Prehospital Emergency Care最新文献

{"title":"Rapid Discharge Following Air Transport in Children.","authors":"Vishal Naik, Pranshu Bhardwaj, Sriram Ramgopal","doi":"10.1080/10903127.2025.2531074","DOIUrl":"10.1080/10903127.2025.2531074","url":null,"abstract":"<p><strong>Objectives: </strong>Air transport can play a crucial role in the care of critically ill or injured children. Use of air emergency medical services (EMS) can be subject to both over- and undertriage, with prior work suggesting that some air transports in children may be unnecessary. Our objective was to evaluate the association of pediatric air transport with emergency department (ED) discharge and short (<48 h) hospitalization.</p><p><strong>Methods: </strong>We performed a multicenter retrospective study of children's hospitals participating in the Pediatric Emergency Care Applied Research Network Registry between 2012 and 2021, including encounters for children (<18 years) transported to the ED by air EMS. Our outcomes were (1) ED discharge and (2) hospitalization with short admission (length of stay <48 h). We evaluated clinical, demographic, and diagnostic factors associated with each outcome using multivariable logistic regression.</p><p><strong>Results: </strong>We included 7722 encounters [60.9% male, median age 5.9 years (IQR 1.9-12.3 years)]; with 35.8% having a trauma-related principal diagnosis (with 38.4% of reporting encounters based on ED and admission codes, and the remainder as ED diagnosis codes only). Overall, 1545 (20.0%) encounters were discharged from the ED. Among admitted patients (<i>n</i> = 6139), 3548 (57.8%) had a short admission. Discharge from the ED was associated with Black non-Hispanic race/ethnicity, other payer status relative to private payer status, and lower triage acuity relative to Emergency Severity Index (ESI) level 1. Certain traumatic, musculoskeletal, neurological, psychiatric, toxicologic, and gastrointestinal diagnoses were also associated with ED discharge. Conditions associated with lower odds of admission for <48 h included genital/reproductive diseases, toxicologic emergencies, brain/skull trauma, facial and dental trauma, contusions, otolaryngological diseases, neurological diseases, and psychiatric, behavioral, and substance abuse disorders.</p><p><strong>Conclusions: </strong>More than two-thirds of children transported to the ED by air are either discharged from the ED or within 48 h of admission. Race, ethnicity, payer status, low triage acuity, and missing vital sign information were associated with ED discharge. While this dataset lacks information on the rationale for initiating air transport, these findings emphasize the need for additional research into the decision-making processes surrounding pediatric air EMS to support optimal resource utilization and patient care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609181","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":"Emergency Medical Technicians Can Administer Nitrous Oxide for Effective Analgesia in an Urban Multi-Tiered EMS System.","authors":"Emiliano Costilla, Bradley Teasley, Xingpei Zhao, Daniel Schwerin, Mirinda Ann Gormley, Michael Troise, Martin Lutz, Matthew Cobb, Stella Self, Thomas Blackwell","doi":"10.1080/10903127.2025.2531546","DOIUrl":"10.1080/10903127.2025.2531546","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effectiveness of self-dosed nitrous oxide administration by emergency medical technicians (EMTs) in treating medical and traumatic pain in the prehospital setting, to quantify the incidence and type of adverse events associated with this intervention, and to identify characteristics associated with subjective improvement following prehospital pharmacologic analgesia.</p><p><strong>Methods: </strong>We performed a state-approved 365-day pilot study in which EMTs administered patient-dosed inhaled nitrous oxide (premixed 50% nitrous oxide and 50% oxygen) to patients in pain in the prehospital setting. We conducted a retrospective cohort analysis of all patients who received pain management following an abnormal pain assessment performed by an EMT. Using paired t-tests and multivariable logistic regression, we analyzed the qualified responses (improved, worsened, or unchanged) and quantified responses (ten-point pain scale) of patients with abnormal pain assessment findings to prehospital treatments.</p><p><strong>Results: </strong>Of the 165 patients who received nitrous oxide, 125 (75.76%) demonstrated an improved response and zero demonstrated a worsened response in the judgment of the attending EMT. Nitrous oxide reduced pain scores by 2.29 (<i>p</i> < 0.01) after five minutes and 2.46 (<i>p</i> < 0.01) at hospital. Two minor adverse events occurred (asymptomatic hypotension and dizziness). An EMT's categorization of a patient's response to nitrous oxide as \"unchanged\" predicted an 89% increase in the need for a paramedic response to the scene (<i>n</i> = 10). Paramedics administered parenteral analgesia to 11 patients, three of whom did not receive nitrous oxide.</p><p><strong>Conclusions: </strong>Nitrous oxide self-dosing, when supervised by trained EMTs, could effectively relieve pain in most out-of-hospital patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659995","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":"Distinguishing Subtypes of Unwitnessed Out-of-Hospital Cardiac Arrest by Estimated Last Seen Alive Time.","authors":"Sophia Snyder, Dalton Wesemann, Maja C Strusinska-Thayer, Jonathan Jui, Ritu Sahni, Shewit P Giovanni, Chris R Shaw, Mohamud R Daya, Joshua R Lupton","doi":"10.1080/10903127.2025.2522824","DOIUrl":"10.1080/10903127.2025.2522824","url":null,"abstract":"<p><strong>Objectives: </strong>Approximately one-half of all out-of-hospital cardiac arrests (OHCA) are unwitnessed and have a very low survival rate. Our objective was to assess if use of a bystander estimated last-seen-alive (ELSA) time could predict a subset of unwitnessed OHCA patients with outcomes resembling those with witnessed OHCA.</p><p><strong>Methods: </strong>This is a registry-based retrospective analysis of adults presenting with emergency medical services (EMS)-treated, non-traumatic OHCA from 2018 to 2023, in the Portland Cardiac Arrest Epidemiologic Registry. We excluded EMS-witnessed arrests, patients with do-not-resuscitate orders and records with incomplete data. Our primary outcome was survival with a favorable neurologic outcome at hospital discharge (Cerebral Performance Category score ≤2). We compared bystander witnessed arrests to unwitnessed arrests with ELSA times <5 min, 5-10 min, 10-15 min, ≥15 min, or unknown. ELSAs were abstracted from EMS charts using bystander estimates of when the patient was last seen, with values averaged if a range was given. We used multivariable mixed effects regression analysis to adjust for potential confounding variables. In the subset of patients where no-flow time (NFT) could be calculated, using the interval from estimated time of arrest (using ELSA and 9-1-1 call time) to initial EMS cardiopulmonary resuscitation, we performed propensity score matching by NFT and potential confounding variables.</p><p><strong>Results: </strong>There were 2067 bystander witnessed and 2755 unwitnessed patients meeting inclusion criteria. Patients with an unwitnessed arrest and an ELSA <5 min had similar adjusted favorable neurologic survival (absolute difference (95% confidence interval)) relative to witnessed arrests (-1.4%, (-6.9%, 4.2%)). Compared to witnessed arrests, neurologically favorable survival was significantly lower in unwitnessed arrests with ELSA 5-10 min (-5.3% (-9.5%, -1.2%)), 10-15 min (-6.8% ((-10.7%, -2.9%)), ≥15 min (-9.2% ((-12.7%, -5.7%))), or unknown (-5.2% ((-7.0%, -3.4%))). In our propensity matched group by NFT and covariates, there was no differences in favorable neurologic survival for unwitnessed arrests (11.4%) and bystander witnessed arrests (10.0%, <i>p</i> = 0.785).</p><p><strong>Conclusions: </strong>OHCA patients with unwitnessed arrests with an ELSA under 5 min or using ELSA to match by NFT displayed similar neurologically favorable survival as witnessed arrests. These findings suggest that the use of ELSA may help better characterize unwitnessed OHCAs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EMS Agency Characteristics Associated with Documentation of Prehospital Stroke Scale and Blood Glucose Level.","authors":"Anjali J Misra, Scott A Goldberg, Kori S Zachrison, Remle P Crowe, Rebecca E Cash","doi":"10.1080/10903127.2025.2528114","DOIUrl":"10.1080/10903127.2025.2528114","url":null,"abstract":"<p><strong>Objectives: </strong>Reasons for emergency medical services (EMS) agency-level variation in prehospital stroke care are poorly understood. Our objective was to identify EMS agency characteristics associated with low-, average-, and high performance for documentation of prehospital stroke scale and blood glucose to inform strategies for improving prehospital stroke care.</p><p><strong>Methods: </strong>This was a retrospective evaluation of EMS activations for patients with suspected stroke/transient ischemic attack (TIA) in the 2019 ESO Data Collaborative, a de-identified dataset of ∼8.3 million EMS activations from 1,200+ agencies who voluntarily agree to include their data for research and benchmarking. We included agencies that provided ≥10 9-1-1 responses with a field impression of stroke/TIA excluding basic life support agencies and those only responding to acute care facilities (i.e., freestanding or hospital emergency department). Agencies were categorized by mean rates of stroke scale and blood glucose documentation. Low, average, and high performance were defined as the 1st, 2nd-9th, and 10th deciles, respectively. Multinomial logistic regression models were used to calculate relative risk ratios (RRR) to compare agency characteristics (including patient demographics, agency type, and service type) between the three performance groups.</p><p><strong>Results: </strong>We analyzed 862 EMS agencies (21.6% fire department-based, 65.1% non-volunteer, 93.6% primarily providing 9-1-1 response). The mean agency-level rates by low-, average- and high-performers were 4.9% (SD 6.1%), 69.0% (SD 26.6%), and 99.6% (SD 0.6%) respectively for stroke scale, and 61.7% (SD 10.6%), 87.6% (SD 6.0%), and 98.7% (SD 1.6%) for blood glucose. There were no significant associations between agency characteristics and rates of stroke scale documentation. For blood glucose, agency characteristics associated with better performance were higher rates of urban encounters and non-volunteer providers (urban: RRR for low performance 0.53, 95% CI 0.33-0.85; non-volunteer: RRR for low performance 0.52, 95% CI 0.32-0.84).</p><p><strong>Conclusions: </strong>The wide agency-level variation in rates of stroke scale and blood glucose documentation indicates an opportunity to better standardize care. Better understanding strategies of high performers and barriers for low performers is key to designing interventions to ensure all stroke patients receive evidence-based, guideline-concordant prehospital care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592023","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 ImageTrend Collaborate as a National EMS Dataset: A Cross-Sectional Comparison with the National EMS Information System.","authors":"Alexander J Ulintz, Christopher B Gage, Jonathan R Powell, Jacob C Kamholz, Rebecca E Cash, Henry E Wang, Ashish R Panchal","doi":"10.1080/10903127.2025.2526160","DOIUrl":"10.1080/10903127.2025.2526160","url":null,"abstract":"<p><strong>Objectives: </strong>ImageTrend Collaborate (ITC) is a new dataset of emergency medical services (EMS) patient care events. While offering a new option for prehospital research, it is unclear if ITC data accurately reflects EMS event characteristics across the United States. Our objective was to assess the national representativeness of the ITC dataset.</p><p><strong>Methods: </strong>We performed a cross-sectional study comparing the 2022 ITC with the 2022 National EMS Information System (NEMSIS) research dataset, a federally funded national EMS data repository. We compared 9-1-1 EMS activations across call (e.g., agency level of service, urbanicity, census region), patient (e.g., age category, sex, dispatch complaint, response time, primary symptom, primary impression), and intervention (e.g., procedures) characteristics. We quantified absolute proportional differences (PD, ITC% - NEMSIS%) with 95% confidence intervals (CI) and standardized mean differences (SMD) to evaluate the effect size of observed differences.</p><p><strong>Results: </strong>We included 9,592,122 EMS events in ITC and 41,997,730 in NEMSIS. ImageTrend Collaborate included a higher proportion of fire-based agencies (PD 8.2, SMD 0.16) and Advanced Emergency Medical Technicians (PD 2.1, SMD 0.12) and lower proportion of volunteer agencies (PD -1.4, SMD -0.12). Census Region differences included West (PD 13.9, SMD 0.31), Northeast (PD -11.0, SMD -0.33), and Midwest (PD -5.2, SMD -0.14). Age, sex, dispatch complaint, and primary impression had absolute proportional differences less than 1.0% with SMD less than 0.10 (i.e., negligible) except for \"sick person\" dispatch (PD -3.0, SMD -0.08) and \"other general\" primary symptom (PD -1.5, SMD -0.11). Median response times were identical in both databases. The most common procedures were similar between the datasets, but differed in proportion, including: catheterization of vein (PD -4.8, SMD -0.12), 12 lead electrocardiogram (PD -7.9, SMD -0.22), and evaluation procedure (PD -3.8, SMD -0.15).</p><p><strong>Conclusions: </strong>ImageTrend Collaborate reflects most national EMS call, patient, and intervention characteristics. Notable and expected differences between ITC and NEMSIS include fire-based agency and census region representation, likely due to self-selection; however, differences in procedures may reflect tradeoffs between granularity of a single vendor dataset versus an aggregated national dataset. Prehospital researchers should understand the characteristics of the ITC dataset to ensure proper use and analysis.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584648","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 Diagnosis of Acute ST-Elevation Myocardial Infarction in a Patient with Situs Inversus Totalis.","authors":"Victoria Gordon, Jason Jones, Brad Ward, Casey Patrick","doi":"10.1080/10903127.2025.2506183","DOIUrl":"10.1080/10903127.2025.2506183","url":null,"abstract":"<p><p>We report a case of a 50-year-old male who presented to emergency medical services (EMS) with acute chest pain, pallor, and diaphoresis. A prehospital diagnosis of ST-elevation myocardial infarction (STEMI) was made following electrocardiogram (ECG) lead reversal by the paramedics secondary to a reported history of situs inversus totalis, a congenital condition with complete reversal or mirroring of the thoraco-abdominal visceral organs. Paramedics initiated a STEMI alert to the emergency department (ED) from the scene, and the patient underwent emergent cardiac catheterization following transport to the hospital. A stent was placed in the left coronary artery, and the patient's symptoms resolved. He was discharged on hospital day three with no complications. This case highlights the need for prehospital clinicians to recognize and adapt when encountering rare conditions like dextrocardia and situs inversus.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102434","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":"Correction.","authors":"","doi":"10.1080/10903127.2025.2527014","DOIUrl":"https://doi.org/10.1080/10903127.2025.2527014","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659920","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":"Inter-Rater Reliability and Acceptability of a Clinical Prediction Rule for Opioid-Associated Out-of-Hospital Cardiac Arrest.","authors":"David G Dillon, Colleen Kellison, Juan Carlos C Montoy, Joanna Sokol, Ralph C Wang, Robert M Rodriguez","doi":"10.1080/10903127.2025.2523986","DOIUrl":"10.1080/10903127.2025.2523986","url":null,"abstract":"<p><strong>Objectives: </strong>One-in-six cases of atraumatic out-of-hospital cardiac arrest (OHCA) in North America are thought to be precipitated by opioid overdose, but many of these cases are not obvious and there is no gold standard used by emergency medical service (EMS) personnel to identify opioid-associated (OA)-OHCA. The NAloxone Cardiac ARrest Decision Instrument (NACARDI) was developed and validated to identify potential OA-OHCA, however it has not yet been used in the field. We sought to prospectively assess the inter-rater reliability and acceptability of NACARDI in real-world OHCA.</p><p><strong>Methods: </strong>Emergency medical service clinicians evaluated the NACARDI criteria during acute resuscitations of patients with OHCA in San Francisco between September 2022-February 2024. The NACARDI rule utilized in this study consisted of two criteria: patient age <60 years and unwitnessed cardiac arrest. Clinicians completed a short survey that included free-text questions, multiple choice question, and Likert-type scales rating NACARDI's ease of use, describing when during the resuscitation they were able to assess NACARDI, and identifying potential barriers. In cases where two clinicians completed NARCADI assessments for a single OHCA case, we calculated a kappa coefficient of agreement.</p><p><strong>Results: </strong>Emergency medical service clinicians evaluated 149 cases of OHCA and completed 198 surveys - 100 (67.1%) cases had one survey response and 49 (32.9%) had survey responses from two EMS personnel. Clinicians were able to ascertain NACARDI criteria \"prior to or during the first cardiac rhythm check\" in 80.3% of cases. NACARDI was reported as \"easy to use\" by 83.3% of respondents. The overall Kappa coefficient for NACARDI was 0.73 (95%CI 0.51-0.95). The three most common reasons why NACARDI criteria were deemed difficult to ascertain were chaotic scene, language barrier, and unreliable bystander accounts.</p><p><strong>Conclusions: </strong>There was reasonable agreement in how NACARDI was interpreted for OHCA cases and the majority of surveyed EMS clinicians found NACARDI easy to use. These findings suggest that NACARDI can be reliably and easily used by EMS clinicians during acute OHCA resuscitations to identify OA-OHCA patients, potentially informing inclusion criteria for future research studies and guiding targeted interventions for this patient population.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12252226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

{"title":"Barriers to Implementing Evidence-Based Guidance for Fatigue Risk Mitigation in the Prehospital Setting.","authors":"P Daniel Patterson, Jennifer Brailsford, Jennifer Fishe, David G L Roach, Mark A Sheffield, Rachel A Lukacz, Richard N Thomas, Molly C Appio, Sarah E Martin, Christian Martin-Gill","doi":"10.1080/10903127.2025.2527365","DOIUrl":"10.1080/10903127.2025.2527365","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this research study was to capture knowledge and awareness, beliefs and behaviors related to, and perceived barriers to adopting, implementing, and maintaining evidence-based guidance as outlined in the 2018 emergency medical services (EMS) evidence-based guidelines (EBG) for fatigue risk management (FRM) and the American Academy of Sleep Medicine/Sleep Research Society's (AASM/SRS) Guiding Principles for determining shift duration.</p><p><strong>Methods: </strong>We used a mixed methods study design with in-depth interviews based on the Theoretical Domains Framework (TDF) for behavior change. Sampling was nationwide and stratified by rural/urban status with goal enrollment of 40 EMS agency administrators (employers) and 100 frontline EMS clinicians (employees). We used deductive coding to assign participant statements to established domains and constructs of the TDF.</p><p><strong>Results: </strong>Thirty-six employer and 100 employee in-depth interviews were completed. Most employers represented a fire-based or third-service agency (64%), employed all-paid personnel (58%), and provided mostly ground-based services (92%). Most employees were paramedic, firefighter-paramedic, or firefighter emergency medical technician (EMT) certified (85%) with 3.8 median years of experience (IQR 2, 7). Most employers (61%) and employees (85%) reported no awareness of the existence of EBGs focused on fatigue. Once informed of the guidance, most employers (78%) and most employees (65%) responded that they \"<i>very much want to</i>\" or \"<i>somewhat want to</i>\" adopt some or all the guidance and recommendations. Most employers (67%) and employees (61%) reported they \"<i>very much needed to</i>\" or \"<i>somewhat needed to</i>\" adopt and implement the existing guidance. Participants identified common barriers to adoption as: lack of awareness and knowledge, a perceived misalignment of some recommendations with expectations, fear of negative emotional reactions in response to changing shift schedules, costs associated with adoption, and fear of disrupting the status quo.</p><p><strong>Conclusions: </strong>While most EMS employers and employees reported the need to adopt EBGs for fatigue mitigation, barriers identified in this study impede adoption and implementation. Overcoming these impediments should include increasing awareness of fatigue EBGs and related guidance, however, increasing awareness alone may not result in a meaningful increase in adoption and implementation. Novel strategies targeting barriers identified in this study are needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}