Prehospital Emergency Care最新文献

{"title":"Disparities of Aspirin Administration for Prehospital Chest Pain and ST Elevation Myocardial Infarctions.","authors":"Anna Maria Johnson, Hei Kit Chan, Renee Johnson, Anastasia S Papin, Daniel C Walter, N Clay Mann, Benjamin Fisher, Larissa Myaskovsky, Ryan M Huebinger","doi":"10.1080/10903127.2025.2473684","DOIUrl":"10.1080/10903127.2025.2473684","url":null,"abstract":"<p><strong>Objectives: </strong>Although disparities exist in aspirin administration for chest pain and ST elevation myocardial infarctions (STEMI), little is known about community-based disparities in aspirin administration for prehospital patients. We evaluated disparities in prehospital aspirin using a national prehospital database.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2018-2021 NEMSIS database linked to census data, including adult prehospital encounters. We created two cohorts: dispatch reason of chest pain and identified STEMI on prehospital EKG. We stratified patients based on majority ZIP Code race/ethnicity (>50% White, Black, and Hispanic) and into quartiles based on household income. Using multivariable logistic regression, we evaluated the association between incident community characteristics and aspirin administration.</p><p><strong>Results: </strong>We included 4,881,663 chest pain encounters and 184,610 STEMIs. Chest pain encounters in majority White communities (32.3%) received aspirin more often for chest pain than Black (22.1%; aOR 0.59, [0.59-0.60]) or Hispanic (24.8%; aOR 0.66, [0.66-0.67]) communities. Compared to the top income quartile (29.0%), the lowest income quartile had lower odds of aspirin administration (4th-27.6%; aOR 0.93, [0.92-0.94]). For STEMIs, adjusted odds of aspirin administration were higher for White (53.4%) than Black (52.5%; aOR 0.81, [0.78-0.84]) or Hispanic (53.6%; aOR 0.93, [0.89-0.96]) patients. Compared to the highest income quartile (55.0%), lower quartiles had lower odds of aspirin administration (2nd-54.2%; aOR 0.95, [0.92-0.97]; 3rd-52.9%; aOR 0.93, [0.91-0.96]; 4th-52.0%; aOR 0.86, [0.84-0.89]).</p><p><strong>Conclusions: </strong>Patients from Black, Hispanic/Latino, and lowest-income communities received aspirin for chest pain at a lower rate than white or high-income patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557792","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":"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":"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":"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":"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}

{"title":"Social Determinants of Health and Emergency Medical Services: A Scoping Review.","authors":"Susan J Burnett, Tessa Alianell, Owen Bitnun, Kathryn Ebersole, Bushra Nuruddin, Seth Butler, Stavros Lalos, Brian M Clemency","doi":"10.1080/10903127.2025.2468796","DOIUrl":"10.1080/10903127.2025.2468796","url":null,"abstract":"<p><strong>Objectives: </strong>Social determinants of health (SDOH) are the non-medical factors that affect people's health and quality of life. Emergency medical services (EMS) clinicians are in a unique position to recognize and respond to SDOH through their presence and responses in the communities they serve. The objective of this study was to generally explore the existing body of literature of SDOH within the context of EMS.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guided the analysis of peer-reviewed literature from PubMed, CINAHL, and Web of Science databases published between January 1960 and June 2024. Using Covidence software, titles and abstracts then, separately, full texts, were reviewed by two distinct researchers to include studies published in English that referenced SDOH and EMS. We later excluded articles that were published before 2010, when the SDOH term was made more popular by its inclusion in the <i>Healthy People</i> 2020 project. Reviewers then performed data extraction for qualitative analysis using a grounded theory approach.</p><p><strong>Results: </strong>Of the 1,503 records imported from the databases (PubMed <i>n</i> = 779, Web of Science <i>n</i> = 687, CINAHL <i>n</i> = 37), 1,164 unique manuscripts were screened, and 62 full texts were assessed for eligibility. Forty-two articles met inclusion criteria; 39 were EMS patient-centric and three were illustrative of EMS clinicians' SDOH, thus excluded from this analysis. Patient-related impact levels included individual characteristics, community characteristics, EMS clinicians' recognition of and response to SDOH, healthcare system factors, and social and cultural considerations. Articles were on the topic areas of medical conditions, EMS practice, trauma, pediatrics, and mental health. More than half (<i>n</i> = 24) of the manuscripts were from studies conducted in North America and a majority (<i>n</i> = 32) of the papers were published since 2020.</p><p><strong>Conclusions: </strong>Research in SDOH and their association with EMS is rapidly growing. A deeper understanding of how the EMS system and EMS clinicians affect, recognize, and manage patients' SDOH insecurities can improve efforts toward health equity and improve patients' health outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449571","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":"Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-Analysis.","authors":"Ian J Saldanha, Enid Chung Roemer, Edbert B Hsu, George S Everly, Genie Han, Allen Zhang, Ritu Sharma, Emmanuel Asenso, Drew Bidmead, Eric B Bass, J Lee Jenkins","doi":"10.1080/10903127.2025.2465715","DOIUrl":"10.1080/10903127.2025.2465715","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.</p><p><strong>Methods: </strong>We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).</p><p><strong>Results: </strong>We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.</p><p><strong>Conclusions: </strong>The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399795","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":"Paramedic-Administered Fibrinolysis in Older Patients with Prehospital ST-Segment Elevation Myocardial Infarction.","authors":"Tan N Doan, Robert Ley Greaves, Daniel Bodnar, Brendan V Schultz, Stephen Rashford","doi":"10.1080/10903127.2025.2467792","DOIUrl":"10.1080/10903127.2025.2467792","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency ambulance services are an essential component of rapid treatment of prehospital ST-segment elevation myocardial infarction (STEMI). The effectiveness and safety of prehospital fibrinolysis in older STEMI patients is unknown. This study investigated the effectiveness and safety of paramedic-administered prehospital fibrinolysis in STEMI patients ≥75 years of age who were identified by paramedics in Queensland, Australia.</p><p><strong>Methods: </strong>Included were STEMI patients ≥75 years of age who were identified by paramedics in Queensland (Australia), and received prehospital fibrinolysis with tenecteplase or did not receive this treatment due to age being the sole contraindication, between 2010 and 2023. Patient characteristics, outcomes, and safety profiles were compared between the two groups, as well as between patients receiving full-dose and half-dose of tenecteplase.</p><p><strong>Results: </strong>In total, 86 patients received prehospital fibrinolysis and 83 did not. Patients receiving prehospital fibrinolysis were slightly younger (median 77 vs 81 years, <i>p</i> < 0.001). There was no statistically significant difference in mortality rates at 24 h (risk difference [RD] prehospital fibrinolysis vs no prehospital fibrinolysis 2.1%, 95% confidence interval [CI] - 5.6 to 9.8%, <i>p</i> = 0.41), 30 days (RD -0.3%, 95% CI -9.6 to 9.0%, <i>p</i> = 0.58), and one year (RD -1.7%, 95% CI -12.1 to 8.7%, <i>p</i> = 0.46) between the two groups. There was no statistically significant difference in functional outcomes on discharge (RD for favorable functional outcome 8.8%, 95% CI -6.0 to 23.6%, <i>p</i> = 0.25). No intracranial or major non-intracranial hemorrhage was observed in the entire study sample. Patients receiving full-dose tenecteplase were younger, closer to a hospital capable of percutaneous coronary intervention, in metropolitan areas, and had shorter time from symptom onset to tenecteplase than those receiving half-dose.</p><p><strong>Conclusions: </strong>This study was the first that investigated the effectiveness and safety of paramedic-administered fibrinolysis in older patients with STEMI. No intracranial or major non-intracranial hemorrhage was recorded for the study sample. There was no association between prehospital fibrinolysis and mortality or functional outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415030","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}