Prehospital Emergency Care最新文献

{"title":"Implementation Barriers of Prehospital Buprenorphine Administration Programs in the United States: A Scoping Review.","authors":"Mirinda Ann Gormley, Phillip Moschella, Tina Pham, Victoria Callicott, Kyle Jardim, Austin Madden, Wesley R Wampler, Daniel Schwerin, Shuchin Shukla, David A Miramontes, Parker Bailes, Alain H Litwin, Sarah B Floyd, Gerald Wook Beltran","doi":"10.1080/10903127.2025.2470965","DOIUrl":"10.1080/10903127.2025.2470965","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital buprenorphine administration programs (PBAPs) have spread throughout the United States (U.S.) with limited information on their locations or barriers to implementation, posing challenges to emergency medical services (EMS) systems adopting this clinical care model. This scoping review identifies where current PBAPs operate and summarizes commonly reported barriers to PBAP implementation.</p><p><strong>Methods: </strong>State Offices of EMS were contacted by phone and email and asked if PBAPs operated within the state. After three failed attempts, representative physicians from remaining states were queried through the National Association of EMS Physicians' state membership. Four databases identified PBAPs from manuscripts, popular media, and conference proceedings from each database's inception to 8/25/2024. Programs were included if EMS clinicians administered buprenorphine. Data extraction from academic manuscripts, popular media, and conference proceedings included PBAP location, personnel, protocols, and implementation barriers. Results were reported utilizing Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews.</p><p><strong>Results: </strong>Nineteen states and Washington D.C. reported at least one PBAP, 28 reported none, 3 were pending implementation. Of 977 identified titles, 17 met inclusion criteria. Seven media articles, 4 conference presentations, 3 cohort studies, 2 case series, and 1 scoping review yielded data on 13 unique PBAPs within 8 states. Most PBAPs delivered buprenorphine <i>via</i> 9-1-1 paramedics (61.5%) during an EMS response, or by community paramedics (46.1%) within 24-48 h of an EMS response to a patient who experienced an overdose. Five (33.3%) PBAPs reported at least one patient-related barrier to PBAP implementation, including reasons buprenorphine was not administered, lack of treatment access, and patient loss of follow-up. Four programs reported operational-level barriers, including in-person restrictions due to COVID-19, siloing of outpatient services, lack of outpatient service options, inconsistent education of PBAP staff, inconsistent application of PBAP protocols by EMS clinicians, high turnover, and difficulty procuring buprenorphine.</p><p><strong>Conclusions: </strong>Whereas 19 states in the U.S. and Washington D.C. reported having at least one PBAP, few are reported in literature, and very few report barriers to PBAP implementation. Developing consensus on metrics assessing PBAP implementation is necessary to inform EMS agencies implementing these novel programs throughout the U.S.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543081","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":"https://doi.org/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 36-216, 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":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","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":"Prehospital Blood Lactate Measurements in Ambulances and Associations with Outcomes: A Cohort Study.","authors":"Louise H Walther, Erika F Christensen, Annmarie T Lassen, Christian B Mogensen, Søren Mikkelsen","doi":"10.1080/10903127.2025.2473034","DOIUrl":"10.1080/10903127.2025.2473034","url":null,"abstract":"<p><strong>Objectives: </strong>The prehospital use of blood lactate measurements is increasing. The blood lactate level is a well-recognized biomarker of poor outcomes, mainly investigated in potentially critically ill patients or patients with specific illnesses. However, evidence of a correlation in a broad prehospital setting with undifferentiated patients is lacking. This study aimed to investigate the correlation between prehospital blood lactate levels and the risks of poor outcomes in undifferentiated prehospital patients with apparent non-life-threatening conditions.</p><p><strong>Methods: </strong>This was a large cohort study of undifferentiated prehospital patients aged ≥18 years old who required intravascular accesses during prehospital care from February 3 to June 14, 2020. StatStrip Xpress Lactate Meter analyzed the lactate levels. The primary outcome was the risk of 7-day mortality. Follow-up was 90 days. The categorical secondary outcomes were 30-day and 90-day mortality risks and risks of mechanical ventilation, vasopressor treatment, or acute renal replacement therapy. Other secondary outcomes were the number of days alive within 30 days outside the hospital, outside the intensive care unit, and without mechanical ventilation. The primary analyses were uni- and multivariate logistic regressions presented as odds ratios (OR) with 95% confidence intervals (CI) and p-values.</p><p><strong>Results: </strong>The study included 11,515 patients. The overall 7-day mortality rate was 3.1%. The 7-day mortality rates were 2.0%, 3.6%, and 12.8% in patients with lactate levels of <2.0 mmol/L, 2.0-3.9 mmol/L and ≥4.0 mmol/L, respectively. The risk of 7-day mortality increased with elevated lactate level, OR = 1.43 (95% CI: 1.36-1.51), <i>p</i> < 0.001. The ORs were similar in all prespecified diagnostic subgroups except for patients receiving diagnoses within the nervous system. Patients with elevated lactate levels had increased risks of all categorical secondary outcomes. They stayed longer in the hospital, in the intensive care unit, and on mechanical ventilation than the patients with normal prehospital lactate levels.</p><p><strong>Conclusions: </strong>: This study found evidence of correlations between elevated lactate levels and poor outcomes in all acute prehospital patients except patients receiving diagnoses within the nervous system. Implementing prehospital lactate measurements is useful if knowledge of the patient's lactate levels adds to existing parameters in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557795","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":"Compliance Evaluation with ChatGPT for Diagnosis and Treatment in Patients Brought to the ED with a Preliminary Diagnosis of Stroke.","authors":"Merve Yazla, Emine Sarcan","doi":"10.1080/10903127.2025.2475513","DOIUrl":"10.1080/10903127.2025.2475513","url":null,"abstract":"<p><strong>Objectives: </strong>Chat Generative Pre-trained Transformer (ChatGPT) is a natural language processing product developed by OpenAI. Recently, the use of ChatGPT has gained attention in the field of health care, particularly for its potential applications in diagnostic and decision-making support. While its utility is still being explored, it shows promise as a supplementary tool in these contexts. This study aims to evaluate the potential of ChatGPT in making decisions about 'transportation to the stroke center, suspicion of large vessel occlusion and treatment decisions' of patients brought to the emergency department by ambulance with a preliminary diagnosis of stroke.</p><p><strong>Methods: </strong>All patients with a stroke code who were transferred to the emergency department (ED) of a tertiary care hospital, Ankara Etlik City Hospital, by ambulance between November 1, 2023, and April 30, 2024, during designated stroke team coverage periods were included in the study. Unlike many stroke centers that operate continuously 24/7, our institution follows a structured on-call system, where specialized stroke teams are assigned time slots to provide stroke care. Data were collected from prehospital records, ED notes, and hospital imaging and treatment records. ChatGPT's decisions were compared to gold standard outcomes using Cohen's kappa test, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated for each directive.</p><p><strong>Results: </strong>A total of 512 patients were analyzed, and ChatGPT's decisions were compared with the patients' final diagnoses and treatments. Analysis comparing ChatGPT's decisions to patient outcomes across prehospital stroke suspicion, large vessel occlusion diagnosis, and treatment phases showed significant agreement (<i>p</i> < 0.001, Kappa: 0.540-0.562). While the sensitivity of the diagnosis of stroke was 91%, the NPV was found to be 98% in patients requiring intravenous tissue plasminogen activator and large vessel occlusion, 97% NPV in patients requiring mechanical thrombectomy.</p><p><strong>Conclusions: </strong>ChatGPT shows promise as a decision-support tool for identifying acute ischemic stroke and determining treatment needs in prehospital and ED settings. However, its reliance on predefined data highlights the need for physician supervision to address clinical complexities and ensure patient safety. Integrating ChatGPT as an adjunct rather than a standalone system can enhance decision-making efficiency while maintaining high-quality care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557790","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":"Opportunities for Physical Activity Behavior Change Among Emergency Medical Services Clinicians: Qualitative Investigation.","authors":"Michael W Supples, Allison M Chandler, Jason T Fanning, Anna C Snavely, Nicklaus P Ashburn, Stephen L Powell, James E Winslow, Jason P Stopyra, Justin B Moore, Simon A Mahler","doi":"10.1080/10903127.2025.2479124","DOIUrl":"https://doi.org/10.1080/10903127.2025.2479124","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians often do not achieve sufficient levels of physical activity. We investigate behavioral determinants that influence participation in physical activity among EMS clinicians.</p><p><strong>Methods: </strong>We enrolled EMS clinicians from a North Carolina third-service EMS agency in 2023. A trained qualitative investigator conducted twenty virtual, 30-minute, individual, semi-structured interviews using an interview guide developed by experts in physical activity behaviors, EMS, and qualitative research. Interviews were guided by the Theoretical Domains Framework and Capability Opportunity Motivation Behavior Change Model. Structured interviews were digitally recorded and transcribed verbatim by a professional transcription service. Transcriptions were verified against audio for accuracy and de-identified. A codebook was established using a hybrid inductive/deductive approach, and thematic analysis was performed.</p><p><strong>Results: </strong>The 20 participants had a median age of 31 years (IQR 27-34), of which 65% (13/20) were female. Several key themes emerged that represent opportunities for behavioral intervention. First, physical activity is often viewed as a process requiring high inhibitory self-regulation and is often paired with highly restrictive behaviors, which likely leads to existing poor behavioral habits. Existing confidence in being physically active was often tied to goal setting and mastery experiences, suggesting an opportunity to leverage specific and achievable goal setting, self-monitoring, and feedback. Further, EMS clinicians often struggle with incorporating physical activity amid work and life demands in a practical, sustainable way. They also identified a lack of available time, resources, and organizational support. High-quality social networks are foundational behavior change components and were often lacking among participants.</p><p><strong>Conclusions: </strong>Behavioral determinants of physical inactivity included a theme of negative implicit associations around physical activity among some participants and need for achievable goal setting, self-monitoring, and building positive social support networks. Further investigation is needed to develop and test toolsets to improve physical activity behaviors among EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625664","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":"Creation of a Novel National Dataset Through Linkage of Emergency Medical Services (EMS) Transport Destination and Verified Emergency Department (ED) Capability.","authors":"Rebecca E Cash, Remle P Crowe, Maeve Swanton, Krislyn M Boggs, Scott A Goldberg, Ashley F Sullivan, Carlos A Camargo, Kori S Zachrison","doi":"10.1080/10903127.2025.2470286","DOIUrl":"10.1080/10903127.2025.2470286","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department (ED) capabilities, such as trauma center or stroke center designation, are key to understanding the effects of emergency medical services (EMS) transport destination decisions on patient outcomes. In current EMS datasets, ED capabilities are self-reported by the EMS clinician or agency. The reliability and validity of the EMS-reported ED capabilities is unknown. Our objective was to link EMS transport destinations with verified ED capability data to develop a novel national dataset to better understand prehospital routing practices.</p><p><strong>Methods: </strong>We linked two cross-sectional databases: the 2021 ESO Data Collaborative and the 2021 National Emergency Department Inventory (NEDI)-USA. The ESO Data Collaborative contains de-identified prehospital patient care records from nearly 2,000 participating EMS agencies across the United States. The NEDI-USA is a survey of all nonfederal, non-specialty U.S. EDs open 24/7/365 (including freestanding EDs), with verified stroke, trauma, and burn capability data. From EMS records, we obtained all unique destinations designated as \"hospital\" as of 2021. After verifying addresses were NEDI-eligible EDs (i.e., providing emergency services 24/7/365), we performed a 3-step linkage process to NEDI-USA: (1) name/address exact matches; (2) probabilistic matching on name/address based on bigrams, accepting adequate (>85%) match scores after review; and (3) hand-matching using Google Maps. We calculated descriptive statistics to describe the linkage process.</p><p><strong>Results: </strong>Of the 9,420 unique \"hospital\" destinations in the EMS dataset, 2,714 (29%) were non-hospital facilities (e.g., nursing home) or were non-NEDI-eligible (e.g., specialty hospital such as a psychiatric facility). We linked 98% (<i>n</i> = 6,605/6,706) of NEDI-eligible EMS hospital transport destinations to EDs in NEDI-USA. Excluding duplicate addresses for a single hospital (e.g., ED address versus main entrance address), the linked addresses represented 3,877 unique EDs in 49 states, which included 68% (<i>n</i> = 3,821/5,580) of the EDs included in the 2021 NEDI-USA database.</p><p><strong>Conclusions: </strong>We successfully linked 98% of EMS ED transport destinations to verified ED capability information. This novel linked dataset now includes rich destination capability information associated with each EMS transport that can be leveraged for describing and improving routing practices for specific patient conditions, such as patients with stroke-like symptoms to stroke centers or major traumas to verified trauma centers.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468777","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 Injured Pregnant Patients- A Position Statement and Resource Document of NAEMSP.","authors":"Lauren M Maloney, Ashley N Huff, Katherine Couturier, Karin A Fox, John W Lyng, Christian Martin-Gill, Rickquel P Tripp, Jenna M B White, Francis X Guyette","doi":"10.1080/10903127.2025.2473679","DOIUrl":"10.1080/10903127.2025.2473679","url":null,"abstract":"<p><p>The assessment and management of critically injured pregnant trauma patients represents a high-risk, low-frequency event. One in every 12 pregnant patients experience physical trauma during their pregnancy, but only 0.1% experience major trauma with an injury severity score (ISS) greater than fifteen. It is crucial that emergency medical services (EMS) clinicians understand the anatomic and pathophysiologic changes that impact morbidity and mortality for pregnant trauma patients so they can effectively provide life-saving interventions and resuscitation for this patient population.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557797","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":"Role of EMS in Disaster Response - A Position Statement and Resource Document of NAEMSP.","authors":"Rachel M Ely, Daniel S Schwartz, J Marc Liu, Kevin F Jura, Ryan Overberger, Jon R Krohmer, Angela Cornelius","doi":"10.1080/10903127.2025.2466754","DOIUrl":"10.1080/10903127.2025.2466754","url":null,"abstract":"<p><p>The National Association of Emergency Medical Services Physicians (NAEMSP) advocates for Emergency Medical Services (EMS) to play an integral role in all phases of disaster management -preparedness, mitigation, response, and recovery. An inherently strong EMS system mitigates some of the negative impacts of disaster by supporting a more resilient population and a robust response capability. EMS must be a sustainable resource that is able to continue to provide care to the community even after a disaster response. This resource document will outline the basis for the corresponding NAEMSP position statement on the role of EMS in disaster management.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493399","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":"Prevalence and Indications for Applying Prehospital Spinal Motion Restriction in Children at Risk for Cervical Spine Injury.","authors":"Caleb E Ward, Lorin R Browne, Alexander J Rogers, Monica Harding, Lawrence J Cook, Robert E Sapien, Kathleen M Adelgais, Leah Tzimenatos, Fahd A Ahmad, Sylvia Owusu-Ansah, Julie C Leonard","doi":"10.1080/10903127.2025.2472269","DOIUrl":"10.1080/10903127.2025.2472269","url":null,"abstract":"<p><strong>Objectives: </strong>Spinal motion restriction (SMR) is commonly applied to injured children with potential cervical spine injuries (CSI). There are, however, risks to indiscriminate SMR application. We recently derived the Pediatric Emergency Care Applied Research Network (PECARN) CSI clinical prediction rule. Effective implementation of this prediction rule requires an accurate understanding of current emergency medical services (EMS) SMR practices. Little is known about the prevalence of prehospital SMR application in children. Our primary objective was to determine the proportion of children sustaining blunt trauma who are placed in SMR by EMS. Our secondary objective was to identify factors associated with SMR placement.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data collected during a prospective study of children 0-17 years with blunt trauma transported by EMS to one of 18 PECARN-affiliated emergency departments. Prehospital clinicians completed surveys regarding CSI risk factors and SMR application. We summarized SMR prevalence, techniques used, reasons for application, and clinician suspicion for CSI by patient age. We conducted univariable and multivariable logistic regression to determine factors associated with SMR placement.</p><p><strong>Results: </strong>Of 13,453 children transported by EMS, we enrolled a convenience sample of 7,721 (57.4%) of whom 1.6% had a CSI and 41.5% had SMR placed. Older children were more likely to have SMR placed (35.5-50.4%) compared to those < 2 years (22.0%). Factors associated with SMR placement included patient demographics (non-Hispanic White race/ethnicity, age >2 years), mechanisms of injury (high-risk motor vehicle crash (MVC), unrestrained MVC passenger, high-risk fall, axial load), clinical history (loss of consciousness, self-reported neck pain, paresthesia, numbness, or extremity weakness) and physical examination findings (altered mental status, neck tenderness, inability to move neck, focal neurological deficits, and substantial head or torso injuries).</p><p><strong>Conclusions: </strong>Of children transported by EMS after blunt trauma in this study, 41.5% had SMR placed, while only 1.6% had CSIs. Factors associated with SMR placement included patient demographics, mechanism of injury, history, and examination findings. Many of these factors are not in the new PECARN CSI clinical prediction rule. Implementation of a risk-centered EMS decision aid for SMR in children after blunt trauma must address this discrepancy.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543092","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: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP.","authors":"Amelia M Breyre, Nicholas George, Alexander R Nelson, Charles J Ingram, Thomas Lardaro, Wayne Vanderkolk, John W Lyng","doi":"10.1080/10903127.2024.2428668","DOIUrl":"https://doi.org/10.1080/10903127.2024.2428668","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest is appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes or massive head trauma. While resuscitation and/or transport is appropriate for some populations, it is appropriate to withhold or discontinue resuscitation attempts for TOHCA patients for whom these efforts are non-beneficial. This position statement and resource document were written as an update to the 2013 joint position statements.&lt;/p&gt;&lt;p&gt;&lt;p&gt;NAEMSP, ACEP, and ACS-COT recommend:EMS resuscitation of adults with TOHCA should:Prioritize prompt identification of patients who may benefit from transport to definitive care at trauma centers when safe and appropriate.Emphasize the identification of reversible causes of traumatic circulatory arrest and timely use of clinically indicated life-saving interventions (LSIs) within the EMS clinician's scope of practice. These include:External hemorrhage control with direct pressure, wound packing, and tourniquetsAirway management using the least-invasive approach necessary to achieve and maintain airway patency, oxygenation, and adequate ventilation.Chest decompression if there is clinical concern for a tension pneumothorax. Empiric bilateral decompression, however, is not indicated in the absence of suspected chest trauma.External chest compressions may be considered but only secondary to other LSIs.Epinephrine should not be routinely used, and if used should not be administered before other LSIs.If point-of-care ultrasound (POCUS) demonstrates no evidence of cardiac motion, this may have utility in TOHCA management for prognostication.Emphasize that placement of cardiac monitors and/or use of POCUS should occur after indicated LSIs have been appropriately performedConditions where resuscitation attempts should be withheld, include TOHCA patients with:Injuries that are incompatible with life (e.g., decapitation, hemi-corpectomy, incineration, open skull injury with extruding brain matter).Evidence of prolonged circulatory arrest (e.g., rigor mortis, dependent lividity, decomposition).Advance care planning documents that indicate Do Not Resuscitate (DNR)/ Do Not Attempt Resuscitation (DNAR)/Allow Natural Death medical orders.Conditions where resuscitation attempts are discontinued for TOHCA patients should recognize:Mechanism of injury should n","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606217","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}