education for upcoming paramedics, and qualified paramedics alike to ensure they are adequately prepared to make moral and ethical decisions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966011","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":"Admission Hypothermia in Trauma Patients Undergoing Prehospital Tracheal Intubation: 15-Year Review of a Level-1 Trauma Center.","authors":"Manuel F Struck, Alexander Nündel, Holger Kirsten, Falk Kaiser, Silke Zimmermann, Natalia Thriemer, Robert Werdehausen, Annette Keß, Christian Kleber, Gunther Hempel","doi":"10.1080/10903127.2025.2558865","DOIUrl":"10.1080/10903127.2025.2558865","url":null,"abstract":"<p><strong>Objectives: </strong>The adverse role of accidental hypothermia in trauma patients has been studied for decades while patients undergoing prehospital tracheal intubation are at particular risk due to impaired temperature autoregulation. The primary objective of the study was to determine the prevalence and risk factors associated with admission hypothermia (body temperature <35 °C) at the emergency department. Secondary objectives included the assessment of the association of hypothermia with all-cause mortality, transfusion requirement, intensive care unit length of stay (ICU LOS), and duration of mechanical ventilation.</p><p><strong>Methods: </strong>In a single-center retrospective analysis, trauma patients aged ≥16 years undergoing prehospital tracheal intubation were analyzed for admission temperature between 2008 and 2022. Multivariable logistic regression analyses and linear regression analyses were used to examine the association between risk factors, hypothermia, and outcomes.</p><p><strong>Results: </strong>A total of 851 patients (72% male) with a median age of 50 years, a median injury severity score (ISS) of 27 points, and a 30-day mortality of 30% were included. The median admission body temperature was 35.1 °C, and 366 patients (43%) were hypothermic. Independent risk factors for hypothermia were outside temperature (OR 1.03 per one degree Celsius decrease, 95% CI 1.01 to 1.05), helicopter transport (OR 2.36, 95% CI 1.68 to 3.33), ISS score (OR 1.03, 95% CI 1.01 to 1.04), admission shock (OR 3.48, 95% CI 2.27 to 5.34), admission acidosis (OR 1.69, 95% CI 1.04 to 2.73), and admission coagulopathy (OR 1.85, 95% CI 1.25 to 2.76). Multivariable outcome analyses revealed significant associations of hypothermia with 24-h mortality (OR 6.6, 95% CI 3.2 to 13.64), 30-day mortality (OR 3.81, 95% CI 2.35 to 6.18), massive transfusion (OR 2.94, 95% CI 1.78 to 4.86), ICU LOS in survivors (beta weight 3.15, 95% CI 0.73 to 5.58) and duration of mechanical ventilation in survivors (beta weight 2.65, 95% CI 0.89 to 4.41).</p><p><strong>Conclusions: </strong>The present findings suggest that a significant proportion of trauma patients who require prehospital tracheal intubation experience hypothermia, which is associated with critical injury severity and high mortality rates. These associations suggest the potential for implementing preventive measures and rewarming strategies until arrival at the emergency department, necessitating further investigation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034066","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":"Intimate Partner Violence and Paramedicine: An Updated Scoping Review of Perspectives and Practices.","authors":"Jeremy R Caspell, Keilin Gorman, Tori N Stranges, Jasmyn Loo, Isaac J Kool, Paul van Donkelaar, Rory A Marshall","doi":"10.1080/10903127.2025.2564841","DOIUrl":"https://doi.org/10.1080/10903127.2025.2564841","url":null,"abstract":"<p><strong>Objectives: </strong>Intimate partner violence (IPV) is increasingly being recognized as a clinical circumstance to which emergency medical services (EMS) clinicians attend; it refers to the use of physical, sexual, psychological, and coercive violence by a current or former intimate partner to exert power and control. The intersection of paramedicine and IPV remains largely unclear. Our objective is to provide a comprehensive synthesis of the available evidence at the intersection of paramedicine and IPV.</p><p><strong>Methods: </strong>This review followed a published protocol (Open Science Framework), and PRISMA-ScR guidelines. Co-developed with two trained librarians, a search strategy was used to locate potential articles in MEDLINE and CINAHL, including a gray literature search. Included articles examined perceptions and/or practice of EMS clinicians and students in the context of IPV. Titles and abstracts were screened by two reviewers, followed by full text reviews when eligible; a third reviewer resolved any disagreement(s). Data were extracted using a purpose-built template and the findings were summarized and synthesized.</p><p><strong>Results: </strong>Of the 517 articles, 34 met inclusion criteria. The literature was varied and heterogenous, preventing mass, detailed synthesis. Generally, EMS clinicians were motivated to assist IPV survivors but perceived their education as insufficient to provide high-quality care, reporting low rates of training/education with corresponding low self-efficacy. Considerations for the specific and unique environment of paramedicine were lacking. Standardized patients and/or simulations were beneficial for pre-practice students acquiring history gathering and interview skills. Jurisdictional variations in legislation, policy, and standards, as well as overlapping agency/department regulations introduced practice variance. The validity and utility of EMS clinician-collected surveillance data were unclear.</p><p><strong>Conclusions: </strong>While EMS clinicians were recognized as a poorly understood, under-utilized, and under-equipped resource for IPV survivors, current literature is insufficient to comprehensively guide practice. Heterogeneity and limited quantity contribute to this challenge. Future research should leverage newly developed and validated measures to identify gaps responsive to educational and/or policy interventions and explore novel technologies to improve the quality of EMS clinician-collected IPV data. Equipping EMS clinicians with the tools to provide high-quality IPV care will benefit IPV survivors, EMS clinicians, and health care more broadly.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-35"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138543","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":"Impact of a Pediatric Prehospital Destination Decision Support Tool (PDTree) on Emergency Medical Services Transport Patterns and Destination Choice.","authors":"Kyle A Fratta, Kevin Psoter, Taylor Craig, Jennifer N Fishe, Jennifer F Anders","doi":"10.1080/10903127.2025.2551172","DOIUrl":"10.1080/10903127.2025.2551172","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to compare emergency medical services (EMS) agency transport patterns for pediatric transports, including bypass of the nearest emergency department, before and after implementation of an evidence-based decision support tool to guide EMS clinicians' pediatric transport destinations.</p><p><strong>Methods: </strong>This is an observational cohort study comparing pediatric transports one year before and one year after implementation of the Pediatric Decision Tree (PDTree) tool in three geographically and demographically distinct fire-based EMS systems in Maryland, USA. Patients aged 0 to 17 years undergoing EMS transport from one of the three participating counties were included. Patients meeting trauma center transport criteria were excluded. Hospital pediatric capabilities were defined a priori, and geocoded scene and transport destination locations were used to determine bypass rates. Bypass patterns and distances were compared between the pre-implementation and post-implementation periods.</p><p><strong>Results: </strong>Included pediatric patients transported from the three counties numbered 9,782 in 2019 (post-implementation) and 11,945 in 2016 (pre-implementation). After implementation of the PDTree, 48.8% of all pediatric patients underwent EMS bypass of the nearest facility compared to 42.6% before implementation (p < 0.001). While the overall rate of bypass increased, the bypass proportion transporting to the highest-level pediatric facility decreased from 63.1% to 50.1% and the proportion of bypass to intermediate pediatric facilities increased from 26.2% to 37.7% (p < 0.001).</p><p><strong>Conclusions: </strong>Implementation of the PDTree pediatric direct transport decision support tool increased the bypass rate and, subsequently, direct transport to more pediatric capable facilities. Despite this increase in the bypass of the nearest facility, the proportion transporting to large tertiary specialty children's centers decreased, while there was a significant increase in transport to intermediate pediatric facilities. Regional and national EMS governing bodies should balance benefits of pediatric direct transport protocols with operational costs to better meet the needs of pediatric populations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965997","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}