Prehospital Emergency Care最新文献

{"title":"Reframing Prehospital Termination of Resuscitation as Withdrawal of Life Support: Applying lessons from the ICU in the prehospital setting.","authors":"Darren Braude, Michael DeFilippo, Naomi George, Robert LaPrise, Kimberly Pruett","doi":"10.1080/10903127.2025.2554914","DOIUrl":"https://doi.org/10.1080/10903127.2025.2554914","url":null,"abstract":"<p><p>Cardiac arrest response and management is a critical piece of prehospital clinical practice yet the majority of these patients do not survive to be transported. Termination of resuscitation and resulting death notification is stressful and emotional for both loved ones and EMS clinicians. We describe a fundamental shift from traditional termination of resuscitation to a patient and family-centered model. This new approach focuses on identifying appropriate situations to have family present at the time resuscitative efforts cease, and possibly throughout the entire resuscitation, thereby reframing termination of resuscitation as withdrawal of life support. This approach draws on best practices from hospital-based end-of-life care and holds the potential to reduce psychological trauma for both families and EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030302","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":"Performance of Prehospital Antibiotic Administration and Blood Culture Collection in a Physician-Staffed Mobile Unit: A Retrospective Cohort Study.","authors":"Romain Bonnet, Mohamed Abbas, Adrien Fischer, Jérôme Pugin, Laurent Suppan, Stephan Harbarth","doi":"10.1080/10903127.2025.2547653","DOIUrl":"10.1080/10903127.2025.2547653","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital antibiotic administration prior to emergency department (ED) admission could reduce the delay of effective antibiotic treatment and thus mortality of septic patients. Additionally, collecting blood cultures early could improve microbial identification. We assessed the effect of ceftriaxone administration before ED admission on mortality. As our secondary objective, we evaluated the positivity and contamination rate of prehospital blood cultures in a prehospital physician-staffed system.</p><p><strong>Methods: </strong>The computerized databases of a physician-staffed prehospital unit were screened for patients presenting with suspected sepsis and low systolic blood pressure (< 90 mmHg) between May 2013 and December 2018. The association between prehospital ceftriaxone administration and 28-day mortality, Intensive care unit (ICU) admission and length-of-stay (LOS) was analyzed. The yield of blood cultures and frequency of contamination were calculated.</p><p><strong>Results: </strong>A total of 165 septic patients matched the inclusion criteria. Prehospital antibiotics were administered in 60.6% (100/165) of cases. Twenty-eight-day mortality was similar between patients receiving and not receiving antibiotics (39.0 % vs 38.5%, <i>p</i> = 1.000). Hazard ratio of 28-day mortality was 0.87 (95%IC 0.51-1.47). Likewise, no statistically significant impact on 7-day mortality, ICU admission or LOS was found. Blood cultures showed a high positivity rate (35.4%, 23/65) and a low contamination rate (3.1%, 2/65).</p><p><strong>Conclusions: </strong>In a physician-staffed prehospital system, prehospital blood cultures among critically ill, septic patients showed high positivity and low contamination rates. However, early ceftriaxone administration showed no impact on 28-day mortality, 7-day mortality, ICU admission and ED and ICU LOS.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848348","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":"Joint Position Statement on Criminal Liability for Alleged Deviations from Clinical Standards of Care in Emergency Medical Services.","authors":"","doi":"10.1080/10903127.2025.2552355","DOIUrl":"https://doi.org/10.1080/10903127.2025.2552355","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144965986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Ultrasound Detection of Pulseless Rhythm with Echocardiographic Motion (PREM) in Prehospital Cardiac Arrest: A Case-Series.","authors":"Martha Watson, Jessica Barbour, David Rayburn","doi":"10.1080/10903127.2025.2543444","DOIUrl":"10.1080/10903127.2025.2543444","url":null,"abstract":"<p><strong>Objectives: </strong>This case series highlights the utility of Point of Care Ultrasound (POCUS) during cardiac arrest pulse checks, and how this tool can be used to identify Pulseless Rhythm with Echocardiographic Motion (PREM), also known as pseudo-pulseless electrical activity (PEA), and the potential changes in prehospital resuscitation management based on that finding.</p><p><strong>Methods: </strong>We've documented four cases of PREM identification in the prehospital field to draw attention to this phenomenon and ideally serve as a blueprint for other agencies to adopt PREM-specific protocols.</p><p><strong>Results: </strong>This case series demonstrates how cardiac visualization alters patient management in the setting of cardiac arrest. Each of the cases presented is unique in presentation and treatment. The use of POCUS has opened a door to the possibility of adopting prehospital guidelines for the management of PREM in prehospital cardiac arrest and subsequently more tailored treatment of patients.</p><p><strong>Conclusions: </strong>Use of portable ultrasound in prehospital cardiac arrest highlights a large gap in our understanding and treatment of PREM. While these patients all ultimately died, their cases highlight the opportunity for more appropriate care, both prehospital and in-hospital. Because literature has posited that PEA is a more complex cardiac rhythm than previously thought, we are suggesting that pre-hospital cardiac arrest care guidelines reflect our current body of understanding. These cases emphasize the importance of emergency medical service (EMS) POCUS use and supports a transition to hands-free, or ultrasound-guided, pulse checks during cardiac arrest. More research is needed regarding the etiology of Pulseless Rhythm with Echocardiographic Standstill (PRES) versus PREM, what treatment guidelines would be best in cases of PREM, and how we can implement PREM recognition to health care personnel of all levels on a national scale.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144795152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating CPR Under Fatigue: Methodological Considerations for Realistic Simulations.","authors":"Melih Imamoglu, Abdul Samet Sahin, Sinan Pasli","doi":"10.1080/10903127.2025.2540425","DOIUrl":"10.1080/10903127.2025.2540425","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile Integrated Health Care and Community Paramedicine: A Position Statement and Resource Document of NAEMSP.","authors":"Alexander J Ulintz, Laurel C O'Connor, Todd M Heffern, Joel Rowe, Jeffrey E Rollman, Gary Wingrove, Matt Zavadsky, Michael R Wilcox, Scott A Goldberg","doi":"10.1080/10903127.2025.2541899","DOIUrl":"10.1080/10903127.2025.2541899","url":null,"abstract":"<p><p>Emergency medical services (EMS) are integral to public health and safety and provide health care to both individuals and communities. Community paramedicine (CP) and mobile integrated health care (MIH) programs are expanded models of EMS that provide needs-based, patient-centered care in the community. Successful implementation requires a community health needs assessment, engaged EMS medical directors, multidisciplinary collaboration, and sustainable reimbursement that recognizes prehospital care delivery beyond traditional payment for transport.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Prehospital Trauma Compendium: Evaluation and Management of Suspected Pelvis Fractures - An NAEMSP Position Statement and Resource Document.","authors":"John W Lyng, Joshua G Corsa, Brad D Raetzke, Bryan R Wilson, Andrew McCoy, Steve C Patterson, Amie Rose, Emily Kraft, Nichole Bosson","doi":"10.1080/10903127.2025.2540420","DOIUrl":"10.1080/10903127.2025.2540420","url":null,"abstract":"<p><p>Emergency Medical Services (EMS) clinicians may encounter trauma patients with major pelvic fractures from multiple mechanisms of injury. In-hospital evidence that stabilization of pelvic fractures leads to improved patient outcomes has been extrapolated to promote the use of pelvic stabilization interventions by EMS clinicians in the prehospital setting. However, there are significant challenges in accurately identifying pelvic fractures in the field, and the clinical benefit of prehospital pelvic stabilizing interventions with use of pelvic circumferential compression devices (PCCDs) is questionable. Therefore, NAEMSP conducted a structured review of the literature to develop evidence-guided recommendations for the prehospital management of suspected pelvic fractures.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-35"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744417","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":"Nebulized Nitroglycerin Improves Carotid Blood Flow During Cardiopulmonary Resuscitation in a Swine Model of Cardiac Arrest.","authors":"Christopher Kelly, Helen Palatinus, Russell Johnson, Taryn Hunt-Smith, Nicole Ewer, Laurence Saint-Pierre, Guillaume L Hoareau, M Austin Johnson, Scott T Youngquist","doi":"10.1080/10903127.2025.2537862","DOIUrl":"10.1080/10903127.2025.2537862","url":null,"abstract":"<p><strong>Objectives: </strong>Pulmonary vasodilators have shown promise in reducing pulmonary vascular resistance during CPR. Most are not currently available outside of an intensive care unit (ICU) setting. Nitroglycerin is widely used by emergency medical services to treat chest pain. If beneficial, the inhalation route of nitroglycerin administration could be implemented by basic life support personnel at the scene of a cardiac arrest. The aim of this investigation was to assess the hemodynamic effects of nebulized nitroglycerin (NIN) in a swine model of ventricular fibrillation (VF)-induced cardiac arrest.</p><p><strong>Methods: </strong>Seventeen Mixed breed Yorkshire swine (54 + 5 kg) were anesthetized. Ventricular fibrillation was then induced by connecting a 9-volt battery to a pacing catheter in the right ventricle. After 7 min of untreated VF, mechanical chest compressions were initiated. Three minutes later, mechanical ventilation was resumed at pre-arrest settings with 100% FiO2. Two minutes later, 5 mL of normal saline (NIS controls, <i>n</i> = 9) or with 10 mg of nitroglycerin (NIN treatment, <i>n</i> = 8) were randomly nebulized through a nebulizer in line with the respiratory circuit. After 4 min of nebulization, an intravenous dose of epinephrine (0.015 mg/kg) was administered, followed 2 min later by defibrillation. Standard advanced cardiac life support resuscitation was continued along with NIN or NIS until full delivery, and continued until return of spontaneous circulation or 40 min had elapsed since arrest. Data were analyzed using mixed effects models.</p><p><strong>Results: </strong>Prearrest arterial and right atrial pressures, chemistries and arterial blood gas values were similar between groups. There were no differences in systolic, diastolic, or coronary perfusion pressures. There was a statistically significant increase in carotid blood flow (CBF) following NIN. Before administering epinephrine, CBF in NIN-treated animals were approximately double those of NIS controls: 92.2 (95%CI 70.69-113.74) versus 41.96 (95% CI 22.28-61.63) mL/min, respectively, a mean difference of 50.26 mL/min (95% CI 24.91-75.61, <i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>Early nebulized nitroglycerin treatment resulted in superior CBF without decreasing systemic arterial pressures or coronary perfusion pressures in this model of cardiac arrest.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699346","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}