Prehospital Emergency Care最新文献

{"title":"Joint Position Statement on Criminal Liability for Alleged Deviations from Clinical Standards of Care in Emergency Medical Services.","authors":"","doi":"10.1080/10903127.2025.2552355","DOIUrl":"https://doi.org/10.1080/10903127.2025.2552355","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addition of Intramuscular Epinephrine to Standard of Care by Paramedics to Decrease Time-to-Initial Epinephrine Dose in Pediatric Out-of-Hospital Cardiac Arrest: A Simulation Trial.","authors":"Jay Loosley, Maysaa Assaf, Katie McKenzie, Saoirse Cameron, Katelyn Gray, Matthew Davis, Facundo Garcia-Bournissen, Michael Miller, Janice A Tijssen","doi":"10.1080/10903127.2025.2536223","DOIUrl":"10.1080/10903127.2025.2536223","url":null,"abstract":"<p><strong>Objectives: </strong>Survival rates for pediatric out-of-hospital cardiac arrest (POHCA) are low at around 10%. Paramedic services administer critical interventions including epinephrine. While typically administered via intravenous (IV) or intraosseous (IO) routes, obtaining these access points in out-of-hospital emergencies is challenging. We aimed to evaluate the time to first dose epinephrine and dosing accuracy in a simulated POHCA event.</p><p><strong>Methods: </strong>Paramedics were randomized to one of three epinephrine administration routes: 1) IV or IO; 2) intramuscular (IM) by autoinjector; or 3) IM by needle/syringe. Each participant was asked to provide resuscitation to a school-aged mannequin with asystole, including administration of epinephrine via their randomized route. Participants were not directly informed of the outcome variables. The primary outcome was time to initial epinephrine dose for each route. Our secondary outcomes were non-inferiority time to definitive dose epinephrine (i.e., by IV or IO), time to secure vascular access (either IO or IV), and administration of correct epinephrine dose (within 20% of correct dose).</p><p><strong>Results: </strong>Sixty six paramedics participated. We demonstrated a significant reduction in time to initial dose of epinephrine of 1.5 min (<i>p</i> < 0.001) by the IM route using epinephrine autoinjectors compared to standard of care by IV or IO. We also demonstrated that using a needle and syringe to administer epinephrine by the IM route offered no benefit in time to initial epinephrine dose and led to more dosing errors for the definitive dose of epinephrine (i.e., by IV or IO) (<i>n</i> = 4). We demonstrated that time to secure vascular access after IM injection with an auto-injector was delayed by 1:07 min (<i>p</i> = 0.002) compared to IV/IO.</p><p><strong>Conclusions: </strong>This is the first study to demonstrate that IM epinephrine by autoinjector is feasible in a simulated POHCA scenario and confers a significant advantage in time to initial dose of epinephrine. This study will inform future human trials of IM epinephrine for POHCA.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Pediatric Prehospital Destination Decision Support Tool (PDTree) on EMS 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":"https://doi.org/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 1 year before and 1 year after implementation of the Pediatric Decision Tree (PDTree) tool in 3 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":"1-21"},"PeriodicalIF":2.0,"publicationDate":"2025-08-26","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}

{"title":"The Role of The Emergency Medical Services Medical Director and Natural Disasters: The Sarasota, Florida Experience During Hurricane Milton.","authors":"George N Nackley, David M Langley, Marshall A Frank, Pia Daniel, O J Ma","doi":"10.1080/10903127.2025.2551893","DOIUrl":"https://doi.org/10.1080/10903127.2025.2551893","url":null,"abstract":"<p><p>The state of Florida prepares for hurricanes annually, particularly from late summer to fall. These hurricanes put immense pressure on public services, especially emergency medical services (EMS). This paper highlights the critical role of the EMS medical director in Sarasota, Florida, within the community during disaster response. It outlines the medical director's responsibilities, situations, protocols, and limitations encountered during Hurricane Milton. Specifically, this paper will illustrate a series of cases and their responses during periods of severe winds, which forced 9-1-1 services, including ambulance and fire, to remain at their stations due to dangerous weather. On October 9th, 2024, Hurricane Milton made landfall in southwest Florida around 20:30. It struck the barrier island of Siesta Key in Sarasota County, which spans 550 square miles and has a population of 469,013. The county reported winds exceeding 120 miles per hour. In the wake of Hurricane Milton's landfall, a record 47 tornadoes simultaneously appeared across the state, leading to widespread destruction. Milton is associated with at least 24 fatalities in Florida, with seven deaths directly linked to the tornadoes. This paper reviews the highest acuity cases and the medical director's role in them, including incidents of carbon monoxide poisoning, a power generator explosion resulting in severe burns, pediatric cardiac arrest, uncontrolled hemorrhage, and hypoxia in individuals dependent on oxygen due to a power outage. The authors recognize that protocols may differ from state to state. However, the goal here is to compile relevant cases to present to the EMS community to better understand the events that transpired, aimed at improving future disaster response when hazardous weather restricts standard on-scene EMS operations. The Sarasota County EMS system believes that out-of-hospital patients are under the care of the EMS medical director until they reach an emergency department. The aim is to clarify the medical director's specific roles by analyzing several cases and their outcomes, where known, and the lessons learned by the medical director, Sarasota County Dispatch, and Sarasota County EMS during periods of inactivity caused by heavy winds accompanied by several recommendations based on these experiences.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966119","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":"Evaluating CPR Under Fatigue: Methodological Considerations for Realistic Simulations.","authors":"Melih Imamoglu, Abdul Samet Sahin, Sinan Pasli","doi":"10.1080/10903127.2025.2540425","DOIUrl":"10.1080/10903127.2025.2540425","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708552","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":"Mobile Integrated Health Care and Community Paramedicine: A Position Statement and Resource Document of NAEMSP.","authors":"Alexander J Ulintz, Laurel C O'Connor, Todd M Heffern, Joel Rowe, Jeffrey E Rollman, Gary Wingrove, Matt Zavadsky, Michael R Wilcox, Scott A Goldberg","doi":"10.1080/10903127.2025.2541899","DOIUrl":"10.1080/10903127.2025.2541899","url":null,"abstract":"<p><p>Emergency medical services (EMS) are integral to public health and safety and provide health care to both individuals and communities. Community paramedicine (CP) and mobile integrated health care (MIH) programs are expanded models of EMS that provide needs-based, patient-centered care in the community. Successful implementation requires a community health needs assessment, engaged EMS medical directors, multidisciplinary collaboration, and sustainable reimbursement that recognizes prehospital care delivery beyond traditional payment for transport.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Tranexamic Acid in Trauma - A Joint Position Statement and Resource Document of NAEMSP, ACEP, and ACS-COT.","authors":"Whitney J Barrett, Kevin A Kaucher, Ross E Orpet, Eric M Campion, Jeffrey M Goodloe, Peter E Fischer, Christopher B Colwell, John W Lyng","doi":"10.1080/10903127.2025.2497056","DOIUrl":"10.1080/10903127.2025.2497056","url":null,"abstract":"<p><p>Prehospital use of tranexamic acid (TXA) has grown substantially over the past decade despite contradictory evidence supporting its widespread use. Since the previous guidance document on the prehospital use of TXA for injured patients was published by the National Association of Emergency Medical Services Physicians (NAEMSP), the American College of Surgeons Committee on Trauma (ACS-COT), and the American College of Emergency Physicians (ACEP) in 2016, new research has investigated outcomes of patients who receive TXA in the prehospital setting. To provide updated evidence-based guidance on the use of intravenous TXA for injured patients in the EMS setting, we performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Emergency Medical Services Systems Approaches to Refusal of Assessment, Treatment, or Transport: Examination of Statewide Protocols.","authors":"Rana Barghout, Joshua Lachs, William Haussner, David Hancock, Alyssa Elman, Emily Benton, Douglas Kupas, Ronald Strony, Dennis Rowe, Cory Henkel, Bess White, Phylise Banner, Mark Lachs, Tony Rosen","doi":"10.1080/10903127.2025.2537861","DOIUrl":"10.1080/10903127.2025.2537861","url":null,"abstract":"<p><strong>Objectives: </strong>Many emergency medical services (EMS) 9-1-1 activations result in patients declining evaluation, treatment, or transport to the emergency department (ED). Assessment of a patient's decision-making capacity to refuse and taking appropriate actions based on that are critical elements of EMS practice. However, EMS clinician approaches in this area are under-studied, and variation may exist. As EMS practice is highly protocolized, our goal was to examine all publicly available United States (U.S.) state protocols and describe their guidance around refusals.</p><p><strong>Methods: </strong>We used a structured, multi-step content analysis and published expert recommendations on managing refusal of care in health care settings to identify 35 specific elements within five domains of prehospital refusal management: decision-making capacity assessment, risk assessment, persuasion, escalation to medical oversight, and documentation. We systematically and comprehensively reviewed 34 state protocols and a U.S. national protocol for the presence of these elements.</p><p><strong>Results: </strong>Among 34 state protocols examined, 24% (8) had no guidance on refusal, with 18% (6) including at least some guidance in all domains. Among states with any guidance on refusal, we found a median of 15, a mean of 15, and a range of 5-25 elements included. Three states (9%) discussed all four components of decision-making capacity. Seven (21%) emphasized assessing risk of a severe medical emergency when considering refusal. Guidance on persuasion for high-risk patients was included in 13 (38%). Escalation to direct medical oversight was present in 20 (59%). Only 21 (62%) of protocols provided specific documentation guidelines. Notably, guidance was identified in state protocols that is inconsistent with expert recommendations for management of refusal in the ED. Checklists were included in 4 (12%).</p><p><strong>Conclusions: </strong>Substantial variability exists among state protocols regarding patient refusal guidance. Few protocols address high-risk patients, provide strategies for persuasion, or include checklists for proper management. Standardizing and expanding protocols may enhance EMS care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699345","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":"Whole Blood Versus Blood Components in Prehospital Care.","authors":"Scott Kostolni, Linh Nguyen, Sharon M Long, Iv Godzdanker, David A Wampler, Lawrence H Brown","doi":"10.1080/10903127.2025.2538741","DOIUrl":"10.1080/10903127.2025.2538741","url":null,"abstract":"<p><strong>Objectives: </strong>Whether clinical outcomes differ for hemorrhaging patients receiving prehospital whole blood versus blood component transfusion is unclear. Furthermore, most prehospital transfusion studies are limited to injured patients and commingle interfacility transfers with 9-1-1 scene responses. This study assessed outcomes exclusively among 9-1-1 scene response patients receiving prehospital transfusion with either whole blood or blood components for traumatic and non-traumatic hemorrhage.</p><p><strong>Methods: </strong>Using the ESO Data Collaborative for 2019- 2023, patients 8 to 100 years old who received whole blood or blood components were identified. Interfacility transports, patients receiving blood products prior to EMS arrival, and those with pre-arrival cardiac arrest were excluded. The primary prehospital outcome was change in shock index, along with changes in individual vital signs (Glasgow coma score (GCS), heart rate, systolic blood pressure). The primary hospital outcome was mortality at emergency department (ED) or hospital disposition. We also analyzed adverse events.</p><p><strong>Results: </strong>Of 1,990 eligible patients, 1,515 received whole blood and 475 received blood components. There were significant baseline differences between the two groups, with whole blood more frequently used by ground ambulance services, in urban areas and for penetrating trauma. Patients receiving blood components had statistically greater decreases in shock index (median change, -0.3 vs. -0.2, <i>p</i> = 0.040) and heart rate (median change, -7 bpm vs. - 4 bpm, <i>p</i> = 0.007), but there was no significant difference in mortality for patients receiving whole blood vs. blood components after multivariable analysis adjusting for baseline differences (adjusted odds ratio: 1.7, CI: 0.6-4.9). No patients in either group received prehospital epinephrine, and there were no ED diagnoses of transfusion reaction. Three whole blood patients had diagnoses related to thromboembolic events, but these were unlikely to be related to the transfusion.</p><p><strong>Conclusions: </strong>In this retrospective observational study of 9-1-1 scene response patients with traumatic or non-traumatic hemorrhage, differences between shock index and heart rate for patients receiving whole blood or blood components were of questionable clinical significance, and adjusted mortality did not significantly differ for the two groups. There were no instances of prehospital anaphylaxis or ED transfusion reactions. Both transfusion strategies appear equally effective and safe.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708554","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":"Long-Range Air Transportation for High-Consequence Infectious Diseases: Findings from a Global Tabletop Exercise on Patients with Viral Hemorrhagic Fever.","authors":"Jocelyn J Herstein, Katie L Stern, Shawn G Gibbs, John J Lowe, Kiran Attridge, Jake Dunning, Andreas Gustavsen, Alexander P Isakov, Abigail E Lowe, Wade Miles, Vikramjit Mukherjee, Darrell Ruby, Timothy M Uyeki, Shawn Vasoo, Lauren M Sauer","doi":"10.1080/10903127.2025.2519538","DOIUrl":"https://doi.org/10.1080/10903127.2025.2519538","url":null,"abstract":"<p><strong>Objectives: </strong>Air medical services evacuation of patients with viral hemorrhagic fevers (VHFs) is a complex process. The United States National Emerging Special Pathogens Training and Education Center held an in-person tabletop exercise (TTX) in June 2023 to review and evaluate global processes and plans for long-range VHF air transportation capabilities. The TTX sought to test the coordination, prioritization, capacities, and plans for using VHF transportation capabilities when multiple countries simultaneously request support in air medical services evacuation of their sick or exposed citizens to a high-level isolation unit in their country for care.</p><p><strong>Methods: </strong>Organizations invited to participate in the exercise (<i>N</i> = 16) were identified based on the TTX planning team's knowledge of their VHF transport capabilities. The TTX included a scenario involving a significant Sudan ebolavirus exposure event of an index case to 18 close contacts of diverse nationalities. Following the exercise, scribes' notes, evaluators' observations, and participant feedback forms were thematically analyzed to develop key findings and opportunities. The After Action Report was reviewed by all participants and finalized with their written approval.</p><p><strong>Results: </strong>Representatives from 15 organizations in six countries participated in the TTX; the only organization unable to attend was the World Health Organization. Findings indicated many countries rely on the same organization for VHF air transportation resources that would be quickly exceeded in this scenario. There is a need to further define processes for determining global prioritization of transportation assets when requests exceed capacity.</p><p><strong>Conclusions: </strong>Reliance on the same limited global transportation assets has implications for health security and limits the global response to multiple patients or individuals needing repatriation simultaneously. This indicates the importance of prioritizing resources, enhancing multinational coordination, and highlights the need to elevate these findings and discussions to national and international policy levels to increase air transportation resources and expand global capacity for managing patients with VHFs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789760","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}