Prehospital Emergency Care最新文献

{"title":"Predicting Prehospital Blood Transfusion After Motor Vehicle Trauma.","authors":"Amanda Pope, Jonathan Zadra, Kent Page, Benjamin Fisher, Jonathan Race, N Clay Mann","doi":"10.1080/10903127.2026.2713132","DOIUrl":"10.1080/10903127.2026.2713132","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital blood transfusion (PHBT) improves outcomes among patients with traumatic hemorrhagic shock, yet the epidemiology and geographic distribution of patients likely to require PHBT remain poorly characterized. We sought to develop predictive models for PHBT among motor vehicle crash (MVC) patients using National Emergency Medical Services Information System (NEMSIS) data and to estimate the national distribution of patients with a high predicted probability of receiving PHBT.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2024 and 2025 NEMSIS data. Eligible encounters included 9-1-1 EMS responses for MVCs among patients aged 8-100 years. A derivation cohort was constructed from EMS agencies with active PHBT programs and at least 10 documented transfusions. Candidate predictors included demographic, physiologic, clinical, and operational variables. Random forest and ridge-penalized logistic regression models were developed to identify covariates associated with PHBT. Variables selected through machine learning approaches were subsequently evaluated in multivariable logistic regression models. Model performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration metrics. Final models were applied to the remaining national cohort to estimate patients with a high predicted probability of PHBT.</p><p><strong>Results: </strong>Among 2,078,452 eligible EMS activations, 303,383 comprised the derivation cohort. The random forest-selected logistic regression model demonstrated strong discrimination with an AUC of 0.901, sensitivity of 75.3%, and specificity of 96.5%. The ridge-selected logistic regression model achieved an AUC of 0.942, sensitivity of 63.9%, and specificity of 97.7%. Both models identified composite physiologic measures, critical hemorrhagic shock designation, and unspecified traumatic shock as significant predictors of PHBT. Application of the final models to the national cohort identified 73,754 and 70,599 predicted PHBT recipients, representing 3.6% and 3.4% of the evaluated population, respectively.</p><p><strong>Conclusions: </strong>Predictive modeling applied to NEMSIS data accurately identified patients with a high probability of receiving PHBT following MVC trauma. These findings provide a framework for estimating geographic demand for prehospital blood products and may inform data-driven expansion of PHBT programs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707342","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":"The Use of Capnometry in Prehospital Intubation and Association with 30-Day Mortality: A Nationwide Registry Study.","authors":"Pelle Harris Krog, Tim Alex Lindskou, Torben Anders Kløjgård, Jakob Friis Schmidt, Jacob Steinmetz","doi":"10.1080/10903127.2026.2717533","DOIUrl":"10.1080/10903127.2026.2717533","url":null,"abstract":"<p><strong>Objectives: </strong>Capnometry is the gold standard for confirming endotracheal tube placement, yet the implementation in prehospital airway management remains inconsistent. This study aimed to investigate the use of capnometry during prehospital endotracheal intubation in Denmark, and to evaluate the association between capnometry use and 30-day mortality.</p><p><strong>Methods: </strong>We conducted an observational study design with a nationwide retrospective registry-based cohort of prehospital endotracheal intubations in Denmark using data from January 1, 2016, to December 31, 2021. Data were obtained from the Danish Prehospital Medical Record system and linked to the Danish Civil Registration System for mortality outcomes. Capnometry use was defined as at least one recorded end-tidal carbon dioxide (EtCO₂) value >0. The primary outcome was capnometry use. Secondary outcomes included 30-day mortality and EtCO₂ values categorized as eucapnic (4.0-6.0 kPa), hypocapnic (<4.0 kPa), hypercapnic (>6.0 kPa). Associations with mortality were assessed using multivariable logistic regression adjusted for age, sex, symptom category, cardiopulmonary resuscitation, and time of day.</p><p><strong>Results: </strong>A total of 8,720 intubations in 8,625 patients were identified, and only the first intubation per patient was included. Capnometry was used in 6,926 of 8,625 cases (80.3%) and increased from 75.4% in 2016 to 82.6% in 2021 (IRR 1.014, 95% CI 1.0004-1.0284; <i>p</i> = 0.04). Thirty-day mortality was 62.6%. Capnometry use was more frequent among survivors (87% vs. 76%, <i>p</i> < 0.001) and was independently associated with lower mortality (adjusted OR 0.52, 95% CI 0.46-0.60). Unadjusted 30-day mortality was higher for patients without capnometry use (74.8% vs. 59.6%; 1,270/1,699 vs. 4,131/6,926; <i>p</i> < 0.001). Abnormal EtCO₂ values were common: hypocapnic in 38.3%, hypercapnic in 19.0%, both in 22.6%, and only 10.1% had values within the normal range. Mortality was highest in patients with recorded hypocapnic values (70.4%; adjusted OR 2.67, 95% CI 2.20-3.24) and lowest in those with normal values (36.7%).</p><p><strong>Conclusions: </strong>Capnometry use during prehospital intubation increased over time but remained incomplete and was independently associated with lower 30-day mortality. Abnormal EtCO₂ values were frequent and associated with worse outcomes, particularly low EtCO₂ values. These findings support adherence to current recommendations for routine EtCO₂ monitoring in prehospital airway management.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797243","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":"Outcome-Informed Emergency Medical Services Response Planning: A Systematic Review.","authors":"Richard Ferron, Jasdeep Brar, Lauren E Griffith, Iwona A Bielska, Gina Agarwal","doi":"10.1080/10903127.2026.2705415","DOIUrl":"https://doi.org/10.1080/10903127.2026.2705415","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) commonly use standardized call interrogation systems to determine response strategies. The findings of caller interrogation are typically combined with local clinical and operational guidelines to determine EMS response plans. These plans dictate assigned resource type and response priority, often with associated response time targets. It is unclear whether EMS response plans have been prospectively aligned with patient outcomes and evaluated in terms of diagnostic accuracy or predictive performance measures. This review examines evidence on the prospective alignment of EMS response plans with linked patient outcomes and the effects of implemented system-level changes.</p><p><strong>Methods: </strong>A systematic review was conducted following preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Electronic databases were searched for studies evaluating ambulance dispatch response assignment informed by linked patient outcomes. Eligible studies (1) prospectively aligned EMS response plans with linked patient outcomes and (2) evaluated the impact of implemented system-level changes utilizing linked patient outcomes <i>via</i> diagnostic accuracy or predictive performance measures. Studies were excluded if they were a single-priority system, did not evaluate fully implemented plans or evaluated single condition changes only. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal for Quasi-Experimental Studies.</p><p><strong>Results: </strong>Of the 2677 identified studies, only three studies met the inclusion criteria, representing a combined total of 2,956,071 EMS responses. All three were non-randomized and quasi-experimental. Outcome measures included short-term mortality, response time performance for high-acuity calls, emergency department presentation, lights-and-sirens utilization, and dispatch accuracy. Narrative synthesis was performed. Directional findings across the three different study interventions were consistent. The evaluated outcome-informed EMS response plans were associated with reduced high-priority responses and improved system efficiency, with no clear evidence of harm. Certainty of evidence was unable to be assessed. Substantial heterogeneity in the study design, outcomes assessed, and analytic approaches used precluded data synthesis, and limits the certainty and generalizability of the findings.</p><p><strong>Conclusions: </strong>Evidence evaluating linked patient outcome-informed optimization of EMS response plans remains limited and heterogenous but offers preliminary insight into the feasibility of such approaches. Additional research is needed to evaluate the effectiveness, reproducibility, and generalizability of system-level response plan optimization.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813815","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":"The Estimated Prevalence of Multiple Record Encounters in the National Emergency Medical Services Information System.","authors":"Sriram Ramgopal, Jake Toy, Rebecca E Cash, Michael Spigner, Nichole Bosson, Christian Martin-Gill","doi":"10.1080/10903127.2026.2711920","DOIUrl":"10.1080/10903127.2026.2711920","url":null,"abstract":"<p><strong>Objectives: </strong>The National Emergency Medical Services Information System (NEMSIS) is a large repository of de-identified Emergency Medical Services (EMS) data supported by the National Highway Traffic Safety Administration and is a cornerstone of large database EMS research. A known concern with large EMS datasets like NEMSIS is that multiple records may exist for a single episode of patient care. However, the extent of potentially related records is not well described. We evaluated potential EMS episodes of care contained within NEMSIS.</p><p><strong>Methods: </strong>We used an observational study design and conducted a retrospective analysis of the 2023 NEMSIS dataset. We identified hierarchical clusters of likely related episodes of care for the same patient using tiered criteria of temporal (dispatch call times of 30 s to 2 min) and Census Division, EMS agency, urbanicity, patient demographics, dispatch characteristics, clinical impression, and location type. We evaluated all possible combinations of these criteria and reported the percentage of episodes of care out of all included records overall and for five specific EMS subpopulations: cardiac arrest, trauma, stroke, airway intervention, and pediatric patients.</p><p><strong>Results: </strong>We included 36,757,562 EMS records. When applying all criteria, the final algorithm identified 36,552,901 likely episodes of care, representing 99.4% of all records. Most episodes of care (36,353,329, 99.5%) consisted of a single EMS record, with fewer episodes having 2 (195,786, 0.5%), 3 (3,088, <0.1%), 4 (428, <0.1%), and 5 or more (270, <0.1%) records. When evaluating all possible alternative combinations of the criteria, most resulted in a similar number of episodes of care. Among the subpopulations, the number of episodes of care approached the total number of encounters for that condition: cardiac arrest (89.2%-98.5%), pediatric (73.8%-99.3%), stroke (89.5%-99.3%), airway procedure (95.4%-99.4%), and trauma (84.1%-99.6%). Findings were robust to sensitivity analyses which relaxed the time- and age-based criteria.</p><p><strong>Conclusions: </strong>Nearly all included EMS records in NEMSIS appeared to represent unique patient-care episodes. Approximately 0.5% of episodes involved more than one EMS record, suggesting that related records or multi-unit documentation is uncommon but should be considered in analyses, particularly for selected clinical subgroups.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620967","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":"The Prevalence of Adverse Events After Prehospital Neuromuscular Blockade-Assisted Airway Management.","authors":"Michael F Spigner, Alyssa Green, Christopher J Naas, Dan Pojar, Shane Hughes, Aster Martinek, Henry E Wang","doi":"10.1080/10903127.2026.2713128","DOIUrl":"10.1080/10903127.2026.2713128","url":null,"abstract":"<p><strong>Objectives: </strong>Neuromuscular blockade-assisted airway management is associated with harmful physiologic adverse events, such as hypoxemia, hypotension, bradycardia, and cardiac arrest. The national scope of these events in the prehospital setting is unknown. We sought to estimate the prevalence of adverse events associated with prehospital neuromuscular blockade-assisted airway management in the United States.</p><p><strong>Methods: </strong>We conducted an observational, cross-sectional study of the 2023 National Emergency Medical Services Information System Public-Release Research Dataset. We included all adult 9-1-1 non-cardiac arrest emergency medical services activations in which neuromuscular blockade-assisted airway management was performed. The primary outcome was the prevalence of hypoxemia, hypotension, and bradycardia within 10 min of neuromuscular blocking agent administration. The secondary outcomes were the timing of adverse events relative to neuromuscular blockade, the odds of adverse events occurring based on vital signs before neuromuscular blockade, and the prevalence of EMS-witnessed cardiac arrest after NMBA administration.</p><p><strong>Results: </strong>Of 54,190,579 9-1-1 emergency medical services activations, there were 11,525 (0.02%) neuromuscular blockade-assisted airway cases. Endotracheal intubation was the first technique performed in 97.5% of cases. First pass success was 80.6%. Overall, 27.5% of patients experienced at least one adverse event in the first 10 min after neuromuscular blockade. The prevalence of hypoxemia, hypotension, bradycardia, and cardiac arrest within 10 min of neuromuscular blockade were 25.0%, 15.0%, 2.7%, and 1.9%, respectively. The odds of an adverse event occurring were higher when vital signs were abnormal before neuromuscular blockade. The presence of preexisting hypoxemia increased the odds of post-neuromuscular blockade hypoxemia by 9.1 (95% CI, 7.9-10.4) and the presence of preexisting hypotension increased the odds of post-neuromuscular blockade hypotension by 16.8 (95% CI, 13.1-21.8). Half of the cases of hypoxemia and hypotension occurred within 6 min (95% CI, 6-7) and 10 min (95% CI, 9-11), respectively.</p><p><strong>Conclusions: </strong>In this national series, 1 of every 4 patients undergoing neuromuscular blockade-assisted airway management experienced a physiologic adverse event. Emergency medical services agencies that adopt this procedure should implement measures to mitigate adverse events.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670442","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 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Patients with Major Trauma and Cardiac Arrest: A Systematic Review.","authors":"Devlyn Sun, Pierre-Marc Dion, Matthew Olejarz, Melissa McGowan, Carolyn Ziegler, Andrew Beckett, Sheldon Cheskes, Johannes von Vopelius-Feldt","doi":"10.1080/10903127.2026.2706098","DOIUrl":"10.1080/10903127.2026.2706098","url":null,"abstract":"<p><strong>Objectives: </strong>Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides temporary hemorrhage control and optimizes perfusion to vital organs. Despite increasing use in civilian and combat prehospital settings, there is limited consensus on its application or effectiveness. Research has shown mixed effects on mid- to long-term survival, and the inherently high mortality risk among patients receiving REBOA complicates the interpretation of literature. This systematic review consolidates evidence on REBOA use in prehospital and transport medicine settings.</p><p><strong>Methods: </strong>We conducted a systematic review of multiple databases to identify studies describing REBOA use in the prehospital or transport medicine setting. Two independent reviewers screened against inclusion and exclusion criteria. The risk of bias was assessed <i>via</i> the ROBINS-I tool. The primary outcomes were feasibility of REBOA and survival rates. Secondary outcomes included complications and other relevant safety outcomes. Owing to anticipated heterogeneity, a narrative synthesis was conducted.</p><p><strong>Results: </strong>The search yielded 1,211 articles, 31 registered trials, and 151 conference abstracts, of which 14 case studies, two prospective cohort studies, one retrospective chart review, one clinical trial, and four registered trials met the inclusion criteria. The included studies were of critical to serious risk of bias due to inherent methodological limitations. When attempted, prehospital REBOA was successfully deployed in 29/38 (76%) of civilian trauma cases, 76/90 (84%) of civilian nontraumatic cardiac arrest cases, and 2/2 (100%) of combat trauma cases. All out-of-hospital cardiac arrest (OHCA) studies reported significant elevation of blood pressure or EtCO₂ following REBOA, although survival rates and complications varied widely. When reported, survival to hospital discharge was 44% (14/32) in civilian trauma cases, 4% (1/25) in civilian OHCA cases, and 88% (7/8) in civilian interfacility transport cases. No survival data were available for REBOA in combat cases. Survival rates were correlated with patient selection criteria and the nature of injuries.</p><p><strong>Conclusions: </strong>The current evidence for REBOA use in the prehospital and transport medicine settings is limited by the small number of cases in most existing studies, the lack of control groups in all but one study, and limited reporting of patient-focused outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620977","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":"Determinants of Timely Prehospital Thrombolysis Administration Within a Pharmacoinvasive STEMI Network in Victoria, Australia.","authors":"Andrew Bishop, Ziad Nehme, Dion Stub, Karen Murdoch, Ashanti Dantanarayana, Jesslyn Wijaya, Benjamin Meadley","doi":"10.1080/10903127.2026.2711274","DOIUrl":"10.1080/10903127.2026.2711274","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to describe the proportion of patients receiving prehospital thrombolysis (PHT) within 30 min of first medical contact (FMC) and identify factors associated with timely administration within a statewide pharmacoinvasive network.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study of consecutive adults (≥18 years) treated with paramedic-administered thrombolysis for suspected ST-segment elevation myocardial infarction (STEMI) between January 2018 and December 2023 using data obtained from the Victorian Ambulance STEMI Quality Initiative registry. Patients presenting in cardiac arrest were excluded. Multivariable logistic regression was used to identify system- and patient-level factors independently associated with FMC-to-PHT time, with delayed PHT defined as FMC-to-PHT greater than 30 min, and findings validated against a 60-minute threshold. Log-linear regression was used to estimate the percentage change in FMC-to-PHT time for each variable.</p><p><strong>Results: </strong>A total of 1440 patients were analyzed (median age, 65 years; 71.0% male). Overall, 32.5% of patients received PHT within 30 min of FMC (median 37 min [IQR 28-48]). Patients with delayed treatment (>30 min) were older and more likely to report mild pain severity (0-3/10), present after-hours, and have paramedics utilize clinical consultation prior to PHT administration. In the multivariable analysis, electrocardiogram (ECG) acquisition within 10 min of FMC was associated with reduced odds of delay (aOR 0.40, 95%CI 0.27-0.59), while mild pain severity was the strongest predictor of delayed PHT administration (aOR 2.08, 95% CI 1.44-3.01). Clinical consultation and after-hours presentations were also independently associated with increased odds of delay. In the log-linear analysis, mild pain severity (+14.8%), clinical consultation (+11.1%), and after-hours presentation (+9.2%) were associated with longer FMC-to-PHT times, whereas early ECG acquisition was associated with a 20% reduction. The findings were broadly consistent in the >60-minute model, with stronger associations for mild pain severity and after-hours presentation. Treatment times improved incrementally over the study period (aOR 0.83 per year, 95% CI 0.76-0.89).</p><p><strong>Conclusions: </strong>Achieving FMC-to-PHT ≤30 min was challenging, and delays were associated with both patient presentation and system- and process-related factors. These findings suggest that opportunities exist to improve the timeliness of thrombolysis administration in pharmacoinvasive settings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620933","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":"Signs of Life During Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study.","authors":"Catherine R Counts, Katherine Sweeney, Lianne J Kniest, Emma R Wender, Charles Maynard, Nicholas J Johnson, Michael R Sayre","doi":"10.1080/10903127.2026.2706747","DOIUrl":"10.1080/10903127.2026.2706747","url":null,"abstract":"<p><strong>Objectives: </strong>Signs of life are observed during out-of-hospital cardiac arrest (OHCA) resuscitation, but their frequency, timing relative to return of spontaneous circulation (ROSC), and prognostic significance remain incompletely described. We evaluated the prevalence of signs of life during resuscitation and their association with survival.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort study of all OHCAs treated by a single urban emergency medical services system from January 1 through December 31, 2022. Data were abstracted from prospectively maintained OHCA and airway management registries. Signs of life include respiratory effort, eye opening or tracking, body movement, and verbal response. Each sign was classified as occurring before or after initial ROSC. We used descriptive statistics, binomial confidence intervals, and unadjusted and adjusted logistic regression to evaluate associations between signs of life, OHCA etiology, and survival.</p><p><strong>Results: </strong>Among 617 treated OHCAs, 156 patients (25.3%) had at least one sign of life. Respiratory effort was most common (148 patients, 24.0%), followed by any body movement (69, 11.2%), eye opening (55, 8.9%), and any verbal response (43, 7.0%). Most documented signs occurred after ROSC, although 44 patients (7.1%) had at least one pre-ROSC sign of life. Patients with signs of life were more likely to have witnessed arrest and initial shockable rhythm and were less likely to receive intra-arrest epinephrine or prehospital advanced airway management. Survival occurred in 91 of 156 patients (58.3%) with signs of life compared with 25 of 461 patients (5.4%) without signs of life. In adjusted analysis, any sign of life was associated with survival (adjusted odds ratio [aOR] 10.3, 95% confidence interval [CI] 5.4-19.9); this relationship held when restricted to signs of life after ROSC (aOR 6.7, 95% CI 3.4-13.3). Among overdose-related OHCA, any body movement (aOR 2.44, 95% CI 1.05-5.67) and any verbal response (aOR 8.06, 95% CI 2.71-24.01) were more frequent than in the non-overdose OHCA cohort.</p><p><strong>Conclusions: </strong>One in four treated OHCA patients displayed at least one sign of life during resuscitation. Signs of life, particularly those after ROSC, were strongly associated with survival and may provide clinically useful information during prehospital resuscitation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549994","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":"National Characteristics of Emergency Medical Services in Rural and Frontier Areas: A 2024 Update on Rural-Urban Differences in EMS Care.","authors":"Reynold Henry, John B Holcomb, Julia R Coleman, Nakul P Raykar, Zain G Hashmi, Christopher D Barrett, Daniel T Lammers","doi":"10.1080/10903127.2026.2712606","DOIUrl":"https://doi.org/10.1080/10903127.2026.2712606","url":null,"abstract":"<p><strong>Objectives: </strong>A prior 2012 national analysis first characterized emergency medical services (EMS) care in frontier and remote areas of the continental United States. We updated that work using the 2024 National EMS Information System (NEMSIS) Public Release Research Dataset to describe rural-urban differences in EMS response characteristics, clinical care, and on-scene mortality, and assess progress.</p><p><strong>Methods: </strong>We performed an observational study and cross-sectional analysis of 911-initiated EMS responses and qualifying specialty-care interfacility transports reported to NEMSIS in 2024 across 50 states and the District of Columbia. We categorized responses as urban or rural using the NEMSIS-computed Rural Urban Area Commuting Area Codes (RUCA)-derived Urbanicity field (RUCA 7+ rural). Rural-urban differences were tested with t tests, Wilcoxon rank-sum tests, and odds ratios with 95% confidence intervals. A multivariable logistic regression for trauma on-scene death adjusted for age, first systolic blood pressure below 90 mm Hg, first oxygen saturation below 90%, and level of care.</p><p><strong>Results: </strong>Of 60,298,684 EMS records, 45,383,694 met inclusion criteria; rural responses comprised 6.9%. Rural patients were older (58.8 vs 56.1 years; P < 0.001), more likely to be American Indian or Alaska Native (3.4% vs 0.8%; OR 3.16), and more likely to use Medicare (24.2% vs 12.9%; OR 2.56). Air-medical use was concentrated in rural responses (OR 7.14, 95% CI 7.03-7.25). On-scene mortality was higher in rural responses overall (8.3 vs 6.0 per 1,000; OR 1.39) and among trauma responses (OR 2.00, 95% CI 1.84-2.18). After multivariable adjustment for age, vital signs, and level of care, the rural trauma-mortality disparity was attenuated (adjusted OR 1.07; 95% CI 1.00-1.14; P = 0.05). No rural disadvantage was observed for stroke mortality (OR 0.82, broad; OR 0.75, ischemic), in contrast to the 2012 stroke OR of 2.29 (95% CI 1.19-4.40).</p><p><strong>Conclusions: </strong>Rural EMS responses in 2024 remain distinct from urban responses, with greater air-medical use and higher on-scene mortality. The rural trauma-mortality excess is largely explained by differences in patient physiology at first EMS contact rather than by a geographic effect. The rural stroke-mortality gap observed in 2012 was not present in 2024, consistent with progress in regionalized stroke systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621047","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 Management of Suspected Spinal Cord Injuries: Perspectives from the American College of Surgeons Committee on Trauma.","authors":"Kristan L Staudenmayer, Avery B Nathens, Jeffrey D Kerby","doi":"10.1080/10903127.2026.2703176","DOIUrl":"10.1080/10903127.2026.2703176","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456608","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}