Prehospital Emergency Care最新文献

{"title":"Prehospital FAST-ED Score Item Agreement with Corresponding In-Hospital NIHSS Item Scores.","authors":"Mark T Baumgarten, Rahul R Karamchandani, Dale E Strong, Lauren Y Macko, Jeremy B Rhoten, Tsai-Wei Wang, Hongmei Yang, Douglas R Swanson, Andrew W Asimos","doi":"10.1080/10903127.2025.2508780","DOIUrl":"10.1080/10903127.2025.2508780","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) can shorten time to endovascular treatment by transporting large vessel occlusion (LVO) acute ischemic stroke (AIS) patients directly to thrombectomy centers. The standard prehospital strategy for identifying LVO AIS is performing an LVO screen, such as the Field Assessment Stroke Triage for Emergency Destination (FAST-ED), which our county EMS adopted in 2019. We aimed to assess agreement of the FAST-ED score items performed by paramedics in the field with the corresponding National Institutes of Health Stroke Scale (NIHSS) score items obtained by neurologists for patients discharged with an AIS diagnosis.</p><p><strong>Methods: </strong>We conducted a retrospective study utilizing a prospectively maintained registry of \"Code Stroke\" patients. We identified patients ≥ 18 years old transported to 1 of 4 hospitals in our system with a FAST-ED score documented. We included patients diagnosed with AIS for whom the Code Stroke protocol was activated and NIHSS recorded in the registry. As each patient was assessed by 1 paramedic from an EMS clinician pool and 1 neurologist from a hospital pool, we measured corresponding item score agreement using unweighted Fleiss Kappa for the dichotomized measure of facial palsy and quadratic Fleiss Kappa for the other ordinal measures.</p><p><strong>Results: </strong>From September 2019 to March 2024, we identified 829 patients meeting our inclusion criteria. There was substantial agreement between FAST-ED and NIHSS for arm weakness (Kappa = 0.68, 95% confidence interval (CI) 0.63-0.72) and speech changes defined as dysarthria and/or aphasia (Kappa = 0.61, 95% CI 0.56-0.67). Moderate agreement was found for eye deviation (Kappa = 0.60, 95% CI 0.54-0.66) and speech changes not including dysarthria (Kappa = 0.48, 95% CI 0.43-0.54). There was fair agreement for facial palsy (Kappa = 0.25, 95% CI 0.19-0.32) and denial/neglect (Kappa = 0.33, 95% CI 0.26-0.40).</p><p><strong>Conclusions: </strong>We found a range of agreement for items of FAST-ED prehospital scores to corresponding items of in-hospital NIHSS, including only fair agreement for facial palsy and denial/neglect. Our findings suggest EMS clinicians may benefit from targeted education in assessing denial/neglect and facial palsy, as well as how to score the speech component in cases of isolated dysarthria.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127669","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":"Ventilation Rates and Capnography in Pediatric Out-of-Hospital Cardiac Arrest with Advanced Airways.","authors":"Kelsey Stanton, Annabella Mershad, Chelsea Kadish, Andrew Murphy, Robert Lowe, Imanol Ania, Andoni Elola, Elisabete Aramendi, Matthew Hansen, Ashish R Panchal, Henry E Wang, Michelle M J Nassal","doi":"10.1080/10903127.2025.2496756","DOIUrl":"10.1080/10903127.2025.2496756","url":null,"abstract":"<p><strong>Objectives: </strong>Ventilation is important in out-of-hospital cardiac arrest resuscitation; however, few studies describe ventilation rates during pediatric out-of-hospital cardiac arrest (pOHCA). Our objective was to characterize ventilations and end-tidal capnography (EtCO₂) after advanced airway placement by emergency medical services (EMS) during pOHCA resuscitation.</p><p><strong>Methods: </strong>This was a retrospective cohort study that included pediatric (age < 18 years) non-traumatic OHCA treated by an urban fire-based EMS system (Columbus Division of Fire, Columbus, Ohio) from April 2019 to December 2020. We identified ventilations delivered during resuscitation by manual review of continuous EtCO₂ recorded by cardiac monitors. We also identified ventilations using automated detection algorithms previously validated in adult resuscitation. Mean ventilation rate and EtCO₂ were summarized in one-minute (min) epochs from advanced airway insertion through end of resuscitation efforts. We compared return of spontaneous circulation (ROSC) vs non-ROSC ventilation rates using Student's t-tests. Cochran-Armitage test of trend was used to evaluate EtCO₂ temporal trends. Associations between ROSC and EtCO₂ were tested using a regression model.</p><p><strong>Results: </strong>We identified 38 pOHCA cases and 30 cases were included for ventilation analysis. Cases were primarily infants (0.7 years, IQR 0.17-2), male (52.6%), and African-American race (63.1%). Most pOHCAs were unwitnessed (65.8%) with non-shockable rhythms (94.8%) and infrequent bystander cardiopulmonary resuscitation (31.2%). Eight patients achieved ROSC (21.2%) and two patients survived (5.3%). Advanced airway attempts included supraglottic airway devices (71.1%), endotracheal intubation (7.8%), or both (7.8%). Ventilation rates ranged from 0-23 per minute. Automated ventilation detection algorithms performed well in pediatric ventilation detection where the mean standard error was 3.7 mmHg in EtCO₂ values and 1.3 per minute in ventilation rates. Ventilation rates differed between ROSC and non-ROSC groups (9.2 vs 6.9 per min, <i>p</i> < 0.001). Ranges of EtCO₂ values included 0-100 mmHg during resuscitation. The EtCO₂ trends over time differed between ROSC and non-ROSC groups (59.82 mmHg to 75.9 mmHg vs 20.7 mmHg to 19.0 mmHg, <i>p</i> < 0.01). EtCO₂ was significantly associated with ROSC (OR 1.0 95% CI 1.00-1.01, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>These results offer one of the first perspectives of ventilation in pOHCA. Differences were observed in ventilation rates and EtCO₂ trends between ROSC and non-ROSC cases.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111820","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":"Quality of Care and Opportunities for Improvement in Prehospital Care of Critically Ill Pediatric Patients: An Observational, Simulation-Based Study.","authors":"Mark X Cicero, Kate Schissler, Janette Baird, Linda Brown, Marc Auerbach, Nicole Irgens-Moller, Natasha Pavlinetz, Kathleen Adelgais","doi":"10.1080/10903127.2025.2500715","DOIUrl":"10.1080/10903127.2025.2500715","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians infrequently care for infants or children. Simulation allows assessment of EMS at the individual, team, and agency level. Standardized tools to evaluate EMS team performance provides educators and EMS clinicians information on the quality of clinical skills performed in pediatric prehospital scenarios, providing opportunities for reinforcement or relearning. This study utilizes skills checklists to describe EMS team performance during three pediatric emergencies and describes skill performance within each simulation. As secondary objectives we evaluated performance differences among three states, and for teams whose agency had a pediatric emergency care coordinator (PECC) compared to those that did not.</p><p><strong>Methods: </strong>This was a prospective cohort study of EMS clinician team performance, across three standardized pediatrics simulations: Respiratory (child asthma/respiratory arrest), Cardiac (infant cardiopulmonary arrest, and Neurological (sepsis/seizure). Simulations were conducted with 11 EMS agencies in three states, video-recorded and evaluated using standardized tools. Video recordings were evaluated if they included the complete simulation and the audio was intelligible. The primary outcome was mean percent of actions performed correctly in each simulation. Using a series of ANOVAs, comparisons were made among the three simulation types, states, and, whether there was an EMS PECC in participating agencies.</p><p><strong>Results: </strong>There were 166 simulations conducted over 30 months of which 140/163 (84.3%) were evaluated. The mean percent of actions performed correctly by teams in the Respiratory simulation was higher than for Cardiac and Neurological simulations (Respiratory = 60.9%, SD = 8.9, range = 40-78.6%; Cardiac 58.7% (SD = 11.8, range = 26.0.1-81.0%); Neurological = 54.9%, SD = 9.9, range = 34.1-72.3%; <i>p</i> = 0.02), and no significant difference between Cardiac and Neurological simulation performance. There were differences by participating states in the Respiratory simulation performance (<i>p</i> = 0.04) and Neurological simulations (<i>p</i> = 0.03). The study was underpowered to determine if PECC presence was associated with improved performance.</p><p><strong>Conclusions: </strong>In high acuity pediatric simulations, EMS teams demonstrated better resuscitation performance for children with child asthma/respiratory arrest than for infants with cardiopulmonary arrest or sepsis/seizure. The gaps noted in EMS quality of care can be used to guide educational and quality of care improvement interventions.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050711","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":"Addressing the Use of Mechanical Compression Devices in Traumatic Out-of-Hospital Circulatory Arrest.","authors":"Jamie Jasti, Jeremy Levin, Jacqueline Blank, Thomas Engel, Daniel Holena, Jacob Peschman, Katie Iverson, Thomas Carver, Marshall Beckman, M Riccardo Colella","doi":"10.1080/10903127.2025.2500714","DOIUrl":"https://doi.org/10.1080/10903127.2025.2500714","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041807","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":"Implementation and Validation of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in a Rural EMS Region.","authors":"Luke Wohlford, Miles Kittell, Jackson Lyttleton, Jane G Morris, Timothy G Lukovits, Kate D Zimmerman, J Matthew Sholl, Thomas W Trimarco, Peter W Callas, Daniel Wolfson","doi":"10.1080/10903127.2025.2498012","DOIUrl":"https://doi.org/10.1080/10903127.2025.2498012","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital identification of large vessel occlusion (LVO) stroke patients is crucial for timely mechanical thrombectomy (MT). The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score effectively predicts LVOs, but its utility in rural, multi-state emergency medical services (EMS) systems remains unexplored.</p><p><strong>Methods: </strong>This prospective cohort study included ground prehospital stroke alerts in Vermont, New Hampshire, and Maine from July 2021 to December 2022. Patients with a prehospital FAST-ED score recorded were enrolled. LVO was confirmed by CT angiography. Our primary outcome was the accuracy of LVO identification with FAST-ED scores. Secondary outcomes included the predictiveness of the prehospital FAST-ED score for Thrombectomy Capable Center (TCC) appropriateness, MT, and 30-day mortality.</p><p><strong>Results: </strong>This study included 370 patients. The overall LVO prevalence was 23.2% (<i>n</i> = 86). A positive FAST-ED score demonstrated a sensitivity of 73% (95% CI, 63%-82%) and specificity of 61% (95% CI, 55%-66%) for presence of LVO. The PPV was 36% (95% CI, 29%-44%) and the NPV was 88% (95% CI, 83%-92%). Positive FAST-ED scores were associated with significantly higher rates of TCC appropriateness (46% vs 10%, <i>p</i> < 0.0001), mechanical thrombectomy (19% vs 6%, <i>p</i> < 0.001) and 30-day mortality (24% vs 6%, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The FAST-ED score can be implemented by prehospital personnel to triage patients to a TCC when faced with options for hospital destination in a rural setting. This study supports incorporating FAST-ED scoring in rural protocols for potential diversions to TCCs. Further research should be done to better characterize the effects of prehospital diversion on time to thrombectomy, functional outcomes, and mortality.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025239","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":"Acute Ischemic Stroke in a Marathon Runner: Last Known Well at Mile 22 Case Report.","authors":"Katie L Tataris, Willard W Sharp, George T Chiampas, Ameera S Haamid","doi":"10.1080/10903127.2025.2500065","DOIUrl":"https://doi.org/10.1080/10903127.2025.2500065","url":null,"abstract":"<p><p>Acute Ischemic Stroke (AIS) with an onset while running a marathon is a rare but time-sensitive medical emergency that requires navigation of event medical resources. The Bank of America Chicago Marathon is a 26.2-mile city-wide race supported by emergency medical services (EMS) teams and course medical stations with centralized event medical direction to direct prehospital patient care and transport destination. We present a case report of a runner that experienced sudden onset of neurologic deficit while running a marathon that required event EMS medical direction and coordinated EMS transport to a stroke center during a city-wide race. A 58-year-old male runner without medical history experienced an acute onset of right sided visual deficit at mile 22 of the Chicago Marathon. He completed the race and presented to a medical tent an hour after onset with persistent visual symptoms and confusion. His blood glucose was 66 mg/dL and he received dextrose. After consultation with event EMS medical direction, he was transported by ambulance to a Comprehensive Stroke Center. His computed tomography (CT) scan showed a left occipital lobe hypodensity and thrombus of the left middle cerebral artery M3 segment. The CT angiography showed an atherosclerotic plaque in the left common carotid artery. He received Tenecteplase with improvement in symptoms. He was admitted to the neurological intensive care unit on a heparin drip and discharged three days later with complete resolution of symptoms on atorvastatin and rivaroxaban. Endurance running or other physical activities with excessive exercise over an extended period can increase the risk of stroke due to multiple underlying vascular effects. Studies have shown that marathon running increases circulating endothelial and thrombocyte derived microparticles which is consistent with an acute pro-thrombotic and pro-inflammatory state. Additionally, exercise-induced hypertension increases morbidity and is a risk factor for cardiac and cerebral vascular diseases. Acute ischemic stroke can result from vascular events during physical exertion of a marathon. The EMS and event medical teams in collaboration with centralized marathon medical direction should identify stroke symptoms and transport patients to an appropriate stroke center for time critical diagnosis and intervention within a system of care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-3"},"PeriodicalIF":2.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053323","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":"A Heterogeneous Legal Landscape Governs Community AED Use: Crowdsourced United States AED Legal Review and Gap Analysis.","authors":"David J Adriansen, Bryan L Fischberg, Keith A Marill","doi":"10.1080/10903127.2025.2490804","DOIUrl":"https://doi.org/10.1080/10903127.2025.2490804","url":null,"abstract":"<p><strong>Objectives: </strong>Automatic External Defibrillators (AEDs) are a tremendous advance in the care of victims of out-of-hospital cardiac arrest. We sought to define and assess the legal landscape regarding Automatic External Defibrillators (AEDs) in the United States (U.S.).</p><p><strong>Methods: </strong>We performed a retrospective study of all state and federal laws relevant to the use of AEDs outside the hospital in the U.S. In the first of three phases, we searched a database of U.S. laws and regulations (\"rules\") using broad relevant search terms. Teams of two investigators reviewed all rules identified for relevance to ten realms: location, acquisition, deployment, liability, training, accessibility, maintenance, registration, interface, and reporting. We termed the application of each rule to a single realm an \"action,\" so each rule could have one or more actions. In Phase 2, a third reviewer resolved any differences or discrepancies. A separate team of investigators confirmed or identified a \"URL\" online address for each rule. In Phase 3, we performed quantitative assessments of all included rules using summary statistics and Cohen's kappa to assess reviewer reliability. We made qualitative assessments for each realm across all jurisdictions using SWOT (Strengths, Weaknesses, Opportunities, and Threats) analyses.</p><p><strong>Results: </strong>Nine hundred twenty-one rules, which included 1,987 actions, were deemed relevant to defibrillator access and use in the community, with a mean of 17.4 (SD 14.0) rules and 37.5 (SD 35.0) actions per jurisdiction, suggesting large heterogeneity in actions across states. There were 21 federal rules, including 42 actions. Qualitative analyses revealed that some states have successfully implemented AED training programs and public awareness campaigns, but uneven public awareness, cost, liability, and overly complex or stringent rules have posed barriers to successful AED deployment and use.</p><p><strong>Conclusions: </strong>We have provided a focused overview of U.S. rules governing community AEDs. We found high heterogeneity across states and a limited federal floor of rules. It is hoped this report can be used to improve legislation and resulting future successful AED use.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977017","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":"Intra-Arrest Transport and Neurological Outcomes in Out-of-Hospital Cardiac Arrest with Initial Shockable Rhythm Who Failed the First Defibrillation: A Nationwide Study in Limited Prehospital Advanced Cardiac Life Support (ACLS) Settings.","authors":"Jungho Lee, Jeong Ho Park, Eujene Jung, Hyun Ho Ryu, Kyoung Jun Song, Sang Do Shin","doi":"10.1080/10903127.2025.2489036","DOIUrl":"10.1080/10903127.2025.2489036","url":null,"abstract":"<p><strong>Objectives: </strong>Early hospital transport may benefit out-of-hospital cardiac arrest (OHCA) patients with shockable rhythms who are refractory to defibrillation, particularly in settings with limited advanced on-scene interventions. However, its impact in emergency medical service (EMS) systems with limited advanced cardiac life support (ACLS) capabilities remain unclear. This study aimed to assess the association between intra-arrest transport and survival outcomes in OHCA patients with initial shockable rhythms who remained in refractory shockable rhythms despite the first defibrillation attempt.</p><p><strong>Methods: </strong>Using a nationwide OHCA registry from a country with an intermediate prehospital service level where interventions such as prehospital anti-arrhythmic drugs or double sequential defibrillation are not feasible, adult medical OHCA patients with initial shockable rhythms who failed the first defibrillation between January 1, 2015, and December 31, 2022 were analyzed. The primary outcome was good neurological recovery. Time-dependent propensity score matching was performed to assess the association between intra-arrest transport and survival outcomes. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated, and stratified analyses were performed based on matched time intervals after the first defibrillation.</p><p><strong>Results: </strong>Of 10 246 eligible patients, 8131 underwent intra-arrest transport. After 1:1 time-dependent propensity score matching, 2332 patients each in the intra-arrest transport and on-scene resuscitation groups were included. In the matched cohort, intra-arrest transport was not associated with good neurological recovery (11.7% and 11.5% in the intra-arrest transport and on-scene resuscitation groups, respectively; RR [95% CI] 0.97 [0.91-1.07]). In the stratified analyses based on matched time intervals after the first defibrillation, intra-arrest transport within 5 min after the first defibrillation was associated with poorer neurological outcomes (RR [95% CI] 0.86 [0.77-0.97]).</p><p><strong>Conclusions: </strong>In an EMS setting with a limited-service level, intra-arrest transport showed no benefit for OHCA patients with an initial shockable rhythm who remained in refractory shockable rhythms despite the first defibrillation attempt. High-quality on-scene management is crucial before the initiation of hospital transport. Further research is needed to develop integrated systems ensuring effective prehospital and hospital care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804092","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":"Bystander Defibrillation and Survival According to Emergency Medical Service Response Time After Out-of-Hospital Cardiac Arrest: A Nationwide Registry-Based Cohort Study.","authors":"Mathias Hindborg, Harman Yonis, Filip Gnesin, Kathrine Kold Sørensen, Mikkel Porsborg Andersen, Frank Eriksson, Zehao Su, Fredrik Folke, Kristian Bundgaard Ringgren, Carolina Malta Hansen, Helle Collatz Christensen, Kristian Kragholm, Christian Torp-Pedersen","doi":"10.1080/10903127.2025.2478211","DOIUrl":"10.1080/10903127.2025.2478211","url":null,"abstract":"<p><strong>Objectives: </strong>The impact of emergency medical services (EMS) response times when integrating bystanders' automated external defibrillator (AED) use into established response systems remains unclear. This study aims to investigate 30-day survival probabilities for different EMS response times for bystander and non-bystander defibrillated patients and identify for which EMS response times bystander defibrillation improves 30-day survival probability.</p><p><strong>Methods: </strong>Data on patients with bystander witnessed out-of-hospital-cardiac arrest (OHCAs) with initial shockable rhythm who received bystander cardiopulmonary resuscitation were retrieved from Danish Cardiac Arrest Registry for years 2016-2022. Proportions of 30-day survival were calculated for five intervals of EMS response time for patients who received bystander defibrillation and those who did not. The causal inference framework utilizing targeted maximum likelihood estimation was used to estimate 30-day survival probability for each interval of EMS response time and when comparing cases where bystander defibrillation was performed with those where it was not. This analysis was adjusted for relevant confounding factors and conducted separately for residential and public OHCAs.</p><p><strong>Results: </strong>The study included 3,924 patients with OHCA. Bystander defibrillation was more frequent in public than in residential OHCAs (64.1% vs. 35.9%). Short EMS response times had higher 30-day survival probability. Bystander defibrillation resulted in higher probability of 30-day survival for EMS response times of 7-9 min (survival ratio 1.24 [95% CI: 1.03; 1.49]) in public OHCAs in the adjusted model, when compared to non-bystander defibrillated patients.</p><p><strong>Conclusions: </strong>With EMS response times of 7-9 min, we detected a clear 30-day survival benefit for bystander defibrillated patients in public locations. No 30-day survival benefits were seen for other EMS response time intervals or in residential locations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711081","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":"Diversity Among EMS Fellows.","authors":"Johanna C Innes, Susan J Burnett, Lydia Hyla, Jason Gershgorn, Ameera Haamid, Andra Farcas, Kaori Tanaka, Michael O'Brien, Renoj Varughese, Brian M Clemency","doi":"10.1080/10903127.2025.2470962","DOIUrl":"10.1080/10903127.2025.2470962","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) personnel, including EMS physicians, should reflect the diversity of the patient populations they serve to ensure equitable healthcare outcomes. The historical predominance of White male EMS medical directors may contribute to disparities in patient care. Recruiting and training a diverse cadre of EMS fellows is a key step toward fostering equity in EMS leadership and improving outcomes for diverse communities. This study examines demographic trends among EMS fellows and explores their implications for advancing equity in EMS care delivery.</p><p><strong>Methods: </strong>Publicly available data were extracted from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Books for the academic years 2012-2013 through 2022-2023. Data regarding residents' and fellows' self-identified gender and race/ethnicity were analyzed for EMS fellowships, emergency medicine (EM) residencies, and all residencies/fellowships. The investigation utilized chi-square tests to analyze associations between categorical variables, such as gender and race, and the Cochran-Armitage Trend Test to evaluate trends in proportions across years.</p><p><strong>Results: </strong>Data for 680 EMS fellows during the 11-year period were reviewed. Overall, 66% (range 55-78%) of EMS fellows were male and 34% (range 22-45%) were female. There was a smaller proportion of female EMS fellows than female EM residents (37%), female toxicology fellows (39%), female pediatric emergency medicine (PEM) fellows (65%), and female residents overall (45%). The majority of EMS fellows identified as White (75%, range 69-100%). The next most commonly reported race/ethnicity by EMS fellows was Asian (8%, range 0-13%). There was a larger proportion of White EMS fellows than White toxicology fellows (68%), White EM residents (60%), White PEM fellows (49%), and White residents overall (45%). There were no significant trends in gender or race/ethnicity of EMS fellows over time.</p><p><strong>Conclusions: </strong>Over the first 11 years since fellowship accreditation, one third of EMS fellows were female and more than three quarters of EMS fellows were White. EMS leaders, including fellowship directors, should strengthen the recruitment of women and underrepresented racial and ethnic minority groups in EMS medical direction.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468778","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}