Prehospital Emergency Care最新文献

{"title":"Medical Management of Aortic Emergencies in Critical Care Transport.","authors":"Nicholas H George, Francis X Guyette, Sriram Ramgopal, Nathan L Liang, Christian Martin-Gill","doi":"10.1080/10903127.2026.2728128","DOIUrl":"https://doi.org/10.1080/10903127.2026.2728128","url":null,"abstract":"<p><strong>Objectives: </strong>Aortic emergencies (e.g., dissection or aneurysm; AE) are life-threatening events commonly encountered in critical care transport. Guidelines recommend beta-blockers to control heart rate (HR), with calcium channel blockers added for systolic blood pressure (SBP) control or as an alternative. There is little human data to support either strategy or to document adverse events. We aimed to determine the frequency with which medications commonly used to treat AE reach guideline-recommended hemodynamic targets and characterize adverse events during critical care transport (CCT).</p><p><strong>Methods: </strong>We performed an observational study design and retrospective cohort analysis of patients ≥18 years old with an AE undergoing CCT between 2003-2024. We included patients who received esmolol, nicardipine, labetalol, or combinations. We evaluated the primary outcome of target HR (60-80 bpm) or SBP (90-120 mmHg) with multivariable logistic regression controlling for age, sex, weight, year, and prior vasoactive medications. Secondary outcomes included hypotension (SBP <90 mmHg), bradycardia (HR <50 bpm), tachycardia (HR >100 bpm), and vasopressor support or cardiac arrest.</p><p><strong>Results: </strong>We included 1,530 AE encounters, of which 792 (51.8%) received nicardipine, 236 (15.4%) esmolol, 194 (12.7%) labetalol, 163 (10.7%) esmolol and nicardipine, and 145 (9.5%) labetalol and nicardipine. Compared to esmolol alone, all other treatment strategies had a similar likelihood of achieving target HR or SBP goals. Patients receiving labetalol alone had the lowest incidence of hypotension (2.1% [0.1-4.1%]) and combined esmolol/nicardipine had the lowest incidence of tachycardia (11.0% [6.2-15.9%]). Esmolol compared to nicardipine alone had similar rates of tachycardia (19.1% [14.1-24.1%] versus 25.3% [22.2-28.3%], respectively), while esmolol had the highest incidence of hypotension (9.3% [5.6-13.0%]).</p><p><strong>Conclusions: </strong>We observed a similar odds of achieving HR and SBP targets regardless of medication used in a large sample of patients with aortic emergencies. While a combination of beta and calcium channel blockers may be optimal medical therapy, treatment with esmolol, labetalol, or nicardipine as single agents may be reasonable to achieve HR and SBP goals.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983348","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 Whole Blood Transfusion During Medically Directed Rescue of an Entrapped Trauma Patient: A Case Report.","authors":"Kelsey Wilhelm, Jonathan Warren, Saman Kashani, Clayton Kazan, Craig Goolsby, George Singer, Sylvia Alexander, Molly Deane, Brant Putnam, Rachel Rangwala, Enitan Banjo, Nichole Bosson","doi":"10.1080/10903127.2026.2727591","DOIUrl":"https://doi.org/10.1080/10903127.2026.2727591","url":null,"abstract":"<p><p>Prehospital blood programs and Hospital Emergency Response Teams (HERT) have independently emerged to address critical gaps in early trauma care, particularly when rapid transport is not feasible. We describe a case demonstrating coordinated use of these capabilities during a prolonged and complex medically directed rescue. A multi-agency response, involving a fire-based paramedic unit with prehospital blood capability, an Urban Search and Rescue (US&R) team, and a HERT for physician-level on scene care, managed an entrapped patient following a major motor vehicle collision. Prolonged extrication necessitated extended field care, including advanced airway management, finger thoracostomies, and multiple units of O-positive low-titer group O whole blood (O-positive LTOWB) to treat hemorrhagic shock in the prehospital setting . This case demonstrates that coordinated integration of prehospital blood programs can enhance medically directed rescues of patients with prolonged entrapment. Notably, the blood units deployed with the HERT were supplied through the regional prehospital blood transfusion program and redistributed to the trauma center prior to the response, demonstrating bidirectional integration of blood resources across prehospital and hospital systems.</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":"148983383","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":"Identifying Quality Indicators for Prehospital Care Following Out-of-Hospital Cardiac Arrest: A Focused Scoping Review.","authors":"Petrus Malherbe, Eric Bustos, Will Dunn, Lindsey Cella, Lara Rappaport","doi":"10.1080/10903127.2026.2719960","DOIUrl":"10.1080/10903127.2026.2719960","url":null,"abstract":"<p><strong>Objectives: </strong>Out-of-hospital cardiac arrest (OHCA) has a high rate of mortality. While prehospital management of OHCA is well described, post-return of spontaneous circulation (ROSC) care in the prehospital setting is often based on in-hospital care and broadly lacks evidence-based prehospital-specific recommendations. Additionally, there are no formal standardized quality indicators to benchmark post-ROSC care in the prehospital setting. This study served to systematically identify and appraise post-ROSC documents to synthesize a set of potential quality indicators to inform the survey of a multi-stage Delphi consensus for national quality indicators for prehospital care after OHCA.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across various databases for quality indicators and recommendations for prehospital care for post-ROSC following OHCA. Two reviewers performed title and abstract screening, full-text review, and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) independently and in duplicate. Identified quality indicators and recommendations were extracted as potential quality indicators and categorized into functional domains by the research team.</p><p><strong>Results: </strong>The search yielded 337 initial records, of which 87 underwent full-text review, and 46 studies met the <i>a priori</i> inclusion criteria. Studies from over 17 different countries were identified, of which the United States published the majority (<i>n</i> = 13). Randomized control trials represented the largest portion of the included studies (<i>n</i> = 18). The majority of study settings were in-hospital. Only five of the included studies made formal recommendations, and only two listed quality indicators. A total of 36 underwent appraisal with MMAT, of which the overall quality was generally high. A total of 16 potential quality indicators were extracted from the included studies and were grouped into five different domains.</p><p><strong>Conclusions: </strong>This focused scoping review highlights a lack of specific prehospital post-ROSC benchmarks and quality indicators. The identified potential quality indicators provide a foundational framework for a Delphi process for expert consensus on specific and measurable quality indicators. These indicators aim to standardize prehospital post-ROSC care for OHCA for national datasets like the Cardiac Arrest Registry to Enhance Survival.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797302","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":"Public Acceptance, Trust, and Self-Efficacy Related to Drone-Assisted Emergency Medical Response in Louisiana.","authors":"Benjamin A Swig","doi":"10.1080/10903127.2026.2724534","DOIUrl":"10.1080/10903127.2026.2724534","url":null,"abstract":"<p><strong>Objectives: </strong>Drones can deliver automated external defibrillators and other emergency supplies to bystanders before an ambulance arrives, but their public-health value depends on whether the public accepts, trusts, and feels able to use them. This study examined public acceptance of drone-assisted emergency medical response in Louisiana, including trust in drone systems and self-efficacy for using drone-delivered medical supplies, and identified demographic, experiential, and attitudinal predictors of acceptance, trust, and self-efficacy among Louisiana adults.</p><p><strong>Methods: </strong>Cross-sectional, observational online survey of 586 Louisiana adults recruited through the Dynata panel and administered <i>via</i> the Research Electronic Data Capture platform. Participants reviewed a standardized educational sequence describing a drone-assisted emergency response scenario before completing validated composite measures of acceptance, trust, and self-efficacy (Cronbach's alpha = .89-.91). Descriptive statistics, independent-samples t tests, paired-samples t tests, one-way analyses of variance, Pearson correlations, hierarchical multiple regression, and thematic analysis of open-ended responses were conducted.</p><p><strong>Results: </strong>Overall attitudes were favorable: mean acceptance 4.1 (standard deviation [SD] = 1.0), trust 3.8 (SD = 1.0), and self-efficacy 4.0 (SD = 0.9). Trust and self-efficacy were the strongest predictors of acceptance (R² = .57), and trust was the strongest predictor of self-efficacy, indicating that modifiable attitudinal factors, rather than fixed demographic characteristics, drive adoption. Telecommunicator guidance increased self-efficacy versus independent action for both family members and strangers (Cohen's <i>d</i> = 0.41-0.44, <i>p</i> < .001), with no difference by recipient type. Younger and Black or African American respondents reported lower acceptance and self-efficacy. Concerns centered on reliability, navigation accuracy, and user competency; confidence was associated with demonstrated reliability, normalization, telecommunicator support, and training.</p><p><strong>Conclusions: </strong>Public acceptance is driven primarily by trust and self-efficacy, modifiable factors amenable to targeted implementation. Programs emphasizing operational reliability, telecommunicator integration, public education, and clear user guidance may accelerate adoption. These findings suggest that equity-focused outreach by emergency medical services agencies and public health partners, particularly toward younger adults and Black or African American respondents, who reported lower acceptance and self-efficacy, may help narrow demographic gaps in the public's readiness to use drone-assisted emergency response.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831991","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":"Harm Reduction on Campus: A National Survey of Collegiate-Based EMS Agencies.","authors":"Patryk A Dabek, Tenzin Dhondup, Felix J Fein, Ava Ospina, Laura Hanson, Gail D'Onofrio, Katherine Couturier, David Yang, Robert Heimer","doi":"10.1080/10903127.2026.2724039","DOIUrl":"10.1080/10903127.2026.2724039","url":null,"abstract":"<p><strong>Objectives: </strong>While collegiate-based emergency medical services (CBEMS) agencies have traditionally been focused on acute emergency response, their integration within student life uniquely positions them to support public health initiatives and prevent emergencies. The purpose of this study was to explore the current role of CBEMS agencies in substance use harm reduction efforts and identify the strategies and barriers that impact implementation.</p><p><strong>Methods: </strong>We conducted an observational study with a cross-sectional online survey of CBEMS agency leaders using the National Collegiate Emergency Medical Services Foundation database. Eligible agencies demonstrated recent operational activity; those agencies outside the continental United States were excluded. The survey was distributed between May 16 and September 12, 2024 with two follow-up reminders. Quantitative data were analyzed descriptively, and qualitative responses underwent inductive thematic analysis.</p><p><strong>Results: </strong>The survey achieved a 33% response rate (41/124). Among respondents, 93% stocked naloxone for emergency overdose response, 46% offered public naloxone education, and 7% distributed fentanyl test strips. Additionally, 85% offered cardiopulmonary resuscitation (CPR) training to the public. Qualitative analysis identified three primary barriers to program implementation: (1) Institutional and Policy Barriers, referring to policies and administrative inefficiencies that delay program approval; (2) Challenges in Community Engagement and Coordination and (3) Resource Constraints.</p><p><strong>Conclusions: </strong>Despite heterogeneity in operational structures, respondents demonstrated readiness for opioid overdose reversal, with naloxone stocked in nearly all agency gear bags, and established educational outreach including public CPR training and naloxone education. However, adoption of broader harm reduction strategies remained limited. Systemic barriers limited expansion of harm reduction programming. Coordinated institutional investment and standardized implementation are needed to enhance CBEMS-led CPR education and overdose preparedness.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813862","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":"Predicting the Prehospital Blood Transfusion Need in a Large Metropolitan Center.","authors":"Jonathan Warren, Juliana Tolles, Jake Toy, Nichole Bosson, Brant Putnam, Rachel Rangwala, Kelsey Wilhelm","doi":"10.1080/10903127.2026.2723329","DOIUrl":"10.1080/10903127.2026.2723329","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital blood transfusion (PHBT) has been associated with reduced mortality for trauma patients in hemorrhagic shock. However, there are currently no standardized prehospital criteria to identify patients who may benefit from PHBT. We designed this study to assess the positive predictive value (PPV) of a set of PHBT criteria to identify patients requiring emergent transfusion within four hours of emergency department (ED) arrival.</p><p><strong>Methods: </strong>We conducted an observational retrospective cohort study of all trauma patients ≥ 15 years-old who were transported by emergency medical services (EMS) between November 1st, 2021 and September 30th, 2023 to a trauma center prior to the implementation of PHBT protocols in LAC. We retrospectively applied the PHBT criteria: systolic blood pressure (SBP) < 70 mmHg, a simultaneous reading of SBP < 90 mmHg and heart rate (HR) ≥ 110 beats per minute (BPM), or EMS-witnessed traumatic arrest. We excluded patients with cardiac arrest prior to EMS arrival, isolated head injury, or ground-level fall as the only mechanism of injury. Our primary outcome was the PPV of the PHBT criteria as a whole as well as each individual PHBT criterion for emergent transfusion need, which we defined as the proportion of trauma patients requiring in-hospital transfusion within four hours of ED arrival.</p><p><strong>Results: </strong>Of the 25,473 trauma patients, 905 met one or more PHBT criterion with no exclusion. These patients were primarily male (76%, <i>n</i> = 688) with a median age of 35 (IQR 27-47) and most suffered blunt trauma (68%, <i>n</i> = 618). Overall, 475 (52%) received blood within four hours of hospital arrival. The PHBT criterion of SBP < 90 mmHg and HR ≥ 110 BPM was found to have the highest PPV (56%, 95% CI 52-60%) for in-hospital transfusion within four hours. PPV for the other PHBT criteria ranged between 51-53%.</p><p><strong>Conclusions: </strong>The PHBT criteria of SBP < 90 mmHg and HR ≥ 110 bpm had the greatest PPV for transfusion within four hours of ED arrival. This information may be used to further optimize criteria for PHBT and identify patients most likely to benefit.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888123","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":"Documentation of Weight in Pediatric 9-1-1 Responses with Administration of Weight-Based Medications.","authors":"Susan J Burnett, Baruch Schwartz, Amy M Eisenhauer, Sara Moore, Jonathan R Powell, Macall Leslie Salewon, Brian M Clemency","doi":"10.1080/10903127.2026.2719957","DOIUrl":"10.1080/10903127.2026.2719957","url":null,"abstract":"<p><strong>Objectives: </strong>Determining a child's weight is a critical first step in administering the appropriate dose of a medication in an emergency. The National Emergency Medical Services Quality Alliance (NEMSQA) patient safety process measure, \"Pediatrics-03b,\" calls for weight documentation in kilograms or length-based weight estimate for pediatric patients who receive weight-based medications in the prehospital setting. To date, no publication has identified compliance with this measure at a national level. The goal of this study was to describe weight documentation in pediatric 9-1-1 responses and factors associated with this quality measure.</p><p><strong>Methods: </strong>Using the ImageTrend Collaborate 2024 national dataset, we analyzed 9-1-1 responses for pediatric patients (<18 years of age) who received medication by EMS clinicians consistent with the Pediatrics-03b definition denominator. Weight documentation was obtained from eExam01 and eExam02 National EMS Information System fields. Differences in weight documentation were assessed by patient demographics, unit, and scene characteristics. Furthermore, medication type and administration routes were examined. Statistical analyses included chi-square tests for comparison of proportions and population averaged univariable logit regression models for the binary outcome of weight documentation with clustering for state.</p><p><strong>Results: </strong>Overall, 57,378 responses met inclusion criteria, and 41,963 (73.1%) had a documented weight. Weights were less likely to be documented in cases involving adolescent (age 13-17) patients (Odds Ratio [OR]: 0.87, 95% Confidence Interval [95% CI]: 0.75-0.99), patients described as Black (OR: 0.72, 95% CI: 0.61-0.85), or those with lower acuity (OR: 0.59, 95% CI: 0.50-0.71). Weights were more likely to be documented in cases managed by advanced life support units (OR: 2.02, 95% CI: 1.31-3.11) and in patients described as male (OR: 1.08, 95%: 1.03-1.14).</p><p><strong>Conclusions: </strong>Three quarters of 9-1-1 responses meeting the Pediatrics-03b case definition were compliant with the measure. Future studies should be focused on evaluating the case definition for the measure to determine how to best evaluate and improve care in this domain. Establishing a benchmark, evaluating that benchmark, and understanding barriers to optimal implementation are critical to improving prehospital care and documentation of pediatric patients by EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813803","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":"Rate of Future Hemolytic Disease of the Fetus and Newborn Following the Prehospital Transfusion of RhD-Positive Blood Products to Females of Childbearing Potential in the United States of America.","authors":"Mark H Yazer, Casey Vieni, Jansen N Seheult","doi":"10.1080/10903127.2026.2725214","DOIUrl":"10.1080/10903127.2026.2725214","url":null,"abstract":"<p><strong>Objectives: </strong>Transfusing females of childbearing potential (FCP) in hemorrhagic shock with RhD-positive blood products risks inducing the formation of anti-D that can cause hemolytic disease of the fetus and newborn (HDFN) in future pregnancies. A previous study found that 957 FCPs were transfused with RhD-positive blood products over approximately 5-years in the United States (U.S.) in the prehospital phase of their resuscitation. This study used an <i>in silico</i> simulation to calculate the rate of future HDFN amongst these 957 transfused FCPs.</p><p><strong>Methods: </strong>A model that calculated the overall risk of any severity of HDFN was updated with the most current nativity data in the U.S. population. The model first simulated 1,000 FCPs of unknown RhD type at each age between 12-50 years to determine their age-specific rate of future HDFN. This model was instantiated 500 times representing a total of 19.5 million simulated FCPs. The model then used the IQR of the median ages of the 957 transfused FCPs, stratified by U.S. geographic region, to simulate the future HDFN outcomes of these FCPs. This model was instantiated 500 times representing approximately 2,500 years.</p><p><strong>Results: </strong>The maximum rate of HDFN for FCPs of unknown RhD type was approximately 0.8% and occurred when the FCPs were between ages 18-20 years. The risk of future HDFN for the 957 RhD-type unknown transfused FCPs ranged from 0.214% (Northeast) to 0.294% (South) per year. Over this 2,500 year simulation a total of 1,368 HDFN cases were calculated to occur (0.55 per year). The number of prehospital transfused FCPs was not equal between the geographic regions and ranged between 29 (Northeast) to 710 (South) every 5-years. Thus, based on the historical trends in these four geographic regions, one case of HDFN would be expected to occur every approximately 2.4- to 80.7-years depending on the geographic region.</p><p><strong>Conclusions: </strong>Due to the generally advanced maternal age of the 957 transfused FCPs and their low probability of being RhD-negative, the risk of future HDFN because of urgent prehospital RhD-positive transfusion is low.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850905","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":"Between Hemorrhage and Harm: Complications of the Abdominal Aortic and Junctional Tourniquet-Stabilized.","authors":"Grant Gerstner, Julie Rizzo, Charles Kieffer, Joshua Lowe","doi":"10.1080/10903127.2026.2725890","DOIUrl":"10.1080/10903127.2026.2725890","url":null,"abstract":"<p><p>Hemorrhage is a leading cause of preventable death after trauma, with direct pressure, appropriate tourniquet application, and volume resuscitation established as principles of hemorrhage management. In recent years, several junctional tourniquet devices have been proposed as adjuncts for groin and axillary hemorrhage control, including the Abdominal Aortic Junctional Tourniquet-Stabilized (AAJT-S), which has been marketed for non-compressible torso hemorrhage. To date, evidence supporting its use has been primarily limited to studies on cadavers, porcine models, healthy human subjects, and a few case reports. We present the case of a young adult male with multiple gunshot wounds to the pelvis and lower extremities who presented to a level I trauma center with an AAJT-S in place. Device removal in the trauma bay was followed by cardiac arrest and subsequent complications to include metabolic acidosis, compartment syndrome, rhabdomyolysis, renal and liver infarcts, pulmonary emboli, and stroke. This case highlights the potential harm of the device. We review and contrast these outcomes with the limited available literature and present our recommendation for future evaluation and caution with application of this device.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850871","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":"RhD-Positive Transfusion in Females of Childbearing Potential in Hemorrhagic Shock: Risk, Reality, and Policy.","authors":"Thomas O Murphy, Philip C Spinella, Pampee P Young, Stephen P Emery, Riin Kullaste, Christine M Leeper, Courtney K Hopkins, Molly R Sherwood, Daíse E Müller, Sarah Horvath, Joanne Pink, Mark H Yazer","doi":"10.1080/10903127.2026.2701877","DOIUrl":"10.1080/10903127.2026.2701877","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital transfusion using Rh-D antigen positive low-titer group O whole blood (LTOWB) or red blood cells is increasingly common when RhD-negative blood products are not available. However, concerns remain regarding D-alloimmunization in RhD-negative females of childbearing potential (FCPs), which could lead to future hemolytic disease of the fetus and newborn (HDFN). The magnitude of these risks, and their policy implications, have been the subject of recent investigation. The objectives of this review are to summarize the biological and epidemiological impacts and post-exposure management of RhD-positive transfusion in FCPs in hemorrhagic shock.</p><p><strong>Methods: </strong>This narrative review synthesizes the literature on the rate of D-alloimmunization, describes the results of modeling studies on the risk of HDFN following RhD-positive transfusion to FCPs, and examines epidemiologic studies estimating the HDFN risk at local, regional, and national levels. The D-alloimmunization risk mitigation strategies and current clinical guidelines are also reviewed.</p><p><strong>Results: </strong>Several factors, including the low prevalence of RhD-negative individuals, the low rate of D-alloimmunization itself, potentially reduced pregnancy rates post-trauma, and advances in modern perinatal care decrease the overall risk of HDFN following the transfusion of RhD-positive blood products to FCPs in trauma. Some modeling studies estimated that fetal death due to anti-D-mediated HDFN would occur in fewer than 0.1% of FCPs exposed to RhD-positive blood products. Timely prehospital transfusion has demonstrated survival benefits for injured adults and children. National and regional epidemiological studies support the safety and utility of RhD-positive blood product use in emergency settings. Risk mitigation strategies include Rh immune globulin (RhIg) administration and structured post-exposure follow-up to detect alloimmunization and reduce potential future pregnancy harm.</p><p><strong>Conclusions: </strong>RhD-positive transfusion in FCPs during hemorrhagic shock when RhD-negative products are not available is supported by current evidence and ethical considerations. The risk of future HDFN is low and favorable perinatal outcomes can be achieved when the woman has access to modern prenatal health care. Risk may be further mitigated through post-exposure protocols. Prehospital transfusion policies should reflect this risk-benefit balance by enabling access to RhD-positive blood products for all trauma patients, including FCPs, if RhD-negative blood products are not available.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437550","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}