Prehospital Emergency Care最新文献

{"title":"Factors Associated with EMS Clinician Preparedness to Provide Care for Patients with Limited English Proficiency.","authors":"Esmeralda Melgoza, Andra Farcas, Jonathan R Powell, Christopher B Gage, Remle Crowe, Nichole Bosson, Anjni Joiner, Ameera Haamid, Shira Schlesinger, Ashish R Panchal","doi":"10.1080/10903127.2025.2524744","DOIUrl":"10.1080/10903127.2025.2524744","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians report challenges in providing care to patients with limited English proficiency (LEP); however, associated factors are not well defined. The objective of this study was to examine EMS clinicians' self-reported preparedness to provide emergency care to patients with LEP in the prehospital setting.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey between October 10 and December 3, 2024, to assess the education and training received by nationally certified EMS clinicians on providing care to patients with LEP. We analyzed the data using univariate and bivariate analyses, including Pearson's chi-square and analysis of variance tests. We used least absolute shrinkage and selection operator to identify key predictors and logistic regression models (Odds Ratio (OR), 95% Confidence Interval (CI)) to determine associations with preparedness.</p><p><strong>Results: </strong>Of the 986 EMS clinicians who responded to the survey, 58.3% reported providing care to one or more patients with LEP over the past month. Although provision of EMS care to patients with LEP was common, only 28.8% of clinicians reported receiving initial education on delivering care to patients with LEP and 29.5% reported additional education. Among respondents, 44.3% reported access to professional interpreter services. Of these, 64.9% reported that it was easy or very easy to access services, 88.0% reported that the services were effective or very effective, but 64.9% reported using interpreter services less than 25% of the time or never. Respondents with initial (OR 1.96, 95% CI (1.46-2.63)) or additional (OR 1.54, 95% CI (1.15-2.06)) education on the provision of care for patients with LEP reported feeling more prepared when delivering care to this population, compared to clinicians who did not receive education on this topic.</p><p><strong>Conclusions: </strong>Prehospital clinicians commonly provide care to patients with LEP; however, EMS education or training on delivering care to this population is uncommon and interpreter use is rare. Clinicians felt more prepared in delivering care when provided any LEP education. Future efforts in EMS should consider incorporating LEP-related content in initial and additional education efforts and create strategies to overcome the low use of professional interpreter services.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Implementing Evidence-Based Guidance for Fatigue Risk Mitigation in the Prehospital Setting.","authors":"P Daniel Patterson, Jennifer Brailsford, Jennifer Fishe, David G L Roach, Mark A Sheffield, Rachel A Lukacz, Richard N Thomas, Molly C Appio, Sarah E Martin, Christian Martin-Gill","doi":"10.1080/10903127.2025.2527365","DOIUrl":"10.1080/10903127.2025.2527365","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this research study was to capture knowledge and awareness, beliefs and behaviors related to, and perceived barriers to adopting, implementing, and maintaining evidence-based guidance as outlined in the 2018 emergency medical services (EMS) evidence-based guidelines (EBG) for fatigue risk management (FRM) and the American Academy of Sleep Medicine/Sleep Research Society's (AASM/SRS) Guiding Principles for determining shift duration.</p><p><strong>Methods: </strong>We used a mixed methods study design with in-depth interviews based on the Theoretical Domains Framework (TDF) for behavior change. Sampling was nationwide and stratified by rural/urban status with goal enrollment of 40 EMS agency administrators (employers) and 100 frontline EMS clinicians (employees). We used deductive coding to assign participant statements to established domains and constructs of the TDF.</p><p><strong>Results: </strong>Thirty-six employer and 100 employee in-depth interviews were completed. Most employers represented a fire-based or third-service agency (64%), employed all-paid personnel (58%), and provided mostly ground-based services (92%). Most employees were paramedic, firefighter-paramedic, or firefighter emergency medical technician (EMT) certified (85%) with 3.8 median years of experience (IQR 2, 7). Most employers (61%) and employees (85%) reported no awareness of the existence of EBGs focused on fatigue. Once informed of the guidance, most employers (78%) and most employees (65%) responded that they \"<i>very much want to</i>\" or \"<i>somewhat want to</i>\" adopt some or all the guidance and recommendations. Most employers (67%) and employees (61%) reported they \"<i>very much needed to</i>\" or \"<i>somewhat needed to</i>\" adopt and implement the existing guidance. Participants identified common barriers to adoption as: lack of awareness and knowledge, a perceived misalignment of some recommendations with expectations, fear of negative emotional reactions in response to changing shift schedules, costs associated with adoption, and fear of disrupting the status quo.</p><p><strong>Conclusions: </strong>While most EMS employers and employees reported the need to adopt EBGs for fatigue mitigation, barriers identified in this study impede adoption and implementation. Overcoming these impediments should include increasing awareness of fatigue EBGs and related guidance, however, increasing awareness alone may not result in a meaningful increase in adoption and implementation. Novel strategies targeting barriers identified in this study are needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542014","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":"Comparison of Standard Method and Triple Airway Maneuver on LMA Insertion Times in Prehospital Cardiac Arrest Simulation.","authors":"Ahmet Emir Sarı, Asım Enes Özbek, Emre Şancı, Hüseyin Cahit Halhallı, Merve Akın Özdemir, Akın Güllü, Erdem Aydın, Burhan Pehlivan, Hakan Özerol","doi":"10.1080/10903127.2025.2520297","DOIUrl":"10.1080/10903127.2025.2520297","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we hypothesized that in prehospital ambulance environments, the use of the triple airway maneuver-which facilitates airway patency in the mannequin-may allow for faster and easier placement of the Laryngeal Mask Airway (LMA). This study aimed to evaluate the effect of the triple airway maneuver on the LMA insertion times of paramedics with and without chest compression.</p><p><strong>Methods: </strong>This study was designed as a randomized, prospective, crossover simulated manikin study. Paramedics who were working in the Prehospital Command and Control Center were informed about the study. A randomized, crossover study design was used to reduce the learning curve of the participants. For each participant, four scenarios were created in a randomized order: 1) standard method with chest compressions, 2) triple airway maneuver with chest compressions, 3) standard method without chest compressions, and 4) triple airway maneuver without chest compressions. The study was carried out in a moving ambulance in an empty area. The standard method was defined as passive manual support of the head from below. For the triple airway maneuver, an emergency medicine specialist served as the second operator. The LMA application time was defined as the time until the LMA was held, and effective ventilation was provided. The primary outcome of the study was defined as the comparison of LMA insertion times of the standard method and triple airway maneuver for each method.</p><p><strong>Results: </strong>Twenty-eight participants were included in the study. When all scenarios were compared LMA insertion times did not differ between triple airway maneuver and standard method groups (<i>p</i> = 0.730). During chest compressions, no statistically significant difference was found between the LMA insertion times (mean difference: 0.57 s, 95% CI: -0.819 to 1.961; <i>p</i> = 0.406). Similarly, when chest compressions were not applied, no significant difference was observed between the groups (mean difference: 0.5001 s, 95% CI: -2.00 to 3.50; <i>p</i> = 0.675).</p><p><strong>Conclusions: </strong>The findings of this study suggest that both the triple airway maneuver and the standard method may be effectively utilized in patients undergoing chest compressions as well as in those without chest compressions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476423","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":"Working with the Socially Vulnerable - An Observational Cross-Sectional Study Investigating the Association between Exposure to Socially Vulnerable Patients and Symptoms of Burnout in Ambulance Personnel.","authors":"Nanna Lindekilde, Pernille Melander-Nyboe, Maria L Vang, Ask Elklit, Lars-Peter S Andersen, Denise Bäckström, Jesper Pihl-Thingvad","doi":"10.1080/10903127.2025.2521407","DOIUrl":"10.1080/10903127.2025.2521407","url":null,"abstract":"<p><strong>Objectives: </strong>In Scandinavia, ambulance operations involving socially vulnerable patients, i.e., mentally ill, neglected or marginalized patients, have been highlighted as one of the most demanding challenges for the future prehospital work. However, little is known about the mental health implications of working extensively with this patient group. This study aims to investigate the proportion of operational tasks within the Danish prehospital setting that involve working with socially vulnerable patients, and whether there is a significant positive association between the workload involving socially vulnerable patients and the level of burnout symptoms among ambulance personnel.</p><p><strong>Methods: </strong>This observational cross-sectional study is based on data from the project \"You Don't Stand Alone,\" using baseline data collected through validated questionnaires completed by a sample of 451 ambulance personnel. Descriptive analyses were conducted to investigate the proportion of operational tasks involving socially vulnerable patients, and linear regression models were utilized to analyze the associations between exposure to socially vulnerable patients and burnout.</p><p><strong>Results: </strong>In this study, we found that 98.5% of the ambulance personnel were involved in operational tasks with socially vulnerable patients, and that 24% of the participants had experienced more than 20 incidents with at least one of the three subgroups of socially vulnerable patients throughout the past year. Furthermore, we found that workload involving socially vulnerable patients was positively associated with the level of burnout (<i>B</i> = 2.05, SE = .28, t(432) = 7.31, 95% CI: 1.50-2.60), and that age and bonding social capital were protective factors, whereas specific work functions were associated with an increased level of burnout. We also found that the significant association between workload involving socially vulnerable patients and levels of burnout attenuated to a non-significant level when adjusting for overall workload of additional critical incidents.</p><p><strong>Conclusions: </strong>The load of socially vulnerable patients in the operational work of ambulance personnel is important to consider due to its potential mental strain. The findings from this study emphasize the relevance of the potential strain of working with these groups of patients, but also highlights that this type of operational tasks is just one of many demanding exposures in ambulance work.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476425","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":"Care of the Operational Canine in the Prehospital Environment - A Joint Position Statement and Resource Document of NAEMSP, NAVEMS, and VetCOT.","authors":"Kate D Zimmerman, Lee Palmer, Kelly E Hall, Rita M Hanel, Kevin F Jura, Richard D Maricle, Esther I Hwang, Jonathan D Shecter, Rama Heyratifar, Allen Yee","doi":"10.1080/10903127.2025.2526718","DOIUrl":"10.1080/10903127.2025.2526718","url":null,"abstract":"<p><p>The National Association of Emergency Medical Services Physicians (NAEMSP), National Association of Veterinary Emergency Medical Services (NAVEMS), and the American College of Veterinary Emergency and Critical Care's Veterinary Committee on Trauma (VetCOT) agree that the operational canine (OpK9) injured in the line of duty should be entitled to safe, efficacious, and ethical treatment and transport by prehospital personnel to higher levels of veterinary care. It remains clear that, in situations involving both human and OpK9 casualties, the priority of care and available medical resources should be directed toward preserving human life. The fact that there is currently no organized preveterinary care system in place to treat or transport the injured OpK9 drives the need for collaboration between the existing emergency medical services (EMS) system and the veterinary community.</p><p><p>NAEMSP, NAVEMS, and VetCOT recommend:Operational canines injured in the line of duty should receive the highest level of resuscitative care, as close to the point of injury as possible, even without trained and licensed veterinary personnel.Established veterinary and EMS organizations should:Create collaboratively-developed consensus-based guidelines, aligned with the EMS clinician's scope of practice, for providing prehospital preveterinary care of ill or injured operational canines.Support advocacy for legislation and policy development to ensure that prehospital preveterinary care is more readily available to operational canines.Promote increased awareness of the needs and challenges hindering prehospital preveterinary care for ill or injured operational canines.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529386","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":"Short-Term Outcomes of Paramedic Treat and Discharge: A Cohort Study of Emergency Service Use in Ontario, Canada.","authors":"Ryan P Strum, Shawn Mondoux, Andrew Costa, Brent McLeod, Tim Dodd, Katie Turcotte, Paul Miller","doi":"10.1080/10903127.2025.2525528","DOIUrl":"10.1080/10903127.2025.2525528","url":null,"abstract":"<p><strong>Objectives: </strong>Canadian emergency departments (EDs) are under unprecedented strain due to record-high patient volumes and limited capacity expansion. To mitigate overcrowding, Ontario implemented a paramedic 'treat and discharge' model, enabling paramedics to assess, treat, and discharge patients with resolved seizure, hypoglycemia, or supraventricular tachydysrhythmia under specific clinical criteria. This study evaluates the short-term safety and effectiveness of this model by examining subsequent emergency service utilization.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using linked data from paramedic services in southwestern Ontario and a provincial health care database from June 1, 2023, to November 15, 2024. All patients discharged by paramedics under this model were included. We analyzed the incidence of emergency service use (9-1-1 calls and ED visits), mortality, and other health care utilization within seven days post-discharge, categorized by the reason for service use as related-cause and all-cause. We computed descriptive statistics and relative risk (RR) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 123 patients, 11 (8.9%) required emergency services for a related-cause within seven days. Seizure patients had the highest incidence of related emergency service utilization (<i>n</i> = 7), followed by hypoglycemia (<i>n</i> = 4), while tachydysrhythmia had none. All patients visiting an ED either following a 9-1-1 call or by walk-in for a related-cause were discharged. The overall incidence of all-cause emergency service use was 14 patients (11.4%). There were no deaths in the community or ED within seven days. Seizure patients had a higher risk of using emergency services after discharge if they had called for paramedics within the 14 days prior (RR 6.80, 2.44-18.96) or received paramedic medications (RR 5.83, 2.89-12.21). No significant risk increase was observed for patients tended to by primary care paramedics compared to advanced care, or those presenting with an emergent acuity on initial contact.</p><p><strong>Conclusions: </strong>The low incidence of subsequent emergency service use supports the safety and feasibility of the paramedic treat and discharge model for select patients. These findings highlight the potential of alternative care models that optimize paramedic and ED resources and suggest that treat and discharge directives could be expanded to additional patient cohorts.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529387","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":"How to Define a Frequent Caller to the Prehospital Emergency Medical Services? Literature-Based vs. Data-Driven Approach.","authors":"Maria Kjærgaard, Astrid Karina Valås Harring, Tine Bennedsen Gehrt","doi":"10.1080/10903127.2025.2517863","DOIUrl":"10.1080/10903127.2025.2517863","url":null,"abstract":"<p><strong>Objectives: </strong>To provide and test different definitions of a frequent caller to the prehospital emergency medical services, grounded in both literature and empirical data, in order to spark discussion about definitions and how to make studies on frequent callers more comparable.</p><p><strong>Methods: </strong>A cross-sectional register study of emergency calls made to the Emergency Medical Coordination Center (EMCC) covering the Central Denmark Region in 2022. Three definitions were developed: one as the average number of calls derived from definitions in the previous literature, while the other two were determined using a data-driven approach, representing the top 1% and 0.5% most frequent callers. Unadjusted logistic regression was used to measure odds ratios to examine non-causal associations between predictive factors and frequent callers within each definition.</p><p><strong>Results: </strong>The analysis included 65,522 emergency calls concerning 49,623 unique individuals. For this specific population, the definitions resulted in the following three thresholds; literature-based definition: ≥43, top 1%: ≥5, and top 0.5%: ≥8 emergency calls per year. There was great variation between the populations of frequent callers captured by the three definitions. Across definitions, frequent callers constituted a relatively small proportion of the total population contacting the EMCC, while they made a significant share of the calls.</p><p><strong>Conclusions: </strong>We suggest that the 1%-definition is the most suitable for future research on frequent callers to the prehospital EMS as it was able to account for the complexity of this group of citizens and could be applied across prehospital EMS in other contexts and countries. Based on this definition, the most characteristic patterns in emergency calls from frequent callers were low level of urgency, recontact within 24 h, and more calls due to behavioral, psychological, and unclear problems compared to non-frequent callers.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476424","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":"Frequency and Factors Associated with Patient Safety Events During Prehospital Obstetric Emergencies.","authors":"Rebecca E Cash, Maeve F Swanton, Melissa A Meeker, Margaret E Samuels-Kalow, Lindsay V Walsh, Gia E Ciccolo, Kira G Chandran, Anjali J Kaimal, Carlos A Camargo","doi":"10.1080/10903127.2025.2514480","DOIUrl":"10.1080/10903127.2025.2514480","url":null,"abstract":"<p><strong>Objectives: </strong>Patient safety events (PSE) in the prehospital setting are common for high acuity and pediatric patients; however, little is known about PSE during prehospital obstetric emergencies. Our objective was to examine the frequency and factors associated with PSEs during out-of-hospital delivery and postpartum hemorrhage (PPH) treated by emergency medical services (EMS) clinicians in the United States.</p><p><strong>Methods: </strong>We conducted a cross-sectional evaluation of advanced life support EMS 9-1-1 activations for patients aged 12-50 years with out-of-hospital delivery or PPH in the 2018-2019 National EMS Information System dataset. Patient safety events were defined as adverse events or complications from an EMS-provided intervention, suboptimal actions (e.g., intervention indicated and not given), or errors (e.g., wrong drug dose). Indicated interventions were determined based on the National EMS Model Clinical Guidelines. We fit modified Poisson mixed effects regression models with a random intercept for EMS agency to calculate prevalence ratios, and we calculated marginal adjusted prevalence to identify subgroups at highest and lowest risk of PSEs.</p><p><strong>Results: </strong>A total of 7283 activations for out-of-hospital delivery and 1273 for PPH were included, with 1960 (27%) activations for out-of-hospital delivery and 882 (69%) for PPH having at least one PSE. For out-of-hospital delivery, multiples, preterm labor, shorter scene times, and higher community diversity were associated with lower prevalence of PSEs, while presence of an obstetric-capable hospital in the county and delivery complication were associated with higher prevalence of PSEs. For PPH, being found at home during the day was associated with lower prevalence of PSEs while delivery complications, multiples, longer scene time, higher community vulnerability, and presence of an obstetric-capable hospital in the county were associated with higher prevalence of PSE. Older age, being at home, complications, longer scene time, and rural location had the highest marginal adjusted prevalence of PSEs during out-of-hospital delivery.</p><p><strong>Conclusions: </strong>There was a high rate of PSEs during out-of-hospital delivery and PPH treated by EMS, with specific subgroups at highest and lowest risk of PSEs. Focusing on these associations may help guide educational or system resource interventions to help reduce the risk of PSEs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216649","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":"Physician Directed Prehospital Treatment in Psychostimulant Induced Hyperthermia: A Case Series.","authors":"Dorothy A Habrat, William S Dukes, Michael M Neeki, Shira A Schlesinger","doi":"10.1080/10903127.2025.2508788","DOIUrl":"10.1080/10903127.2025.2508788","url":null,"abstract":"<p><strong>Objective: </strong>Psychostimulant induced hyperthermia is a high mortality condition encountered at mass gatherings such as music festivals. Early, rapid resuscitation and cooling may improve outcomes. This case series describes the use and patient outcomes of a physician directed medical resuscitation guideline including on-scene sedation, intubation, and ice-water submersion in the prehospital setting, followed by transport to non-specialized emergency departments (EDs).</p><p><strong>Methods: </strong>We performed a retrospective chart review of hyperthermia cases treated at electronic dance music festivals by physician-led prehospital resuscitation teams using ice-water bath submersion. Initial prehospital and ED core body temperatures were recorded as were initial ED vital signs, laboratory values, imaging studies, and hospital outcome.</p><p><strong>Results: </strong>Twenty-one cases of hyperthermia were identified that were treated using emergency resuscitation and ice-water submersion. All were presumed to have involved the recreational use of psychostimulant drugs. Median initial rectal temperature was 42.2 °C (107.9 °F) (IQR 41.8-42.4 °C). All patients underwent sedation, intubation, and attempted cooling per the event-medicine specific guideline. Eighteen patients were cooled using ice-water submersion and on arrival to the ED the measured mean core temperature was 35.89 °C (96.65 °F) (SD 2.39 °C). Three patients did not complete the cooling process as they developed cardiac arrest before or during cooling, necessitating removal from the submersion tank, cardiopulmonary resuscitation (CPR), acute resuscitation led by the physician, and transport to the closest hospital. On arrival to the ED, mean rectal temperature was 35.89 °C (96.65 °F) (SD: 2.39 °C). Of the 21 patients that met study inclusion, 19 survived to hospital admission, of which 18 were discharged from the hospital neurologically intact.</p><p><strong>Conclusions: </strong>A prehospital physician-directed guideline, including ice-water submersion after sedation and intubation, was used in mass gatherings to reduce body temperature in patients with psychostimulant induced hyperthermia. In this case series, we present the largest series of patients treated by physician directed guideline in the out-of-hospital environment at music festivals. Our outcomes suggest that a physician-directed guideline incorporating ice-water immersion on site before transfer to an emergency department can be used to decrease the mortality risk of psychostimulant induced hyperthermia in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182507","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":"A Case Report of Prehospital Point-Of-Care Ultrasound in Acute Aortic Dissection: Reinforcing the Out-of-Hospital Chain of Survival.","authors":"Alba Ripoll-Gallardo, Maddalena Cabrini, Matteo Cairo, Alessandro Mori, Valeria Diana, Pietro Boschiroli, Annibale Navoni, Giacomo Balladore, Daniele Sozzani, Antonella De Pirro, Riccardo Stucchi","doi":"10.1080/10903127.2025.2517154","DOIUrl":"10.1080/10903127.2025.2517154","url":null,"abstract":"<p><p>This case report highlights the importance of prehospital point<b>-</b>of-care ultrasound (POCUS) when acute aortic dissection is suspected. At 2:09 pm the local emergency medical services (EMS) received a call from a small town in Lombardy, Italy, reporting that a 54-years-old man had collapsed while lifting weights in a fitness club. Response teams found him lying on the floor, fully responsive and very pale; he was a lean man, with no allergies, no home therapy and no significant past medical history. He had had a transient facial paralysis and complained of dizziness and mild chest discomfort. During physical examination he became suddenly hypotensive (60/30 mmHg). The electrocardiogram showed a sinus rhythm, 80 beats per minute (bpm) and unaltered T wave and ST segment. The POCUS showed a dilated aortic root with intimal flap and small pericardial effusion. A diagnosis of Type A acute aortic dissection was made on the spot. The EMS dispatch center identified the closest hospital with available cardiothoracic surgery and provided a full report of the patient's condition, diagnosis and initial treatment. At 3:10 pm, the patient entered the emergency room and a rapid transthoracic ultrasound confirming the diagnosis was performed in the presence of the cardiac anesthetist and cardiothoracic surgeon. The patient was agitated, tachycardic (110 bpm) and hypotensive (50/30 mmHg). Upon stabilization with intravenous norepinephrine and fluids, a computed tomographic angiogram was performed demonstrating a Stanford Type A aortic dissection with intimal flap starting from the bulb/valvular plane and extending to the origin of supra-aortic trunks down to the left common iliac artery. At 4.00 pm the patient was ready for surgery; he underwent successful ascending aorta replacement with a regular postoperative course and no signs of neurological damage. On post-operative day eight he was referred to an inpatient cardiac rehabilitation facility and later discharged home. At prehospital level, POCUS is feasible and may provide key diagnostic findings in some threatening medical (non-trauma-related) conditions that are normally diagnosticated only once the patient has reached the hospital. In addition, this report highlights a perfect interaction between out-of-hospital medical personnel, dispatch center and in-hospital multidisciplinary health staff.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234939","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}