Prehospital Emergency Care最新文献

{"title":"Prevalence and Indications for Applying Prehospital Spinal Motion Restriction in Children at Risk for Cervical Spine Injury.","authors":"Caleb E Ward, Lorin R Browne, Alexander J Rogers, Monica Harding, Lawrence J Cook, Robert E Sapien, Kathleen M Adelgais, Leah Tzimenatos, Fahd A Ahmad, Sylvia Owusu-Ansah, Julie C Leonard","doi":"10.1080/10903127.2025.2472269","DOIUrl":"10.1080/10903127.2025.2472269","url":null,"abstract":"<p><strong>Objectives: </strong>Spinal motion restriction (SMR) is commonly applied to injured children with potential cervical spine injuries (CSI). There are, however, risks to indiscriminate SMR application. We recently derived the Pediatric Emergency Care Applied Research Network (PECARN) CSI clinical prediction rule. Effective implementation of this prediction rule requires an accurate understanding of current emergency medical services (EMS) SMR practices. Little is known about the prevalence of prehospital SMR application in children. Our primary objective was to determine the proportion of children sustaining blunt trauma who are placed in SMR by EMS. Our secondary objective was to identify factors associated with SMR placement.</p><p><strong>Methods: </strong>We conducted a secondary analysis of data collected during a prospective study of children 0-17 years with blunt trauma transported by EMS to one of 18 PECARN-affiliated emergency departments. Prehospital clinicians completed surveys regarding CSI risk factors and SMR application. We summarized SMR prevalence, techniques used, reasons for application, and clinician suspicion for CSI by patient age. We conducted univariable and multivariable logistic regression to determine factors associated with SMR placement.</p><p><strong>Results: </strong>Of 13,453 children transported by EMS, we enrolled a convenience sample of 7,721 (57.4%) of whom 1.6% had a CSI and 41.5% had SMR placed. Older children were more likely to have SMR placed (35.5-50.4%) compared to those < 2 years (22.0%). Factors associated with SMR placement included patient demographics (non-Hispanic White race/ethnicity, age >2 years), mechanisms of injury (high-risk motor vehicle crash (MVC), unrestrained MVC passenger, high-risk fall, axial load), clinical history (loss of consciousness, self-reported neck pain, paresthesia, numbness, or extremity weakness) and physical examination findings (altered mental status, neck tenderness, inability to move neck, focal neurological deficits, and substantial head or torso injuries).</p><p><strong>Conclusions: </strong>Of children transported by EMS after blunt trauma in this study, 41.5% had SMR placed, while only 1.6% had CSIs. Factors associated with SMR placement included patient demographics, mechanism of injury, history, and examination findings. Many of these factors are not in the new PECARN CSI clinical prediction rule. Implementation of a risk-centered EMS decision aid for SMR in children after blunt trauma must address this discrepancy.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP.","authors":"Amelia M Breyre, Nicholas George, Alexander R Nelson, Charles J Ingram, Thomas Lardaro, Wayne Vanderkolk, John W Lyng","doi":"10.1080/10903127.2024.2428668","DOIUrl":"https://doi.org/10.1080/10903127.2024.2428668","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The National Association of Emergency Medical Services Physicians (NAEMSP), American College of Surgeons Committee on Trauma (ACS-COT), and American College of Emergency Physicians (ACEP) believe that evidence-based, pragmatic, and collaborative protocols addressing the care of patients with traumatic out-of-hospital circulatory arrest (TOHCA) are needed to optimize patient outcomes and clinician safety. When the etiology of arrest is unclear, particularly without clear signs of life-threatening trauma, standard basic and advanced cardiac life support (BCLS/ACLS) treatments for medical cardiac arrest is appropriate. Traumatic circulatory arrest may result from massive hemorrhage, airway obstruction, obstructive shock, respiratory disturbances, cardiogenic causes or massive head trauma. While resuscitation and/or transport is appropriate for some populations, it is appropriate to withhold or discontinue resuscitation attempts for TOHCA patients for whom these efforts are non-beneficial. This position statement and resource document were written as an update to the 2013 joint position statements.&lt;/p&gt;&lt;p&gt;&lt;p&gt;NAEMSP, ACEP, and ACS-COT recommend:EMS resuscitation of adults with TOHCA should:Prioritize prompt identification of patients who may benefit from transport to definitive care at trauma centers when safe and appropriate.Emphasize the identification of reversible causes of traumatic circulatory arrest and timely use of clinically indicated life-saving interventions (LSIs) within the EMS clinician's scope of practice. These include:External hemorrhage control with direct pressure, wound packing, and tourniquetsAirway management using the least-invasive approach necessary to achieve and maintain airway patency, oxygenation, and adequate ventilation.Chest decompression if there is clinical concern for a tension pneumothorax. Empiric bilateral decompression, however, is not indicated in the absence of suspected chest trauma.External chest compressions may be considered but only secondary to other LSIs.Epinephrine should not be routinely used, and if used should not be administered before other LSIs.If point-of-care ultrasound (POCUS) demonstrates no evidence of cardiac motion, this may have utility in TOHCA management for prognostication.Emphasize that placement of cardiac monitors and/or use of POCUS should occur after indicated LSIs have been appropriately performedConditions where resuscitation attempts should be withheld, include TOHCA patients with:Injuries that are incompatible with life (e.g., decapitation, hemi-corpectomy, incineration, open skull injury with extruding brain matter).Evidence of prolonged circulatory arrest (e.g., rigor mortis, dependent lividity, decomposition).Advance care planning documents that indicate Do Not Resuscitate (DNR)/ Do Not Attempt Resuscitation (DNAR)/Allow Natural Death medical orders.Conditions where resuscitation attempts are discontinued for TOHCA patients should recognize:Mechanism of injury should n","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Determinants of Health and Emergency Medical Services: A Scoping Review.","authors":"Susan J Burnett, Tessa Alianell, Owen Bitnun, Kathryn Ebersole, Bushra Nuruddin, Seth Butler, Stavros Lalos, Brian M Clemency","doi":"10.1080/10903127.2025.2468796","DOIUrl":"10.1080/10903127.2025.2468796","url":null,"abstract":"<p><strong>Objectives: </strong>Social determinants of health (SDOH) are the non-medical factors that affect people's health and quality of life. Emergency medical services (EMS) clinicians are in a unique position to recognize and respond to SDOH through their presence and responses in the communities they serve. The objective of this study was to generally explore the existing body of literature of SDOH within the context of EMS.</p><p><strong>Methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guided the analysis of peer-reviewed literature from PubMed, CINAHL, and Web of Science databases published between January 1960 and June 2024. Using Covidence software, titles and abstracts then, separately, full texts, were reviewed by two distinct researchers to include studies published in English that referenced SDOH and EMS. We later excluded articles that were published before 2010, when the SDOH term was made more popular by its inclusion in the <i>Healthy People</i> 2020 project. Reviewers then performed data extraction for qualitative analysis using a grounded theory approach.</p><p><strong>Results: </strong>Of the 1,503 records imported from the databases (PubMed <i>n</i> = 779, Web of Science <i>n</i> = 687, CINAHL <i>n</i> = 37), 1,164 unique manuscripts were screened, and 62 full texts were assessed for eligibility. Forty-two articles met inclusion criteria; 39 were EMS patient-centric and three were illustrative of EMS clinicians' SDOH, thus excluded from this analysis. Patient-related impact levels included individual characteristics, community characteristics, EMS clinicians' recognition of and response to SDOH, healthcare system factors, and social and cultural considerations. Articles were on the topic areas of medical conditions, EMS practice, trauma, pediatrics, and mental health. More than half (<i>n</i> = 24) of the manuscripts were from studies conducted in North America and a majority (<i>n</i> = 32) of the papers were published since 2020.</p><p><strong>Conclusions: </strong>Research in SDOH and their association with EMS is rapidly growing. A deeper understanding of how the EMS system and EMS clinicians affect, recognize, and manage patients' SDOH insecurities can improve efforts toward health equity and improve patients' health outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health and Occupational Stress Among Emergency Telecommunicators: A Systematic Review and Meta-Analysis.","authors":"Ian J Saldanha, Enid Chung Roemer, Edbert B Hsu, George S Everly, Genie Han, Allen Zhang, Ritu Sharma, Emmanuel Asenso, Drew Bidmead, Eric B Bass, J Lee Jenkins","doi":"10.1080/10903127.2025.2465715","DOIUrl":"10.1080/10903127.2025.2465715","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review the (1) incidence, prevalence, and severity of mental health issues and occupational stress issues among emergency telecommunicators, and (2) effectiveness and harms of interventions to promote resistance and resilience regarding these issues.</p><p><strong>Methods: </strong>We searched Medline, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, journals, and websites from January 1, 2001, through June 30, 2024. We conducted duplicate screening of titles and abstracts followed by full texts of potentially relevant records. We included studies of telecommunicators in high-income countries that reported the incidence/prevalence/severity of mental health issues and occupational stress issues or evaluated interventions targeting resistance/resilience regarding these issues. We excluded studies of telecommunicators in training during the study. We assessed the risk of bias using study design-specific tools, conducted meta-analyses using random-effects models, and evaluated strength of evidence (SoE) per Agency for Healthcare Research and Quality methods. We registered the systematic review prospectively in PROSPERO (CRD42023465325).</p><p><strong>Results: </strong>We included 31 studies (29 cross-sectional studies, 1 pre-post study, and 1 randomized controlled trial) that evaluated a total of 6,621 participants. Research Question 1 (30 studies): No study reported on incidence of any outcome. During routine practice, prevalence estimates were: any depression 15.5%, suicidal ideation 12.4%, suicide plans 5.7%, suicide attempts 0.7%, alcohol abuse 15.5%, high/extreme peri-traumatic distress 5%, high secondary traumatic stress 16.3%, and acute stress disorder 17% (low SoE for each). In terms of severity, on average, depressive symptoms and stress were mild/low to moderate, burnout was mild to severe (moderate SoE); peri-traumatic distress was moderate, and secondary traumatic stress was mild (low SoE). After critical incidents, the prevalence of high and medium general stress was 39.7% and 28.2%, respectively (low SoE). In terms of severity, on average, burnout and general stress were moderate (low SoE). Research Question 2 (2 studies): The evidence was insufficient regarding the impacts of interventions on anxiety, depression, posttraumatic stress disorder, and alcohol use.</p><p><strong>Conclusions: </strong>The prevalence and severity of mental health and occupational stress issues in the emergency telecommunicator workforce merits greater attention. Much more research is needed regarding the effectiveness of interventions for strengthening the resistance and resilience of the workforce.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic-Administered Fibrinolysis in Older Patients with Prehospital ST-Segment Elevation Myocardial Infarction.","authors":"Tan N Doan, Robert Ley Greaves, Daniel Bodnar, Brendan V Schultz, Stephen Rashford","doi":"10.1080/10903127.2025.2467792","DOIUrl":"10.1080/10903127.2025.2467792","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency ambulance services are an essential component of rapid treatment of prehospital ST-segment elevation myocardial infarction (STEMI). The effectiveness and safety of prehospital fibrinolysis in older STEMI patients is unknown. This study investigated the effectiveness and safety of paramedic-administered prehospital fibrinolysis in STEMI patients ≥75 years of age who were identified by paramedics in Queensland, Australia.</p><p><strong>Methods: </strong>Included were STEMI patients ≥75 years of age who were identified by paramedics in Queensland (Australia), and received prehospital fibrinolysis with tenecteplase or did not receive this treatment due to age being the sole contraindication, between 2010 and 2023. Patient characteristics, outcomes, and safety profiles were compared between the two groups, as well as between patients receiving full-dose and half-dose of tenecteplase.</p><p><strong>Results: </strong>In total, 86 patients received prehospital fibrinolysis and 83 did not. Patients receiving prehospital fibrinolysis were slightly younger (median 77 vs 81 years, <i>p</i> < 0.001). There was no statistically significant difference in mortality rates at 24 h (risk difference [RD] prehospital fibrinolysis vs no prehospital fibrinolysis 2.1%, 95% confidence interval [CI] - 5.6 to 9.8%, <i>p</i> = 0.41), 30 days (RD -0.3%, 95% CI -9.6 to 9.0%, <i>p</i> = 0.58), and one year (RD -1.7%, 95% CI -12.1 to 8.7%, <i>p</i> = 0.46) between the two groups. There was no statistically significant difference in functional outcomes on discharge (RD for favorable functional outcome 8.8%, 95% CI -6.0 to 23.6%, <i>p</i> = 0.25). No intracranial or major non-intracranial hemorrhage was observed in the entire study sample. Patients receiving full-dose tenecteplase were younger, closer to a hospital capable of percutaneous coronary intervention, in metropolitan areas, and had shorter time from symptom onset to tenecteplase than those receiving half-dose.</p><p><strong>Conclusions: </strong>This study was the first that investigated the effectiveness and safety of paramedic-administered fibrinolysis in older patients with STEMI. No intracranial or major non-intracranial hemorrhage was recorded for the study sample. There was no association between prehospital fibrinolysis and mortality or functional outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effect of Intelligent Virtual Reality First-Aid Training on Cardiopulmonary Resuscitation Skill Proficiency.","authors":"Nai Zhang, Yu-Juan Liu, Chuang Yang, Peng Zeng, Tao Gong, Lu Tao, Ying Zheng, Gui-Ying Ye","doi":"10.1080/10903127.2025.2465718","DOIUrl":"10.1080/10903127.2025.2465718","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the long-term effect of intelligent first-aid training based on virtual reality (VR) technology on cardiopulmonary resuscitation (CPR) skill proficiency.</p><p><strong>Methods: </strong>The convenience sampling method was used to select a total of 100 non-medical volunteers from Nanchang, China, and this cohort was randomized to either the VR training group (VR group) or the traditional simulation scenario training group (traditional group). Relevant data were collected for comparative analysis. Participants were evaluated by measuring mean chest compression depth, chest compression pauses time, the proportion of compressions with correct compression depth, mean chest compression rate, and mean ventilation volume.</p><p><strong>Results: </strong>After initial training, the two groups of participants showed similar results in terms of chest compression depth and chest compression rate. There were significant differences in chest compression pauses time, proportion of compressions with correct compression depth, and ventilation volume (<i>p</i> < 0.001). Long-term follow-up (12 months) after training showed that both groups of participants showed differences in the above indicators (<i>p</i> < 0.001). After training, the VR group had higher pass proportions for mean chest compression rate (<i>p</i> = 0.047) and mean ventilation volume (<i>p</i> = 0.043) than the traditional group. After training, the VR group had higher pass proportion for mean chest compression depth (<i>p</i> < 0.001), mean chest compression rate (<i>p</i> < 0.001), and mean ventilation volume (<i>p</i> < 0.001) than the traditional group.</p><p><strong>Conclusions: </strong>Training with VR can significantly improve CPR knowledge and skill levels and help learners master and maintain high-quality CPR skills.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Trauma Compendium: Prehospital Administration of Antibiotics in Trauma Patients - an NAEMSP Resource Document.","authors":"Whitney J Barrett, Kevin A Kaucher, Ross E Orpet, Christopher B Colwell, John W Lyng","doi":"10.1080/10903127.2025.2460203","DOIUrl":"10.1080/10903127.2025.2460203","url":null,"abstract":"<p><strong>Objectives: </strong>To conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds.</p><p><strong>Methods: </strong>We performed a literature search and summarized the evidence following the methodology established for the NAEMSP Prehospital Trauma Compendium. We searched PubMed from inception to 23 December 2022 for articles relevant to Emergency Medical Services, trauma, and antibiotics. Due to resource limitations, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was not used during review of the evidence, and no formal assessment of bias or strength of evidence was performed.</p><p><strong>Results: </strong>Of 105 articles identified in the initial search, 13 articles were included in the final evidence review and synthesis. Prehospital administration of antibiotics in combat and civilian trauma patients consists of mostly observational, retrospective studies that describe use as likely safe, but with uncertainty as to its effect on important clinical outcomes. Both combat and civilian analyses of protocol adherence and inter-rater reliability for recognition and treatment of injuries have also produced variable and inconsistent results. These results pose a challenge for implementation and highlight the inherent limitations and external validity of efficacy outcomes published to date.</p><p><strong>Conclusions: </strong>Prehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071247","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":"Association Between Response Time and Time from Emergency Medical Service Contact with the Patient to Hospital Arrival as well as Survival and Neurological Outcomes in Pediatric Out-of-Hospital Cardiac Arrest.","authors":"Hitomi Kubota, Shunsuke Amagasa, Masahiro Kashiura, Hideto Yasuda, Yuki Kishihara, Akira Ishiguro, Satoko Uematsu","doi":"10.1080/10903127.2025.2460217","DOIUrl":"10.1080/10903127.2025.2460217","url":null,"abstract":"<p><strong>Objectives: </strong>In out-of-hospital cardiac arrest (OHCA), prehospital time is crucial and can be divided into response time, from emergency call to emergency medical service (EMS) contact, and time from EMS contact to hospital arrival. To improve prehospital strategies for pediatric OHCA, it is essential to understand the association between these time intervals and patient outcomes; however, detailed investigations are lacking. The current study aimed to examine the association between response time and time from EMS contact to hospital arrival as well as survival and neurological outcomes in pediatric OHCA.</p><p><strong>Methods: </strong>This nationwide retrospective analysis used data from an OHCA registry in Japan between June 2014 and December 2021. Pediatric patients aged <18 years who had OHCA were included in the analysis. The primary outcome was 1-month survival, and the secondary outcome was 1-month favorable neurological outcome. Generalized additive model analyses and logistic regression analyses, adjusted for confounders, were performed to examine the non-linear and linear relationship between response time and patient care time (time from EMS contact with the patient to hospital arrival) and outcomes, respectively.</p><p><strong>Results: </strong>In the generalized additive model analyses of response time, both survival and neurological outcomes worsened with response time, with outcomes appearing to further decline with a response time of approximately 15 min. On the other hand, there was a linear association between patient care time as well as 1-month survival and favorable neurologic outcomes. In logistic regression analyses, shorter response times were significantly associated with survival (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.79-0.91]) and a favorable neurological outcome (OR: 0.75, 95% CI: 0.59-0.93). In contrast, time from EMS contact to hospital arrival was not significantly associated with survival (OR: 0.99, 95% CI: 0.97-1.02) and favorable neurological outcomes (OR: 1.02, 95% CI: 0.97-1.07).</p><p><strong>Conclusions: </strong>A response time of <15 min can be associated with better survival and neurological outcomes. However, there is no significant association between time from EMS contact to hospital arrival as well as survival and favorable neurological outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053278","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 Administration Not Associated with Increased Transfusion Reactions: The Experience of a Metropolitan EMS Agency.","authors":"Emily Raetz, David Wampler, Leslie Greebon, Donald Jenkins, Erika Brigmon, Jacquelyn Messenger, Vipulkumar Prajapati, William Bullock, Emmanuel Rayas, Lauren Barry, Brian Ferguson, Rachel Ely, Christopher Winckler","doi":"10.1080/10903127.2025.2464247","DOIUrl":"10.1080/10903127.2025.2464247","url":null,"abstract":"<p><strong>Objectives: </strong>Low titer O⁺ whole blood (LTO+WB) has been shown to improve outcomes in trauma patients and use is increasingly common. Studies on prehospital use and efficacy have been published throughout the literature, but few of these fully address the risks of transfusion reactions and other side effects. The focus of this study is to look at prehospital LTO+WB transfusions in trauma patients and review for transfusion reactions.</p><p><strong>Methods: </strong>This was a retrospective review of consecutive trauma patients who received prehospital LTO+WB over a 4.5-year period. We used EMS agency transfusion records and institutional blood bank data from two urban level I trauma centers for records on blood transfusion reactions. Excluded from the study were patients declared dead on arrival to the hospital, patients transfused for non-traumatic complaints, patients for whom hospital records were unavailable, and any transfusion reaction that occurred more than 10 days after the prehospital transfusion. Descriptive statistics were used for data analysis.</p><p><strong>Results: </strong>Of 1126 prehospital transfusions 572 met inclusion criteria. There were 2 (0.35%) suspected transfusion reactions, none of which were determined to be hemolytic reactions. There was 1 febrile non-hemolytic reaction on hospital day 1 and there was 1 allergic reaction with hives and shortness of breath that occurred on hospital day 1.</p><p><strong>Conclusions: </strong>Prehospital LTO+WB is safe to use and has a similar rate of transfusion reaction as when given in-hospital. Concerns about transfusion reactions caused by LTO+WB should not preclude its use prehospital. Regardless of the low incidence of transfusion reactions, prehospital personnel should be trained in their recognition and management. Limitations include retrospective study design and the inability to distinguish transfusion reactions from prehospital LTO+WB versus reaction to blood products transfused at the trauma center.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415031","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":"Analysis of 67,975 Emergency Deployments in a Major German City - Criteria for More Efficient Dispatching of Emergency Physicians.","authors":"Yacin Keller, Anne Schrimpf, André Gries","doi":"10.1080/10903127.2025.2460071","DOIUrl":"10.1080/10903127.2025.2460071","url":null,"abstract":"<p><strong>Objectives: </strong>Efficient dispatching of physician-staffed vehicles in emergency medical services requires clear criteria to ensure timely allocation of resources, improve patient outcomes, and minimize response time under high-pressure conditions. The aim of this study was to identify criteria ensuring that emergency physicians are safely managed and efficiently deployed.</p><p><strong>Methods: </strong>Rescue service deployments in the city of Dresden, Germany (01/01/2021-12/31/2021), were analyzed retrospectively. The rescue mission indications determined by the telecommunicator, along with the presence of vital sign abnormalities at site - such as airway, breathing, circulation, and disability - based on the ABCDE approach from the Advanced Life Support and Advanced Trauma Life Support algorithms, were analyzed. Specific emergency medical procedures carried out in the particular mission were assigned to the respective competence level (CL): CL1: invasive measures reserved for physicians; CL2: invasive measures that paramedics are trained to use independently in emergency situations; CL3: standard measures; CL4: counseling only; and CL5: no measures.</p><p><strong>Results: </strong>In all, 67,975 missions were analyzed. Missions were most frequently dispatched for internal indications, such as cardiovascular and pulmonary emergencies (28.4%), and traumatological indications (20.4%). Despite the physician being dispatched in 36.5% of cases, invasive measures (CL1/CL2) were only used in 13.9% of missions. Internal indications (11.8%) and resuscitation (19.6%) frequently required CL1 measures. CL2 measures were more frequently applied than CL1 measures for allergic (44.2% vs. 1.9%), neurological (12.5% vs. 3.4%), and psychological (6.1% vs. 0.7%) indications. In most interventions (62.2%), only the standard competencies (CL3) were used as the highest level of competence. For most mission indications, the probability of invasive measures (CL1/CL2) increased significantly in the presence of at least one vital sign abnormality.</p><p><strong>Conclusions: </strong>The results show opportunities for optimizing emergency physician dispatch. The presence of a vital sign abnormality should be given greater consideration in the future. Query algorithms for detecting cases with a high probability of requiring CL1/CL2 measures could support efficient dispatching. Furthermore, emergencies requiring CL2 but rarely CL1 measures could be handled independently by emergency paramedics, particularly if they have access to the support of a tele-emergency physician for situations where CL1 measures become necessary.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365077","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}