Prehospital Emergency Care最新文献

{"title":"Interobserver Agreement in Pediatric Asthma Examination Findings Between Emergency Medical Services and Emergency Department Clinicians.","authors":"Michael F Taylor, Caleb E Ward, Jennifer F Anders, Adjoa A Andoh, James M Chamberlain, Nidhya Navanandan, Sylvia Owusu-Ansah, Kyle Schmucker, Bobbe Thomas, Kathleen M Brown","doi":"10.1080/10903127.2026.2717525","DOIUrl":"10.1080/10903127.2026.2717525","url":null,"abstract":"<p><strong>Objectives: </strong>Asthma exacerbations constitute 10-15% of all pediatric emergency medical services (EMS) calls. There are several validated scoring tools to assess acute asthma severity, which have good inter-rater reliability and correlate with clinical outcomes in the emergency department (ED), but have not been validated with EMS clinicians. This study sought to assess the level of agreement between EMS and ED clinicians on components of asthma scoring tools to inform a prehospital asthma severity scoring tool.</p><p><strong>Methods: </strong>We conducted a prospective observational study of children 2-18 years old transported by EMS with an impression of asthma exacerbation to five pediatric EDs. EMS and ED clinicians independently completed surveys assessing the patient's exam on arrival to the ED. Survey items were drawn from existing asthma scoring tools and refined by focus groups and a Delphi process with EMS clinicians and expert stakeholders. To determine agreement between EMS and ED clinicians regarding survey items, inter-rater reliability was calculated using Kappa and intraclass correlation coefficient for binary and ordinal variables, respectively.</p><p><strong>Results: </strong>We enrolled a convenience sample of 295 children with a median age of 7 years (inter-quartile range 3-12 years). There was slight agreement among EMS and ED clinicians (κ = 0.01-0.20) for suprasternal retractions and fair agreement (κ = 0.21-0.40) for tachypnea, accessory muscle use, and elevated respiratory rate. There was poor agreement (ICC = 0-0.50) for breathlessness, work of breathing, degree of hypoxia, type of wheeze, and wheezing intensity.</p><p><strong>Conclusions: </strong>We observed limited agreement between EMS and ED clinicians when assessing children for components of asthma severity scores. Developing a prehospital asthma exacerbation severity scoring tool to guide EMS interventions may be challenging. Further research is needed to determine whether education improves EMS performance with asthma scoring tools or whether standardized EMS asthma protocols, regardless of exacerbation severity, improve patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075751","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":"Pediatric Rural Interfacility Transfers by Emergency Medical Services.","authors":"Caroline S Morris, Christopher E Gaw, Christopher B Gage, Chelsea B Kadish, Anne P Runkle, Joelle Donofrio-Odman, Ashish R Panchal","doi":"10.1080/10903127.2026.2742416","DOIUrl":"https://doi.org/10.1080/10903127.2026.2742416","url":null,"abstract":"<p><strong>Objectives: </strong>Interfacility transports (IFTs) are critical for the care of pediatric patients in the United States (US), particularly in rural areas that may have limited pediatric specialty resources. Given the paucity of data describing rural pediatric IFTs, we aimed to characterize pediatric rural IFTs in the US.</p><p><strong>Methods: </strong>We conducted a retrospective, observational study using the 2023 National Emergency Medical Services Information System dataset. Rural IFTs involving patients aged >1 day to <18 years were included and stratified into the following age groups: infant (1 day to <1 year), toddler (1-2 years), preschooler (3-5 years), young child (6-11 years), and teenager (12 to <18 years). Using descriptive statistics, we analyzed patient demographics, clinical characteristics, emergency medical services (EMS) transport characteristics, medications, procedures, and transport time intervals.</p><p><strong>Results: </strong>We identified 29,992 rural pediatric IFTs (median age: 8 years [IQR: 2-14 years]; 52.9% male). Teenagers represented the largest age group transferred (38.8%). Respiratory diseases (12.3%) were the most common primary impression overall, whereas psychiatric and behavioral health conditions predominated among teenagers. Ground transport accounted for most IFTs (79.4%), and advanced life support units were the most common transport level of care (62.7%). Infants demonstrated the highest proportion of specialty critical care transports (32.1%) and longer median response and total call intervals across transport modalities compared with older age groups. Younger children more commonly received respiratory-focused medications and procedures, whereas teenagers more frequently received pain management and sedative medications.</p><p><strong>Conclusions: </strong>Nearly 30,000 pediatric rural IFTs occurred in 2023, with substantial age-related differences in clinical presentations, transport characteristics, and EMS interventions. Infants more frequently required specialty critical care transport and experienced longer transport intervals, whereas psychiatric and behavioral health conditions represented a substantial proportion of adolescent transfers. These findings underscore the importance of pediatric-focused EMS preparedness, transport readiness, and clinical training initiatives to support safe rural pediatric interfacility care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114126","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":"Response to the Letter to the Editor by Dr. Chong.","authors":"Ryerson Emil Magdaleno R Soliven, Yutaka Igarashi, Tatsuya Norii, Shoji Yokobori","doi":"10.1080/10903127.2026.2743288","DOIUrl":"https://doi.org/10.1080/10903127.2026.2743288","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114201","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":"Enhancing Far-Forward Resuscitation: A Quantitative Laboratory Analysis of Blood Warmer Devices Used in Austere Environments.","authors":"Wayne Papalski, Matthew A Tovar, Eric Sulava, Eric J Koch, Mariah A Jensen-Wachspress, Matthew Monaco, Conner Murphy, Emily Friedrich, Fernando U Gonzalez, Lorie Gower, Kay-Cee Patterson, Christopher Treager, Brittany Dellinger","doi":"10.1080/10903127.2026.2736179","DOIUrl":"10.1080/10903127.2026.2736179","url":null,"abstract":"<p><strong>Objectives: </strong>It is well known that hypothermia increases organ dysfunction and mortality in traumatically injured patients. While several small, portable blood warmers are commercially available, comparative data on their warming efficiency and flow dynamics remain limited. Thus, the objective of this study was to identify optimal blood warming devices for far-forward austere trauma resuscitation.</p><p><strong>Methods: </strong>This prospective experimental study assessed six blood warming devices: QinFlow Warrior Lite^™, MWarmer^™, Buddy Lite^™, Thermal Angel^®, the LifeWarmer Quantum^™, and the Ready Heat Blanket^™, using whole blood stored at 4 °C. Devices were tested in triplicate under two pressure conditions (0 and 300 mmHg). Flow was measured volumetrically and converted into average (Qavg), ideal (Qi), and maximum (Qmax) flow rates. Temperature was measured at the distal end of intravenous tubing and analyzed using average (Tavg), ideal (Ti), and maximum (Tmax) definitions. Time-to-one-unit (TT1U) was calculated as a clinically meaningful metric. Two-way ANOVA with interaction terms and post hoc Tukey testing were used for statistical comparison, with significance defined as multiplicity-adjusted <i>p</i> < 0.05.</p><p><strong>Results: </strong>The Quantum exhibited the highest Qi at both pressure levels, achieving a TT1U of 1.55 ± 0.10 min at 300 mmHg, significantly faster than all other devices. However, its warming performance declined significantly with increased pressure, with Ti decreasing from 34.7 °C to 25.6 °C (<i>p</i> < 0.0001). In contrast, the MWarmer demonstrated the highest and most consistent warming performance across all pressure conditions, maintaining Ti of 40-41 °C (<i>p</i> < 0.0001) at both pressure conditions. The Buddy Lite showed poor warming performance with pressure-related degradation, while Ready Heat provided negligible warming capacity with flow comparable to control.</p><p><strong>Conclusions: </strong>This is an independent quantitative comparison of portable blood warming devices using cold-stored whole blood under clinically relevant pressure conditions. Results suggest that the MWarmer offers the most favorable balance of thermal performance and flow for far-forward resuscitation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017765","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":"Differences in EMS Calls, Delays, and Payer Types in U.S. Southern Border Counties and Non-Border Counties.","authors":"Christine Crudo Blackburn, Huiwen Zheng, Elena Andreyeva","doi":"10.1080/10903127.2026.2735429","DOIUrl":"10.1080/10903127.2026.2735429","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to address the gap in understanding of how the emergency medical services (EMS) experience differs in border counties compared to non-border counties by examining differences between EMS provision in a matched comparison to identify challenges and experiences that result primarily from EMS agency or department location along the United States (U.S.)-Mexico border.</p><p><strong>Methods: </strong>The retrospective observational study analyzed secondary National Emergency Medical Services Information System data from 2018-2024, including 421,877 EMS encounters across eight rural counties, with 242,029 cases occurring in border counties, and 179,848 cases occurred in comparison counties. We compared the patterns of primary payer, number of patients at the scene, mass casualty incident, trauma triage criteria, and delays of EMS encounters. These variables were summarized using frequencies and percentages and compared between border and non-border counties using chi-square tests. Given the large number of EMS encounters, absolute percentage point differences and Cramer's V were also reported to assess the magnitude of differences between the two groups.</p><p><strong>Results: </strong>We found that differences exist regarding payer types, injury types, and delay types, with varying effect sizes. Effect sizes for payer, high risk of serious injury, response delay and scene delay between border and comparison counties were moderate to large, while those for moderate risk of serious injury and transport delay were small to moderate. Regarding injury types, border counties had more cases of falls from 20 feet or more compared to non-border counties, as well as higher injuries that represent severe trauma or environmental exposure compared to non-border counties (25.5% vs. 8.2%).</p><p><strong>Conclusions: </strong>These findings suggest that important differences exist between counties along the U.S.-Mexico border and comparison non-border counties because of their location along the international boundary, with implications for EMS performance.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991106","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":"Cardiopulmonary Resuscitation Quality During the Transition in Care from Paramedic Services to Emergency Department Teams.","authors":"Victoria Myers, Ian R Drennan, Steve Lin, Sheldon Cheskes, Dana Bradshaw, Garrick Mok","doi":"10.1080/10903127.2026.2731188","DOIUrl":"10.1080/10903127.2026.2731188","url":null,"abstract":"<p><strong>Objectives: </strong>In patients who experience out-of-hospital cardiac arrest (OHCA), high quality cardiopulmonary resuscitation (CPR) is associated with improved outcomes. The transition of care from paramedic services to emergency department (ED) teams represents a potentially vulnerable period where CPR quality may deteriorate. This study evaluated CPR quality during the prehospital-to-ED transition.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of adult patients with non-traumatic OHCA transported to a tertiary academic ED between August 2023 and August 2024. Metrics assessing CPR quality were obtained from prehospital and ED defibrillator recordings. Four predefined intervals were analyzed: paramedic baseline, paramedic pre-transition, ED post-transition, and ED baseline. The primary outcome was each adherence to the American Heart Association (AHA) guidelines defined as the mean depth of compressions, mean rate of compressions, and mean chest compression fraction for each interval. Secondary outcomes included comparison between intervals for each metric. Continuous variables were compared using a linear mixed effect model and comparison of categorical data, including the proportion of cases adhering to AHA guidelines, was done using the Cochran's Q test.</p><p><strong>Results: </strong>Thirty-five OHCA cases met inclusion criteria. Mean patient age was 49.9 years (SD 13.6), and 80.0% were male. Mean CCF was guideline compliant throughout all intervals (89-92%) with no significant differences between intervals. Compression rate was guideline compliant across all intervals (109.9-117.5 compressions/minute). Compression depth was guideline compliant during paramedic intervals (5.8 and 5.9 cm) and was significantly higher (<i>p</i> < 0.001) during ED transition and ED baseline intervals (6.4 and 6.8 cm) exceeding guideline targets. No significant differences across intervals were observed in the proportion of cases meeting guideline targets for CCF, rate, or depth.</p><p><strong>Conclusions: </strong>Quality of CPR was overall maintained during the transition of care from paramedic services to the ED, with no deterioration in chest compression fraction or overall guideline adherence. Compression depth exceeded guideline recommendations in the ED, representing a potential target for future quality improvement initiatives.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945646","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 Early Prehospital Administration Antibiotic and 28-Day Mortality in Sepsis.","authors":"Karn Suttapanit, Pannita Deeiad, Siriporn Damdin, Damon C Scales, Praphaphorn Supatanakij","doi":"10.1080/10903127.2026.2733964","DOIUrl":"10.1080/10903127.2026.2733964","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a life-threatening emergency requiring prompt recognition and timely treatment. Delayed antibiotic administration is consistently associated with increased mortality. However, evidence regarding the impact of empirical antibiotic administration in the prehospital setting on mortality outcomes remains limited. This study aimed to evaluate the association between prehospital antibiotic administration and 28-day mortality among patients with suspected sepsis.</p><p><strong>Methods: </strong>An observational cohort study was conducted at the Emergency Medical Operation Unit, Ramathibodi Hospital, from September 1, 2022, to September 30, 2025. Patients aged ≥18 years with suspected sepsis in prehospital care were included. Adjusted absolute risk reduction (ARR) was estimated to compare 28-day mortality between prehospital antibiotic administration and usual care. Multivariable logistic regression adjusted for the Charlson Comorbidity Index, Ramathibodi early warning score, modified Sequential Organ Failure Assessment score without creatinine, intravenous fluid volume, blood lactate level, scene time, distance from the scene to the hospital, vasopressor administration, and prehospital intubation was performed to assess the independent association between prehospital antibiotic administration and 28-day mortality. Multivariable linear regression was performed to compare differences in time to antibiotic administration and scene time between prehospital antibiotic administration and usual care groups.</p><p><strong>Results: </strong>A total of 364 patients were enrolled, of whom 154 (42.3%) received prehospital antibiotics, and 210 (57.7%) did not. The 28-day mortality rate was 25.9% in the prehospital antibiotic group and 28.1% in the usual care group. The adjusted ARR was 8.9% (95% Confidence Interval [CI] 0.8-17.1 %; <i>p</i> = 0.031), and the adjusted odds ratio was 0.51 (95% CI 0.27-0.95; <i>p</i> = 0.035). The adjusted mean difference in time to antibiotic administration was significantly shorter in the prehospital group (-124.6 min; 95% CI -183.9 - -65.2; <i>p</i> < 0.001), whereas scene time increased by 8.5 min (95% CI 5.2-11.8; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Prehospital antibiotic administration was associated with a lower 28-day mortality among patients with suspected sepsis. Further multicenter studies are warranted to confirm these findings and improve prehospital sepsis management protocols.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970648","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 Causal Model for Prehospital Blood Transfusion and Mortality in Traumatic Hemorrhagic Shock.","authors":"Joshua B Gaither, Milton Lerman, Chengcheng Hu, Amber D Rice, Dan W Spaite, Yigit Baykara, Rachel Munn, Jan O Jansen, Manish Shah, Jason McMullan, Sam Keim, Collin Stewart, Louis Magnotti, Alma Brenda Granillo, Gail Bradley, Bruce Barnhart, Henry Wang","doi":"10.1080/10903127.2026.2733966","DOIUrl":"https://doi.org/10.1080/10903127.2026.2733966","url":null,"abstract":"<p><strong>Objectives: </strong>Utilization of prehospital blood transfusion (PBT) as a treatment for traumatic hemorrhagic shock (THS) has been expanding nationally, yet evidence supporting the practice in some operational environments remains limited. Development of strong scientific evidence to support this practice requires a clear causal model linking prehospital transfusion to mortality and other clinically relevant outcomes. The aim of this project is to develop such a causal model, identifying pathways among the intervention, mediators, and contextual factors through which PBT may impact mortality.</p><p><strong>Methods: </strong>The causal model was designed to link PBT with all-cause mortality, compared with standard resuscitation using crystalloid fluid, in patients with suspected THS. An initial causal model was developed based on existing literature and emergency medical services (EMS) operational workflows. The model was subsequently refined through an iterative expert-informed review process involving multidisciplinary stakeholders, including EMS clinicians, EMS physicians, trauma surgeons, transfusion medicine specialists, and investigators with expertise in EMS system and causal inference.</p><p><strong>Results: </strong>The causal model includes exposure to PBT, confounders, mediators, and colliders, all of which may impact the primary outcome of interest: patient survival. The model includes multiple exposures, or types of PBT, including packed red blood cells (PRBCs), plasma, platelets, and whole blood. Potential confounders include EMS system-level factors, such as EMS system times (response time, on-scene time, and transport time), EMS clinician training and protocols, units of blood products available, and quality improvement programs associated with program operation. Patient-level confounders include type of injury, injury severity, age, and patient comorbidities. The model also includes two categories of mediators through which PBT is thought to impact patient outcomes: physiologic mediators, such as improved blood pressure, heart rate, acidosis and coagulopathy, and system mediators, including reduced crystalloid exposure and decreased time from injury to transfusion.</p><p><strong>Conclusions: </strong>A causal model was developed to provide a transparent framework and methodological foundation for pragmatic research and comparative effectiveness studies. The model identifies key confounding processes that should be considered when developing study-specific adjustment strategies for observational analyses. This model is intended to guide implementation, evaluation, and future research on the impact of PBT in patients with THS.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002619","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":"Management of Patients with Medetomidine Withdrawal During Interfacility Transfer.","authors":"Justin K Kenney, Michael J Lynch, Anthony F Pizon, Christian Martin-Gill","doi":"10.1080/10903127.2026.2728131","DOIUrl":"https://doi.org/10.1080/10903127.2026.2728131","url":null,"abstract":"<p><strong>Objectives: </strong>Alpha-2 agonists including medetomidine are becoming increasingly prevalent as adulterants in the United States opioid supply. Complicated withdrawal following use of these agents is characterized by severe symptoms including agitation and nausea, often requiring treatment with high-dose dexmedetomidine infusion and transfer between community emergency departments and tertiary critical care units. We aimed to describe interventions and outcomes of patients undergoing interfacility transport while receiving a dexmedetomidine infusion for medetomidine withdrawal to inform safe transfer practices for this patient population.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort study of consecutive non-intubated patients receiving dexmedetomidine infusion for management of suspected medetomidine withdrawal transported by a regional critical care transport agency between March 2024 and February 2026. We identified clinical characteristics, characterized withdrawal symptoms, and identified the incidence of and indications for supplemental medical therapy provided during transport. We also identified the prevalence of hemodynamic instability, hypoxia, or need for advanced airway interventions.</p><p><strong>Results: </strong>Among the 100 patients receiving dexmedetomidine infusion for suspected medetomidine withdrawal, most experienced agitation (53%), nausea/vomiting (58%), tachycardia/bradycardia (62%), or hypertension (71%) upon or prior to crew arrival. During transport, 10% of patients received dexmedetomidine titration, 12% received additional antiemetics, 9% received sedatives, and 1% received vasoactive infusion for hypotension. No patients received additional sedative infusions. Many patients exhibited hypertension (systolic blood pressure [SBP] > 140 mmHg; 78%) or profound hypertension (SBP >180 mmHg or diastolic BP >110 mmHg; 39%). Patients also experienced tachycardia (heart rate [HR] > 120; 35%), bradycardia (HR <50; 6%), or hypotension (SBP <90 mmHg; 6%). Only 3% of patients experienced hypoxia (SpO2 < 90%), or were treated with supplemental oxygen, and no patients required advanced airway management.</p><p><strong>Conclusions: </strong>Patients undergoing transport while receiving dexmedetomidine infusion for suspected medetomidine withdrawal were commonly hypertensive and rarely hypoxic. While some patients required additional antiemetic or sedative medications, no patients required alternate sedative infusions, most remained stable on the dexmedetomidine infusion, and need for vasopressors was very rare. Early symptom recognition and pharmacologic alpha-2 agonism are likely key in prehospital management of this toxidrome, which can safely be continued during interfacility transport.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983314","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 Transfusion for Medical Causes of Hemorrhage: A Case Series.","authors":"Angela P Cornelius, Jeffrey Siegler, Melissa Kroll, Brian L Miller, Betty Y Yang, Daniel Verna, Allison Scanlon, Jeffrey Jarvis","doi":"10.1080/10903127.2026.2726541","DOIUrl":"10.1080/10903127.2026.2726541","url":null,"abstract":"<p><strong>Objectives: </strong>Much attention has been given to prehospital blood use for trauma, but evidence is lacking for non-traumatic hemorrhage. Therefore, we sought to evaluate the epidemiology of patients receiving prehospital whole blood for nontraumatic hemorrhage.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients receiving prehospital blood transfusions for non-traumatic hemorrhagic shock within two fire-based emergency medical services (EMS) systems, between February 20, 2024, and April 23, 2026. Patients were included if blood products were administered for a non-traumatic cause of hemorrhagic shock. Exclusion criteria included cardiac arrest and blood transfusion prior to EMS arrival. Data collected from electronic patient care records included demographics, scene type, blood product administered, operational time intervals, and physiologic parameters. Shock index was calculated at patient-level by dividing heart rate (HR) by systolic blood pressure (SBP) at initial EMS assessment, immediately prior to transfusion, and emergency department (ED) arrival.</p><p><strong>Results: </strong>Of 163 blood transfusions, 50 (30.7%) were administered for non-traumatic hemorrhagic shock. After exclusions, 47 patients were included. Mean age was 66 years, and 55% were male. Gastrointestinal bleeding (GI) was the most common source (49%), followed by unspecified hemorrhagic shock (43%) and obstetric/gynecologic hemorrhage (4.3%). Most encounters occurred in private residences (57%) or rehabilitation/skilled nursing facilities (32%). Mean heart rate decreased from 102 at initial EMS assessment to 96 on ED arrival, while mean systolic blood pressure increased from 83 mmHg to 106 mmHg. Mean shock index decreased from 1.34 to 1.01.</p><p><strong>Conclusions: </strong>Our two-system observational study found just under a third of patients received blood for non-traumatic reasons, with the majority being for GI bleeding. Further work is needed to better understand the impact of blood for medical patients on patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}