Prehospital Emergency Care最新文献

{"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}

{"title":"Ambulance Staff Experiences and Perceptions of Medical Emergencies in Care Homes in the East Midlands, United Kingdom: A Qualitative Interview Study.","authors":"Despina Laparidou, Viet-Hai Phung, Maria Kordowicz, Gregory A Whitley, Ffion Curtis, Nicoya Palastanga, Lissie Wilkins, Robert Spaight, Elizabeth Miller, Adam L Gordon, Aloysius Niroshan Siriwardena","doi":"10.1080/10903127.2025.2490810","DOIUrl":"10.1080/10903127.2025.2490810","url":null,"abstract":"<p><strong>Objectives: </strong>Care home residents often experience medical emergencies requiring ambulance attendance that may lead to potentially avoidable hospitalization. We aimed to explore ambulance staff experiences of medical emergencies in care homes.</p><p><strong>Methods: </strong>We used a qualitative design and purposive sampling to recruit frontline ambulance staff who had attended medical emergencies in care homes in England, United Kingdom. Data were collected using semi-structured interviews (conducted by telephone or online) and were analyzed using thematic analysis.</p><p><strong>Results: </strong>We interviewed 15 ambulance staff members and developed four analytical themes, capturing what ambulance staff perceived facilitated or impeded high-quality care being provided during emergencies in care homes. Participants felt that effective communication was important to ensure a good care experience and discussed barriers to communications, such as language difficulties or disagreements during decision-making. They highlighted the need for better ongoing care in care homes, further training for ambulance and care staff, and that the current service pressures were a barrier to providing high-quality emergency care.</p><p><strong>Conclusions: </strong>This study highlights the main challenges and facilitators that ambulance staff are faced with when dealing with emergencies in care homes. The findings will help inform the development and evaluation of interventions to improve outcomes and experiences of emergencies in care homes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980646","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 Emergency Medical Services Termination of Resuscitation Practices for Patients with Out-of-Hospital Cardiac Arrest.","authors":"Christopher J Naas, Lauren B Nickel, Tom P Aufderheide, Benjamin W Weston","doi":"10.1080/10903127.2025.2487135","DOIUrl":"10.1080/10903127.2025.2487135","url":null,"abstract":"<p><strong>Objectives: </strong>There are well-described racial, ethnic, and gender-based inequities following out-of-hospital cardiac arrest (OHCA). Few studies have analyzed disparities in emergency medical services (EMS) termination of resuscitation (TOR) practices. This purpose of this study was to identify inequities in duration of prehospital resuscitation prior to TOR.</p><p><strong>Methods: </strong>A retrospective cohort of adult (≥18 years-old), non-traumatic OHCA events in a single metropolitan, fire-based EMS system was evaluated. Duration of resuscitation prior to prehospital TOR was separately evaluated among racial/ethnic (Black, Hispanic, and White) and gender (female and male) groups using a multivariable linear regression model. Variables in the model included bystander cardiopulmonary resuscitation (CPR) provision, arrest witnessed status, initial rhythm (shockable versus non-shockable), and patient age. Multiple imputation was used to account for missing data entries where duration of resuscitation was not documented. Incidence of hospital transport between racial/ethnic and gender groups was also assessed.</p><p><strong>Results: </strong>Between February 1, 2020 and February 28, 2023, 3700 patients met inclusion criteria, of which 1,895 (51.2%) had field TOR and 1,328/1,895 had a documented time of TOR. When controlling for arrest witnessed status, bystander CPR provision, initial shockable rhythm, and subject age, Black race [24.1 min (95% confidence interval 21.2-27.0, <i>p</i> < 0.001)] and Hispanic ethnicity [23.7 min (95% CI 20.0-27.5, <i>p</i> = 0.03)] were associated with shorter duration of resuscitation compared to White race [25.8 min (95% CI 23.9-27.7)]. These racial inequities persisted when using multiple imputation modeling. There was no difference in duration of resuscitation between female [24.3 min (95% CI 22.4-26.2)] and male gender [24.7 min (95% CI 21.8-27.5), <i>p</i> = 0.46]. There were no differences in incidence of hospital transport.</p><p><strong>Conclusions: </strong>This study identified inequities in prehospital termination of resuscitation practices following OHCA. Black and Hispanic patients, as compared to White patients, received approximately 2-min-shorter prehospital resuscitative efforts prior to TOR despite controlling for bystander CPR, witnessed status, initial rhythm, and patient age. There were no gender-based differences in prehospital duration of resuscitation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754296","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":"Rural Emergency Medical Services Perspectives on Improving Acute Stroke Care: A Qualitative Study.","authors":"Emma N Johnson, Mahesh V Pinapaka, Mary E Grewe, Lindsay E Stewart, Edward C Jauch, Jane H Brice, James E Winslow, Mehul D Patel","doi":"10.1080/10903127.2025.2490180","DOIUrl":"10.1080/10903127.2025.2490180","url":null,"abstract":"<p><strong>Objectives: </strong>For underserved rural communities with limited geographical access to comprehensive stroke centers, emergency medical services (EMS) play a crucial role in timely, high-quality acute stroke care. This qualitative study aimed to understand rural EMS perspectives on barriers and facilitators to optimal acute stroke care in rural communities.</p><p><strong>Methods: </strong>Qualitative, individual semi-structured interviews were conducted with rural EMS professionals. Ten EMS agencies in North Carolina were contacted for participation in virtual 45-60 minute interviews and interested agency professionals self-selected into the study. Covered topics included stroke training and education; stroke care experience and expertise; clinical and sociodemographic patient characteristics; EMS workflows; and system- and patient-level interactions and outcomes. Recorded interviews were transcribed and then coded using an inductive and deductive, iterative approach by two independent reviewers in MAXQDA software. Facilitators and barriers to optimal acute stroke care were derived from thematic analysis.</p><p><strong>Results: </strong>Twelve EMS professionals from 4 rural EMS agencies and 1 mixed urban-rural agency were interviewed. Participants worked in clinical (6 Paramedics, 1 EMT) and leadership (2 chiefs, 1 supervisor, 1 field training officer, 1 quality assurance manager) roles for a mean of 4 years (range 1-11 years). Commonly noted facilitators of high-quality stroke care were comprehensive stroke assessment and destination decision protocols, as well as bidirectional communication between EMS and hospital staff. Identified barriers included patient and bystander delays in calling 9-1-1, long transport distances to stroke centers, and limited EMS staffing. EMS professionals noted challenges interacting with nursing home staff and hospital clinicians during patient transfer. Interviewees also discussed the importance of educating the public about stroke signs and symptoms and community engagement.</p><p><strong>Conclusions: </strong>Within rural populations, EMS professionals determined that public education and community engagement are high-priority needs. Professionals also noted EMS' opportunities to enhance rural stroke care through consistent bidirectional communication and improved prehospital protocols. Future research is needed to further explore these themes in rural EMS agencies outside of North Carolina.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035424","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":"Prehospital Gastric Lavage for the Treatment of Critically Ill Overdose or Poisonings: A Case Report.","authors":"Nicholas M Studer, Robert S Hoffman","doi":"10.1080/10903127.2025.2491757","DOIUrl":"https://doi.org/10.1080/10903127.2025.2491757","url":null,"abstract":"<p><p>A 72 year-old female with past medical history that included anxiety, depression, hypertension, and hyperlipidemia was found unconscious in her bed at home by family members, surrounded by pill bottles and numerous loose baclofen tablets. Emergency medical service (EMS) was activated and responded quickly, finding an unresponsive patient with snoring respirations, clenched jaw, and foamy, bilious emesis. Vital signs included bradycardia and hypoxia. Initial attempts at basic airway management were followed by movement to a waiting ambulance, and the arrival of an EMS physician and advanced paramedic. Despite use of sodium bicarbonate and multiple doses of a vasopressor, the patient developed widening QRS complex on electrocardiogram and refractory hypotension. After rapid sequence intubation, aspiration and low-volume gastric lavage was performed with a 34 F Edlich tube, resulting in removal of visible pill fragments. Subsequently, the patient's hypotension resolved, and she was transferred to the care of the emergency department in stable condition. Gastric lavage remains clinically indicated for rare cases of recent, potentially lethal ingestions of poisons without effective antidotes, and is a standard component of emergency medicine residency training. The proliferation of EMS fellowship trained physicians suggests that this procedure should be considered an option in highly select cases, and EMS physician vehicles may consider carrying Edlich lavage tubes or similar prepackaged kits.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-3"},"PeriodicalIF":2.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028389","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 Ketamine Administration in Benzodiazepine Refractory Status Epilepticus: A Case Series Review.","authors":"Joseph D Finney, Margaret Kowalski, Jinli Wang, Michael Perlmutter, Jordan Anderson, Jeffrey Siegler, Bridgette Svancarek, Robert Silbergleit, Fahd A Ahmad, Casey Patrick","doi":"10.1080/10903127.2025.2486302","DOIUrl":"10.1080/10903127.2025.2486302","url":null,"abstract":"<p><strong>Objectives: </strong>Benzodiazepines are the treatment for seizures in prehospital settings, but fail in up to 40% of cases, leading to benzodiazepine refractory status epilepticus (BRSE). Early treatment of BRSE is essential to prevent neurological damage and death. Ketamine, an N-methyl-D-aspartate receptor antagonist used by emergency medical services (EMS) for a variety of indications, has potential as a safe, effective prehospital treatment for BRSE. However, safety and efficacy data for early treatment of patients with seizures are limited.</p><p><strong>Methods: </strong>We retrospectively analyzed patients treated by EMS clinicians with ketamine for BRSE at a single urban ground-based EMS system between September 1, 2021, and December 1, 2023. Ketamine dose and route, patient characteristics, and airway interventions are described. Data were gathered from EMS records.</p><p><strong>Results: </strong>Forty-two patients aged 8 months to 79 years, were included. Ketamine was administered intramuscularly in 22 with an average dose of 3.3 mg/kg, and intravenously or intraosseous in 20, with an average dose of 2.2 mg/kg. Ketamine stopped seizures in 38 patients (90.5%). Transient hypoxia occurred in 9 patients (22%). Respirations were supported with bag-valve-mask ventilation in 13 patients (31%), a supraglottic airway in three (7%), and one patient was endotracheally intubated (2.4%).</p><p><strong>Conclusions: </strong>Ketamine appears safe and effective for prehospital treatment of BRSE. Monitoring and intervention for respiratory complications appears necessary, but rates of these complications are consistent with expected rates from seizures and appropriate benzodiazepine dosing. These findings support ketamine's use in EMS for BRSE. Larger prospective studies are needed to confirm safety and efficacy.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804093","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}