Prehospital Emergency Care最新文献

{"title":"Developing an Emergency Medical Services Research Reading List for Emergency Medical Services Practitioners.","authors":"Christopher T Richards, Rebecca E Cash, Remle P Crowe, Jennifer Fishe, Jeffrey L Jarvis, Manish I Shah, Joan Somes, Nathan White, Christian Martin-Gill","doi":"10.1080/10903127.2026.2693158","DOIUrl":"10.1080/10903127.2026.2693158","url":null,"abstract":"<p><strong>Objectives: </strong>High-impact primary research is a cornerstone of emergency medical services (EMS) education and protocol development, yet EMS practitioners and EMS leaders often lack a clear, prioritized way to identify the most important recent primary literature. Because formal evidence-based guideline (EBG) development frequently lags behind emerging evidence, curated primary research plays a critical role in translating science into practice. Therefore, we sought to identify and evaluate recent high-impact EMS research-related publications through recommendations and ratings from key stakeholders and experts in EMS to identify a priority research reading list in EMS medicine.</p><p><strong>Methods: </strong>We issued an open call through member organizations of the Prehospital Guidelines Consortium for high-impact primary literature (excluding EBGs) published between 2021-2023 related to EMS clinical care and operations. An expert panel, selected from the Prehospital Guidelines Consortium and member organizations, reviewed submissions, rating each by importance (1-5, with 5 being most important) in an asynchronous electronic survey. The expert panel selected a cutoff point using average importance rating to generate the final priority reading list.</p><p><strong>Results: </strong>A total of 29 submissions resulted from the public call. After submissions outside the date range, duplicate submissions, and prehospital EBGs were excluded, nine experts in EMS medicine rated 22 submissions. The average importance rating of submissions ranged from 1.56 to 4.56. There was a natural inflection point in average importance scores at 3.56, and we classified the 10 primary articles at or above this threshold as being highly rated.</p><p><strong>Conclusions: </strong>We identified 10 high-impact primary publications to prioritize for inclusion in initial and ongoing EMS education to inform evidenced-based out-of-hospital care and address gaps in existing prehospital EBGs.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472317","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 Services Physician-Led Activation for Extracorporeal Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest.","authors":"Stephen L Powell, John Gaillard, Christopher A Davis, Joseph McIlwain, Alex Vaughn, Bret Nicks, Nicklaus P Ashburn, Michael Supples","doi":"10.1080/10903127.2026.2704728","DOIUrl":"https://doi.org/10.1080/10903127.2026.2704728","url":null,"abstract":"<p><strong>Objectives: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) has been associated with improved survival among out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular tachycardia (VT) or ventricular fibrillation (VF). However, the ideal approach for integrating an ECPR program within an emergency medical services (EMS) agency and local hospitals is unknown. The objective of this study was to investigate an EMS physician-led prehospital ECPR program.</p><p><strong>Methods: </strong>We conducted an observational cohort study of a locally developed, EMS physician-led prehospital ECPR activation protocol within a third-service EMS agency serving an urban population and a large, academic tertiary care center in North Carolina between May 1, 2024 and May 19, 2025. Adult OHCA patients aged 18 to 60 years with non-traumatic, witnessed cardiac arrest, receipt of bystander cardiopulmonary resuscitation, and an initial rhythm of VT or VF or automated external defibrillator advised shock, refractory to three defibrillation attempts were eligible for ECPR activation. For eligible patients, paramedics consulted an online EMS physician, who could activate ECPR with subsequent intra-arrest transport to the hospital for cannulation. The primary outcome was the proportion of patients with non-traumatic OHCA who were eligible for ECPR. Secondary outcomes included the proportion of eligible patients with ECPR activation, cannulation, survival to hospital discharge, and cerebral performance category (CPC). Data were abstracted from the EMS and hospital electronic medical records.</p><p><strong>Results: </strong>During the one-year study period, 347 patients experienced non-traumatic OHCA, of whom 4.3% (15/347) were eligible for ECPR. These 15 patients had a median age of 53 years (interquartile range 45-60), 80% (12/15) were male, and 60% (9/15) were non-White. The ECPR protocol was activated in 66.7% (10/15). Among these, cannulation occurred in 50% (5/10). Survival to hospital discharge occurred in 40% (4/10) of the ECPR activation group, all with CPC of 1. Among those eligible patients without ECPR activation, 60% (3/5) survived to discharge with 1 having a CPC of 1.</p><p><strong>Conclusions: </strong>The EMS physician-led ECPR protocol identified a subset of eligible patients for ECPR activation and resulted in successful cannulation of 5 patients. Further investigation in a larger, multi-system study is needed to determine the impact on patient-centered outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472245","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":"Disparities in Pediatric Out-of-Hospital Cardiac Arrest Outcomes Relating to Race, Urbanicity, and Poverty: A Study of the NEMSIS Database.","authors":"Mary E Bernardin, Paul Schuler, Jyoti Arora, Emily Morales, Elizabeth Kendrick, Danielle Zoellner","doi":"10.1080/10903127.2026.2695249","DOIUrl":"10.1080/10903127.2026.2695249","url":null,"abstract":"<p><strong>Objectives: </strong>Sociodemographic disparities exist in out-of-hospital cardiac arrest (OHCA) outcomes among adults, though less is known regarding social drivers of OHCA outcomes among children. Our objective was to evaluate for sociodemographic disparities in pediatric OHCA (POHCA) outcomes using a nationwide database.</p><p><strong>Methods: </strong>This cross-sectional study utilized the National Emergency Medical Services Information System (NEMSIS) Database to obtain nationwide POHCA data from 2021-2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). Patient demographic data included age, sex, and race/ethnicity. Patient home population-based geographic categories (urban, suburban, rural/frontier) and community poverty levels were obtained from the United States Census Bureau. Multivariable logistic regression was used to assess for associations between sociodemographic factors and POHCA outcomes.</p><p><strong>Results: </strong>Among the 14,783 POHCAs, 56.2% received bystander CPR, 20.7% bystander AED usage, and 21.2% ROSC achievement. When compared to White children, Black children were less likely to receive CPR [OR 0.72 (95%CI 0.66-0.80)] and achieve ROSC [OR 0.71 (95%CI 0.63-0.80)]. Hispanic children were less likely to receive CPR [OR 0.73 (96%CI 0.65-0.82)] and AED usage [OR 0.77 (95%CI 0.66-0.89)], though there was no association with a difference in ROSC achievement. When compared to children from urban areas, children from rural [OR 1.24 (95%CI 1.08-1.42)] and suburban areas [OR 1.21 (95%CI 1.03-1.42)] were more likely to receive CPR. When compared to communities with moderate poverty levels, communities with the lowest poverty levels were associated with increased CPR [OR 1.31 (95%CI 1.11-1.54)] and AED usage [OR 1.46 (95%CI 1.22-1.75)], while high community poverty levels were associated with decreased CPR [OR 0.78 (95%CI 0.69-0.89)], AED usage [OR 0.74 (95%CI 0.63-0.87)], and ROSC [OR 0.76 (95%CI 0.65-0.90)].</p><p><strong>Conclusions: </strong>Bystander cardiopulmonary interventions occur least often for children of racial/ethnic minorities and children from urban and resourced-limited settings. The lowest ROSC rates occur amongst Black children and children from the most impoverished communities. Further studies are needed to understand these complex health disparities, such that public health interventions can better promote equitable outcomes for all children.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369648","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":"Characterizing Pediatric Trauma Patients and EMS Agencies That Are Optimal Targets for Prehospital Pediatric Blood Transfusion Programs.","authors":"Sriram Ramgopal, Christian Martin-Gill","doi":"10.1080/10903127.2026.2696013","DOIUrl":"10.1080/10903127.2026.2696013","url":null,"abstract":"<p><strong>Objectives: </strong>Trauma is a leading cause of death among children in the United States. Prehospital blood product administration is a potentially lifesaving measure for injured children. We evaluated how often injured children meet physiological criteria for transfusion, determined the use of prehospital blood products in this sample, and identified agency characteristics that can inform the implementation of additional prehospital transfusion programs.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2021-2024 National Emergency Medical Services Information System (NEMSIS) datasets. We included children (<18 years) with injury. We identified patients who may be eligible for prehospital blood transfusion based on (a) a combination of a systolic blood pressure (SBP) below the 5^th centile for age and elevated heart rate above the 85^th centile or (b) a systolic blood pressure below the 1^st centile. We characterized encounters potentially eligible for prehospital blood transfusion, the use of blood products in this group, and the EMS agencies that cared for these patients.</p><p><strong>Results: </strong>Of 2,492,731 encounters, 34,221 (1.37%, 95% confidence interval [CI] 1.36%, 1.39%) were potentially eligible for blood transfusion. Patients meeting these criteria were more frequently adolescents (71.1%) and were involved in falls (23.4%) or motor vehicle collisions (22.6%). Blood products were administered in 669 (0.027%; 95% CI 0.025%, 0.029%) encounters overall and to 1.01% (95% CI 0.91%, 1.13%) of encounters meeting criteria for blood transfusion eligibility. In agency-level analysis, 240/16,848 (1.4%) agencies provided blood products to children, and 84.4% of eligible patients were cared for by agencies whose most common level of service was advanced life support (ALS). In multivariable analysis, agencies caring for pediatric trauma patients meeting physiologic criteria for transfusion were more likely to have higher levels of service (ALS or critical care); rural; mixed volunteer/non-volunteer; and governmental non-fire, hospital, or private, non-hospital (vs fire departments).</p><p><strong>Conclusions: </strong>In a nationally representative prehospital sample, many injured children appeared eligible for transfusion. Prehospital blood product use was uncommon and varied by system factors. Expanding access will require implementation of blood programs among EMS agencies most likely to treat these patients, and consideration for equipment and protocols that allow for administration of blood to children.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376715","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":"Open Water Cervical Spine Injury.","authors":"Megan E Foy, Elizabeth Avakoff, Mikaela T Middleton, Rachel P Limon, Amelia Breyre","doi":"10.1080/10903127.2026.2699834","DOIUrl":"10.1080/10903127.2026.2699834","url":null,"abstract":"<p><p>Acute, traumatic cervical spine injuries require a swift and coordinated response for optimal neurologic preservation. This presents a distinct challenge in open water sports where the environment poses unique dynamic hazards and the need for coordinated care. The patient in this case suffered a direct impact to his head and neck during the open water portion of a triathlon in the San Francisco Bay. Prehospital medical rescue teams promptly recognized the swimmer in distress, rapidly extracted him from the event, and transported him to the nearest trauma center. With severe distal weakness greater in the upper extremities than the lower extremities and a supporting Magnetic Resonance Imaging (MRI), he received prompt surgical treatment for acute central cord syndrome with improved neurologic recovery. Furthermore, this case report discusses the risks and benefits of Spinal Motion Restriction (SMR) in both an urban and aquatic environment in the context of evolving standards of care and EMS controversies.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405643","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":"Hypopharyngeal Perforation Associated with King Laryngeal Tube Use in Prehospital Cardiac Arrest Management.","authors":"Koji Maniwa, Masayoshi Miura, Yasukazu Sadoh, Tetsuo Hatanaka, Hiroaki Kuroda","doi":"10.1080/10903127.2026.2693743","DOIUrl":"10.1080/10903127.2026.2693743","url":null,"abstract":"<p><strong>Objectives: </strong>To describe three cases of suspected hypopharyngeal perforation after prehospital King laryngeal tube placement and to highlight clinical features associated with this rare complication.</p><p><strong>Methods: </strong>We report three out-of-hospital cardiac arrest cases in which postmortem computed tomography identified findings suggestive of hypopharyngeal perforation after King laryngeal tube insertion by emergency medical services clinicians.</p><p><strong>Results: </strong>All three patients developed extensive subcutaneous emphysema, and two had pneumothorax. Postmortem computed tomography showed anterolateral device deviation from the esophageal axis. Serial capnographic data were unavailable after placement, but arterial blood gas analyses showed severe acidosis, hypercapnia, and hypoxemia.</p><p><strong>Conclusions: </strong>Hypopharyngeal perforation is a rare but serious complication of prehospital King laryngeal tube placement. Subcutaneous emphysema after insertion should raise concern for upper airway injury or malposition, and continuous end-tidal carbon dioxide confirmation and monitoring may help earlier recognition of inadequate ventilation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-4"},"PeriodicalIF":2.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369563","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":"Ketamine Versus Propofol for Sedation in Acute Psychiatric Emergencies During Aeromedical Retrieval: A Randomized Clinical Trial.","authors":"Jodie Mills, Nicholas H George, Mark A Ross, Tim Wallace, Peter Clark","doi":"10.1080/10903127.2026.2690178","DOIUrl":"10.1080/10903127.2026.2690178","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of psychiatric disease is increasing globally. Regional Australian communities are disproportionately affected and uniquely lacking mental health resources. Those needing inpatient psychiatric care often require aeromedical retrieval, creating safety and operational challenges. The optimal medication regimen for sedation of non-intubated patients experiencing psychiatric agitation is unclear.</p><p><strong>Methods: </strong>We performed a prospective, single-center, open-label, phase IV randomized clinical trial (RCT) of ketamine versus propofol for the sedation of acutely agitated patients undergoing aeromedical transport. Our primary outcome of interest was a composite adverse event endpoint including airway complications (need for adjuncts, manipulation, suctioning), breathing complications (hypoxemia, hypoventilation, need for bag-valve-mask ventilation or stimulation), circulatory compromise (hypotension, need for intravenous fluid bolus), and aspiration. We evaluated clinician satisfaction as a secondary outcome, and medication efficacy as an exploratory analysis.</p><p><strong>Results: </strong>Of 1,078 referrals screened for inclusion, 170 were enrolled after requiring sedation - 52% randomized to receive propofol and 48% ketamine. Most patients were young (median age 30 years), First Nations (75.9%), male (66.5%), and diagnosed with psychosis (82.4%). Adverse events were more common in the propofol group (12.4% vs. 24.7%; RR = 0.50, 95% CI (0.25-0.99); x2(1) = 4.25, <i>p</i> = 0.039), yet clinicians preferred propofol to ketamine (median Likert rating 4 (IQR 4,5) vs. 4 (IQR 2,4), <i>p</i> = 0.0007). Both medications exhibited similar efficacy at reaching the target Richmond Agitation Sedation Scale (RASS) score (OR 0.73 (95%CI 0.50-1.07)). The study stopped early due to low enrollment.</p><p><strong>Conclusions: </strong>In this RCT of 170 patients, ketamine was associated with fewer adverse events compared to propofol when used for sedation during aeromedical retrieval of patients experiencing acute psychiatric agitation. There was no significant difference in achieving the goal RASS between the two agents, however clinicians reported higher satisfaction scores with propofol.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265872","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":"Inclusion of Hospital Performance in Prehospital Stroke Routing: A Simulation Study.","authors":"Kori S Zachrison, Lee H Schwamm, Yizhou Cui, Zhiyu Yan, Francesca Lim, Myles A Ingram, Han Truong, Christopher T Richards, Rebecca E Cash, Chin Hur","doi":"10.1080/10903127.2026.2689666","DOIUrl":"10.1080/10903127.2026.2689666","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital routing decisions for patients with suspected stroke are complex, and consideration of actual hospital performance data for door-to-needle and door-to-puncture times for thrombolysis and endovascular thrombectomy (EVT) may impact on-scene decision making. We sought to determine whether optimal routing destinations for patients with suspected stroke in the prehospital setting differ between three strategies: 1) American Heart Association (AHA) consensus recommendations, 2) personalized decision modeling without hospital-specific performance data (base model) and 3) with inclusion of actual hospital data for door-to-needle and door-to-puncture times for thrombolysis and EVT (enhanced model).</p><p><strong>Methods: </strong>Our previously published decision-analytic model (base model) incorporates geographic, patient, and hospital data to determine optimal transport destination, using a standard distribution of thrombolysis and EVT times by hospital type (primary vs comprehensive stroke center). We enhanced the model by incorporating real hospital performance data on thrombolysis and EVT treatment times from all Northeast United States Get with the Guidelines-Stroke hospitals (enhanced model). We generated 500 probable pick-up locations with 800 patient profiles of varying age, stroke severity, and last known well time, giving 400,000 patient-location scenarios. For each scenario we determined the optimal destination based on AHA consensus recommendations and from 1000 simulations each using base and enhanced models to determine the optimal destination for each strategy. We compared destination recommendations and examined conditions under which results changed.</p><p><strong>Results: </strong>Of the 400,000 patient-location scenarios, 56.1% and 63.1% of routing destinations were different from the consensus recommendations in the base and enhanced models, respectively, as patients were more often directed to hospitals with faster times to reperfusion. Higher stroke severity and greater odds of large vessel occlusion were associated with concordance of recommendations.</p><p><strong>Conclusions: </strong>Prehospital routing models for patients with suspected stroke may benefit from inclusion of actual hospital performance characteristics.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265846","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":"Cardiac Arrest During Interfacility Transport with Emergency Medical Services: A Preliminary Nationwide Cross-Sectional Study.","authors":"Gregory A Peters, Anjali J Misra, Kian D Samadian, Wylie Chang, Kira G Chandran, Jacob A Hurwitz, Christine Muszalski, Nikita Granich, Scott A Goldberg, Rebecca E Cash","doi":"10.1080/10903127.2026.2690618","DOIUrl":"10.1080/10903127.2026.2690618","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to provide the first national study of out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) during interfacility transport (IFT).</p><p><strong>Methods: </strong>We used a nationwide prehospital patient care report dataset from 2023 to complete a cross-sectional observational study of EMS encounters for IFT during which OHCA occurred. Descriptive statistics were computed, stratified by level of EMS care provided. Multivariable logistic regression analysis was completed to evaluate factors associated with return of spontaneous circulation (ROSC) at the end of the IFT encounter upon transfer of care to the receiving facility. Finally, we completed a similar multivariable logistic regression analysis restricted to the subgroup of patients with an unshockable initial rhythm.</p><p><strong>Results: </strong>A total of 1,466 OHCA incidents occurred during an IFT with EMS: 7.5% with basic life support (BLS), 53.6% with advanced life support (ALS), and 38.9% with critical care transport (CCT). Among these incidents 11.8% were associated with trauma, 9.2% involved cardiopulmonary resuscitation (CPR) prior to EMS unit arrival, 14.7% involved a mechanical device to perform CPR, 22.2% had a shockable initial rhythm, and 58.1% were transported <i>via</i> ground as opposed to air. At the conclusion of the IFT EMS encounter, 50.3% had sustained ROSC. Geriatric age (aOR 0.64, 95%CI 0.44-0.94), BLS care (aOR 0.45, 95%CI 0.22-0.90), and ground transport (aOR 0.58, 95%CI 0.38-0.89) were associated with worse outcomes on adjusted analysis, whereas shockable initial rhythm (aOR 3.86, 95%CI 2.42-6.36) and CCT care (aOR 2.21, 95%CI 1.42-3.48) were associated with better outcomes. The sub-analysis for OHCA during IFT with an unshockable initial rhythm also showed greater odds of ROSC when managed by CCT relative to ALS (aOR 2.65, 95%CI 1.64-4.33) while adjusting for other key factors.</p><p><strong>Conclusions: </strong>Using a large nationwide sample of OHCA incidents that occurred during IFT, we found that higher level of EMS care was associated with superior short-term outcomes while controlling for other key factors. These findings underscore the importance of accurate patient triage at sending facilities and the value of CCT for high-risk patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265905","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":"Internationally Informed Consensus on Research Priorities in Paramedicine and Emergency Medical Services (EMS).","authors":"Brett Williams, Christine King, Richard Armour, Abdullah Alobaid, Saeed Alqahtani, Talal AlShammari, Alan Batt, Yu-Tung Chang, Niamh Cummins, Enrico Dippenaar, Georgette Eaton, Eystein Grusd, Thomas Hofmann, Justin Hunter, Sarah Karim, Eihab Khasawneh, William Leggio, Siobhan Masterson, Abdulmajeed Mobrad, Marcus Ong, Alaa Oteir, Walt Stoy, Hidetana Tanaka, Walter Tavares, Julia Williams, Alex Olaussen","doi":"10.1080/10903127.2026.2687828","DOIUrl":"10.1080/10903127.2026.2687828","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital emergency care systems are expanding in scope and complexity, yet research agendas remain disjointed and often nationally focused. An internationally informed set of research priorities is needed to guide strategic investment and evidence generation across emergency medical services (EMS) and paramedicine contexts, while recognizing that local funding environments and needs will continue to shape national research decisions. The objective of this study was to identify and validate internationally informed research priorities for paramedicine and prehospital EMS using a multi-phase, stakeholder-informed consensus and analytic approach.</p><p><strong>Methods: </strong>An observational, three-phase mixed-methods study was conducted. Phase 1 involved an open-ended Delphi survey of international prehospital stakeholders to generate research priorities. Phase 2 asked participants to rate the importance of each priority using a 10-point scale; exploratory factor analysis (EFA) was performed to identify underlying factors. Phase 3 used confirmatory factor analysis (CFA) to test the factor structure. Participants included clinicians, educators, researchers, managers, students, and policy stakeholders from multiple countries to maximize breadth of stakeholder input.</p><p><strong>Results: </strong>Across the three phases, responses were obtained from 1,299, 717, and 954 participants, respectively, with 703 complete cases included in the final CFA. The final model comprised nine interrelated factors encompassing 40 research priorities. Factors reflected key areas of contemporary prehospital practice, including operations, clinical governance, evidence-based practice, health and well-being, special care (community paramedicine), culture, education and training, trauma care, and clinical care. Confirmatory factor analysis demonstrated acceptable model fit, supporting the robustness of the identified structure.</p><p><strong>Conclusions: </strong>This study presents an internationally informed framework of research priorities for prehospital emergency care. The findings provide a practical foundation for researchers, funders, EMS organizations, and policy stakeholders to align future research efforts, reduce duplication, and address high-impact gaps across diverse prehospital systems, while remaining responsive to local context.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265888","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}