Prehospital Emergency Care最新文献

{"title":"Prehospital Sepsis Recognition and Antibiotic Administration: A Retrospective Analysis.","authors":"Peter Antevy, Kenneth A Scheppke, Charles Coyle, Sophie Tenenbaum, Grant Aran, Julia Leser, Nancy Burdett, David A Farcy, Tony Zitek","doi":"10.1080/10903127.2025.2489034","DOIUrl":"10.1080/10903127.2025.2489034","url":null,"abstract":"<p><strong>Objectives: </strong>Although earlier antibiotics are known to be beneficial in sepsis, very few emergency medical services (EMS) agencies have protocols for prehospital antibiotics for sepsis. Therefore, we sought to assess how well a large EMS agency that uses prehospital antibiotics for sepsis adheres to its sepsis protocol (when initiated), and to determine how soon antibiotics are typically given.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients identified as \"sepsis alerts\" by EMS clinicians from a single EMS system in Florida, USA. The prehospital sepsis protocol dictated that EMS clinicians initiate a \"sepsis alert\" if the patient had a suspected infection and at least 2 of the following 3 criteria based on the sequential (sepsis-related) organ failure assessment (qSOFA) score: altered mental status, respiratory rate > 22 breaths per minute or end-tidal CO2 < 25 mmHg, or systolic blood pressure < 100 mmHg. Per protocol, patients meeting sepsis criteria were supposed to receive intravenous ceftriaxone and intramuscular gentamicin. We reviewed the charts of sepsis alert patients to determine demographic information, clinical characteristics, sepsis protocol compliance, and when patients received antibiotics.</p><p><strong>Results: </strong>Between June 1, 2023, and June 30, 2024, there were 1308 patients for whom a prehospital sepsis alert was initiated. Median age was 80.0 years (IQR: 72-87.5), and 48.5% had hypotension (systolic blood pressure < 100 mmHg). Of the 1308 sepsis alert patients, review of documentation confirmed that 1301 (99.5%) had a suspected infection with at least 2 sepsis alert criteria. In total, 1264 (96.6%) received at least 1 antibiotic (either ceftriaxone or gentamicin) prior to hospital arrival. The median time from 9-1-1 call to first antibiotic administration was 26 min (IQR: 21-31 min). The first antibiotic was given a median of 11 min (IQR: 7-16 min) prior to hospital arrival.</p><p><strong>Conclusions: </strong>For patients in whom a sepsis alert was initiated, EMS clinicians adhered to the sepsis protocol and administered antibiotics prior to hospital arrival in 97% of cases. Patients received their first antibiotic a median of approximately 26 min after 9-1-1 call and 11 min prior to hospital arrival.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804094","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 and Emergency Department Vital Sign Abnormalities Among Injured Children.","authors":"Sriram Ramgopal, Jillian K Gorski, Christian Martin-Gill, Ryan G Spurrier, Pradip P Chaudhari","doi":"10.1080/10903127.2025.2488062","DOIUrl":"10.1080/10903127.2025.2488062","url":null,"abstract":"<p><strong>Objectives: </strong>Vital signs are a critical component in the assessment of the injured child. We compared vital sign abnormalities among injured children in the prehospital setting to those in the emergency department (ED) and evaluated the predictive value of each for the presence of major trauma.</p><p><strong>Methods: </strong>We performed a multi-agency and multicenter retrospective study of injured children within a county-based emergency medical services (EMS) system between 2010 and 2021, including injured children (<18 years) transported to the hospital. We compared prehospital vital signs for heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) in the prehospital and ED setting. Using the Standard Triage Assessment Tool to define major trauma, we constructed multivariable models to evaluate the association of prehospital and ED vital sign abnormalities for major trauma.</p><p><strong>Results: </strong>We included 21,298 encounters (median age 13 years, IQR 6-16), with major trauma was present in 3,606 (16.9%). In the prehospital setting, abnormal vital signs were reported in 25.7% for HR, 14.6% for RR, and 24.3% for SBP. ED measurements recorded a higher proportion of abnormal HR (28.2%) and RR (21.3%), and slightly lower proportion with abnormal SBP (21.8%). Cohen's Kappa was fair for HR (0.27) and SBP (0.20), but slight for RR (0.09). Prehospital vital signs most strongly associated with major trauma included tachypnea (odds ratio [OR] 2.7, 95% confidence interval (CI 2.4-3.1) and bradypnea (OR 1.7, 95% CI 1.4-1.9). ED vital signs most strongly associated with major trauma included hypotension (OR 2.4, 95% CI 2.1-2.7) and tachypnea (OR 1.8, 95% CI 1.6-2.0). Prehospital and ED vital signs demonstrated similar performance in predicting major trauma (area under the receiver operator characteristic curve (AUROC 0.63); 95% CI 0.61-0.64 for prehospital; 0.63; 95% CI, 0.61-0.64 for ED). When combining prehospital and ED vital signs into a single model, predictive power increased (AUROC 0.66, 95% CI 0.65-0.67).</p><p><strong>Conclusions: </strong>We identified poor correlation between prehospital and ED vital signs. In both settings, vital sign abnormalities were associated with major trauma. The combined use of prehospital and ED vital signs improved predictive value for major trauma, suggesting potential for future integration into trauma triage tools.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773095","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":"Genre of Music Festivals as a Predictor for Medical Utilization Rate.","authors":"G D van Dijken, J S W R Hofsteede, A E Hoek, D Dekker, D W de Lange","doi":"10.1080/10903127.2025.2481143","DOIUrl":"10.1080/10903127.2025.2481143","url":null,"abstract":"<p><strong>Objectives: </strong>The medical utilization rates (MUR) can be applied to anticipate necessary medical resources at mass gatherings. The MUR describes the number of patients per thousand attendees. The aim of this observational study was to evaluate whether the type of music festival, Electronic Dance Music Festivals (EDMF) versus Mainstream, is related to the MUR and to drug-related incidents.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patient data from Event Medical Service B.V., a Dutch company, providing emergency care at many festivals in the Netherlands. Data were collected in an online database between February 2022 and August 2023. The number of patient contacts per festival type was recorded and patients requiring advanced medical care (unable to sit, potentially hemodynamically unstable, and/or requiring advanced medical care), were analyzed for drug-related causes.</p><p><strong>Results: </strong>A total of 20,829 patients presented at 518 events with a total attendance of almost 7.5 million visitors. There were 253 EDMF events with a median attendance of 12,000 and 265 mainstream events with a median attendance of 10,000 per event. The average MUR for the EDMF group was higher compared to the Mainstream group (28.8 vs. 17.8, <i>p</i> < 0.001). A total of 1,732 patients needed advanced medical care. The proportion of drug<b>-</b>related cases among the patients needing advanced medical care, mainly stimulants and combined drug use, was 74% for the EDMF group compared to 52% in the mainstream group (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In this observational study we found a clear difference in MUR in Electronic Dance Music events compared to Mainstream events with a higher percentage of drug-related cases in patients with more severe conditions at EDMF events. Our findings may help to better plan scarce medical resources at mass gatherings in the music scene and suggest that EDMF need a targeted approach for more drug-related pathology.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721125","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":"Epidemiology of Neonatal Prehospital Care at the San Diego (US) - Tijuana (Mexico) International Border.","authors":"Sriyansh Yarlagadda, Michael Hazboun, Gary Vilke, Jennifer Farah, J Joelle Donofrio-Odmann","doi":"10.1080/10903127.2025.2476196","DOIUrl":"10.1080/10903127.2025.2476196","url":null,"abstract":"<p><strong>Objectives: </strong>Neonates, infants 30 days of age or younger are understudied in prehospital emergencies. Our objective was to describe prehospital assessment and care for patients <30 days of age at the San Diego-Tijuana Point of Entry (POE). Additional objectives included describing assessments, care, frequency, and level of care for newborns brought to the border by Mexican ambulances.</p><p><strong>Methods: </strong>This was a retrospective analysis from January 1, 2014, to January 01, 2020, of all 9-1-1 calls involving patients <30 days of age at the San Diego POEs. The 9-1-1 responses to newly delivered patients were \"newborns\". Patients who were not immediately post-delivery were \"neonates.\" Patient demographics, response intervals, clinician interventions, and dispositional data were collected from electronic patient records. Descriptive statistics were applied.</p><p><strong>Results: </strong>A total of 57 patients <30 days of age were included. With 27 newborn patients, 15 were delivered by emergency medical services (EMS) personnel (27, 55.6%). Initial appearance, pulse, grimace, activity, and respiration (APGAR) scores were 8-10 in 44.4% and 5-7 in 29.6%. Procedures included newborn care (88.9%), advanced life support (ALS) assessment (63.0%), and warming (59.3%). There were five patients that had stimulation, 7 received oxygen, and 3 received Bag-Valve-Mask (BVM) ventilation. No serial heart rates were documented. Regarding 30 neonates, the predominant method of transport to the POE was Mexican ambulance (<i>n</i> 16, 53.3%). Medications administered included oxygen (<i>n</i> 16, 53.3%) and albuterol/ipratropium (<i>n</i> 1, 3.3%). Procedures included ALS assessment (<i>n</i> 19, 63.3%), pulse oximetry (<i>n</i> 22, 73.3%), and 3-lead electrocardiogram (<i>n</i> 8, 26.7%). Three patients (10%) received BVM. Mexican Ambulances brought 16 neonates. A physician or nurse was present in 37.5% of transfers, 50% were incubated, 25% intubated, 37.5% on supplemental oxygen, and 71% had preexisting intravenous access. These were not interfacility transfers but were 9-1-1 activations by U.S. border agents; and 14 neonates did not arrive via Mexican ambulance. Their complaints were respiratory distress (<i>n</i> 7, 50%) and Brief Resolved Unexplained Episode (<i>n</i> 4, 28.6%).</p><p><strong>Conclusions: </strong>We found that 9-1-1 transports at the San Diego-Tijuana POE for patients <30 days were few and involved resuscitation, neonates in Mexican ambulances with specialized equipment, physicians, and unfamiliar medications. Neonates arriving <i>via</i> private transport had respiratory distress and BRUE.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paramedic i-gel^® Placement and Perception of Use in Prehospital Airway Management.","authors":"Kelsey Wilhelm, Jake Toy, Jonathan Warren, Ryan DeVivo, Dipesh Patel, Denise Whitfield, Saman Kashani, Nancy Alvarez, Jennifer Nulty, Adrienne Roel, Jenny Van Slyke, Marianne Gausche-Hill, Nichole Bosson","doi":"10.1080/10903127.2025.2479562","DOIUrl":"10.1080/10903127.2025.2479562","url":null,"abstract":"<p><strong>Objectives: </strong>Use of supraglottic airways by emergency medical services (EMS) clinicians has increased for patients of all ages. However, data are limited on real-world use in the prehospital setting, including success rates, complications, and paramedic experience. The objective of this study was to determine frequency of successful i-gel^® insertion and associated complications, and to describe paramedic perception of i-gel^® use.</p><p><strong>Methods: </strong>This was a prospective study of i-gel^® use in adult patients at four fire-based EMS Provider Agencies in Los Angeles (LA) County from June to September 2021. All paramedics received asynchronous and hands-on training prior to implementation. The i-gel^® was indicated for adult patients in respiratory and/or cardiac arrest of any etiology, as directed by LA County protocols. Patients were included if a paramedic attempted i-gel^® placement at any point. After transition of care, paramedics completed a web-based questionnaire and contacted an on-call EMS physician investigator to discuss the case. Further data were abstracted from the EMS electronic patient care record. The primary outcome was successful placement of i-gel^® based on adequate ventilation post insertion confirmed with capnography. Secondary outcomes were frequency of complications and paramedic perceived ease of placement and of ventilation with i-gel^® measured on a 5-point Likert scale. Descriptive statistics were reported.</p><p><strong>Results: </strong>Of the 102 adult patients, 55 (54%) were female and the median age was 69 years (IQR 53-79). The majority 91 (89%) of the patients had a paramedic impression of non-traumatic cardiac arrest. Placement was successful in 90 (88%) patients overall with 85 (83%) i-gel^® insertions successful on the first attempt. Complications included: 28 (28%) cases with regurgitation/emesis, bleeding (8, 8%), hypoxia (7, 7%), and dislodgement (5, 5%). Among cases of successful i-gel^® placement, the majority of paramedics rated both ease of placement and ease of ventilation as \"very easy\" (69% and 78%, respectively) or \"somewhat easy\" (23% and 9%).</p><p><strong>Conclusions: </strong>Paramedics were successful in 88% of i-gel^® insertion attempts with the most common complication being regurgitation/emesis. Paramedics rated the ease of placement and ease of ventilation of the i-gel^® device as \"very easy\" or \"somewhat easy\" in the vast majority of cases.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754299","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":"Examining the Impacts of Migration on the Mental Health of EMS Clinicians in a Southwestern U.S. State.","authors":"Christine Crudo Blackburn, Claire A Pernat, Mayra Rico, Lauren Knight, Brandy Sebesta, Kirk Niekamp","doi":"10.1080/10903127.2025.2483355","DOIUrl":"10.1080/10903127.2025.2483355","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the impact of migration across the United States southern land border on the mental health of emergency medical services (EMS) clinicians in the border region.</p><p><strong>Methods: </strong>We conducted 67 in-depth interviews with fire-based EMS clinicians in three communities. Interviews took place from June 23 to 27, 2024. We conducted thematic analysis using inductive, latent coding in NVivo 14© software.</p><p><strong>Results: </strong>Primary themes identified were that EMS clinicians were emotionally impacted by helping migrants, that calls to provide care to migrants often led EMS clinicians to feel overwhelmed, and that EMS clinicians have developed support systems and coping mechanisms for the mental health impacts of their job.</p><p><strong>Conclusions: </strong>Given the complex environment of the border region and the uniqueness of migrant-related emergency calls, EMS clinicians in the border region need greater mental health support.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692961","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":"Opportunities for Physical Activity Behavior Change Among Emergency Medical Services Clinicians: Qualitative Investigation.","authors":"Michael W Supples, Allison M Chandler, Jason T Fanning, Anna C Snavely, Nicklaus P Ashburn, Stephen L Powell, James E Winslow, Jason P Stopyra, Justin B Moore, Simon A Mahler","doi":"10.1080/10903127.2025.2479124","DOIUrl":"10.1080/10903127.2025.2479124","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians often do not achieve sufficient levels of physical activity. We investigate behavioral determinants that influence participation in physical activity among EMS clinicians.</p><p><strong>Methods: </strong>We enrolled EMS clinicians from a North Carolina third-service EMS agency in 2023. A trained qualitative investigator conducted twenty virtual, 30-minute, individual, semi-structured interviews using an interview guide developed by experts in physical activity behaviors, EMS, and qualitative research. Interviews were guided by the Theoretical Domains Framework and Capability Opportunity Motivation Behavior Change Model. Structured interviews were digitally recorded and transcribed verbatim by a professional transcription service. Transcriptions were verified against audio for accuracy and de-identified. A codebook was established using a hybrid inductive/deductive approach, and thematic analysis was performed.</p><p><strong>Results: </strong>The 20 participants had a median age of 31 years (IQR 27-34), of which 65% (13/20) were female. Several key themes emerged that represent opportunities for behavioral intervention. First, physical activity is often viewed as a process requiring high inhibitory self-regulation and is often paired with highly restrictive behaviors, which likely leads to existing poor behavioral habits. Existing confidence in being physically active was often tied to goal setting and mastery experiences, suggesting an opportunity to leverage specific and achievable goal setting, self-monitoring, and feedback. Further, EMS clinicians often struggle with incorporating physical activity amid work and life demands in a practical, sustainable way. They also identified a lack of available time, resources, and organizational support. High-quality social networks are foundational behavior change components and were often lacking among participants.</p><p><strong>Conclusions: </strong>Behavioral determinants of physical inactivity included a theme of negative implicit associations around physical activity among some participants and need for achievable goal setting, self-monitoring, and building positive social support networks. Further investigation is needed to develop and test toolsets to improve physical activity behaviors among EMS clinicians.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625664","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":"Effectiveness of Prehospital Critical Care Scene Response for Major Trauma: A Systematic Review.","authors":"Jeremy Penn, Ryan McAleer, Carolyn Ziegler, Sheldon Cheskes, Brodie Nolan, Johannes von Vopelius-Feldt","doi":"10.1080/10903127.2025.2483978","DOIUrl":"10.1080/10903127.2025.2483978","url":null,"abstract":"<p><strong>Objectives: </strong>Major trauma is a leading cause of morbidity and mortality worldwide. It is unclear if the addition of a critical care response unit (CCRU) with capabilities comparable to hospital emergency departments might improve outcomes following major trauma, when added to Basic or Advanced Life Support (BLS/ALS) prehospital care. This systematic review describes the evidence for a CCRU scene response model for major trauma.</p><p><strong>Methods: </strong>We searched Medline (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL (EBSCOhost), Science Citation Index Expanded (Web of Science), Conference Proceedings Citation Index - Science (Web of Science), LILACS (Latin American and Caribbean Health Sciences Literature) for relevant publications from 2003 to 2024. We included any study that compared CCRU and BLS/ALS care at the scene of major trauma, reported patient-focused outcomes, and utilized statistical methods to reduce bias and confounding. The risk of bias was assessed by two independent reviewers, using the ROBINS-I tool. Based on our a priori knowledge of the literature, a narrative analysis was chosen. The review was prospectively registered (PROSPERO ID CRD42023490668).</p><p><strong>Results: </strong>The search yielded 5243 unique records, of which 26 retrospective cohort studies and one randomized controlled trial met inclusion criteria. Sample sizes ranged from 308 to 153,729 patients. Eighteen of the 27 included studies showed associations between CCRUs and improved survival following trauma, which appear to be more consistently found in more critically injured and adult patients, as well as those suffering traumatic cardiac arrest. The remaining nine studies showed no significant difference in outcomes between CCRU and BLS/ALS care. Most studies demonstrated critical or severe risks of bias.</p><p><strong>Conclusions: </strong>Current evidence examining CCRU scene response for major trauma suggests potential benefits in severely injury patients but is limited by overall low quality. Further high-quality research is required to confirm the benefits from CCRU scene response for major trauma.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Spector Job Satisfaction Survey: Associations of Satisfaction with Leaving EMS.","authors":"Christopher B Gage, Lakeshia Logan, Jacob C Kamholz, Jonathan R Powell, Shea L van den Bergh, Eben Kenah, Ashish R Panchal","doi":"10.1080/10903127.2025.2482100","DOIUrl":"10.1080/10903127.2025.2482100","url":null,"abstract":"<p><strong>Objectives: </strong>Detailed job satisfaction evaluations are often used to build strategies for employee retention. Despite recognizing that emergency medical services (EMS) dissatisfaction drives turnover, validated tools rigorously evaluating satisfaction have not been employed. We aim to assess the association between EMS clinician satisfaction and their likelihood of leaving the profession using the validated Spector Job Satisfaction Survey (JSS).</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of nationally certified EMS clinicians in the United States recertifying between October 2022 and April 2023. Our primary outcome was the self-reported likelihood of leaving EMS within 12 months (likely or not likely to leave). The primary exposure was job satisfaction, assessed using the 36-item JSS, scored from 36 to 216, and analyzed in two models: total satisfaction (dissatisfied [scores 36-108], ambivalent [108-144], satisfied [144-216]), and satisfaction subscales (e.g., pay, promotion, supervision). We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify key predictors of intent to leave EMS, adjusting for demographic and agency characteristics. Post-LASSO Bayesian logistic regression estimated odds ratios (OR) and 95% credible intervals (CrI).</p><p><strong>Results: </strong>Among 33,414 EMS clinicians (response rate: 26.3%), the median age was 36 years (IQR: 29,46), 74.2% were male, and 83.0% were White, non-Hispanic. Most respondents worked full-time (77.6%), primarily as EMTs (48.5%), in urban settings (89.9%). Mean satisfaction scores were higher among those not likely to leave EMS (146.7 [standard deviation: 29.0]) than those likely to leave (121.2 [28.4]). Odds of leaving decreased for more satisfied clinicians: ambivalent clinicians [0.35 (0.32-0.38)]; satisfied clinicians [0.11 (0.10-0.13)]; referent dissatisfied. Additionally, specific satisfaction subscales were associated with lower odds of leaving for those satisfied compared to those dissatisfied, including nature of work [0.32 (0.28-0.37)], pay [0.46 (0.40-0.52)], promotion opportunities [0.53 (0.47-0.61)], supervision [0.65 (0.57-0.73)] and contingent rewards [0.77 (0.67-0.88)].</p><p><strong>Conclusions: </strong>The EMS clinicians with higher satisfaction with their nature of work, pay, and promotion opportunities were less likely to report intent to leave. These findings highlight key factors that may inform workforce retention efforts.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664311","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":"Improving Bystander Response: How Long Does It Take to Retrieve an AED From Varying Distances.","authors":"Erin R Gramm, Jorge A Gumucio, Kate Flickinger, David D Salcido, James J Menegazzi","doi":"10.1080/10903127.2025.2475323","DOIUrl":"10.1080/10903127.2025.2475323","url":null,"abstract":"<p><strong>Objectives: </strong>Survival from out-of-hospital cardiac arrest (OHCA) is low, with less than 10% surviving to hospital discharge. Early defibrillation can improve survival from an OHCA with a shockable rhythm. Cell phone applications alert rescuers as to where victims are and where automated external defibrillators (AEDs) are located, but guidance on choosing between going to the victim and doing cardiopulmonary resuscitation and retrieving an AED is lacking. We sought to determine the time required to retrieve AEDs at varying distances in a real-life setting. At a distance greater than 400 meters away, that AED retrieval time will be longer than median emergency medical services (EMS) first response time of 6.9 min, based on national data from the Cardiac Arrest Registry to Enhance Survival (CARES) registry.</p><p><strong>Methods: </strong>Thirty study participants (15 male, 15 female) performed four AED retrieval runs, separated by at least 24 h. Three runs simulated a real-life OHCA situation outdoors on a busy street in our city (in all four seasons), and one was unimpeded on an indoor track. The AED retrieval distances were 200 meters (400 roundtrip), 400 meters (800 roundtrip), and 600 meters (1,200 roundtrip) The middle distance (400/800 meters) was chosen for the track run.</p><p><strong>Results: </strong>The mean run times were 4.05 min for the 200/400 m retrieval, 6.62 min for the 400/800 m, 8.62 min for the 600/1,200 m, and 4.35 min for the 400/800 m track run, which is 2.3 min shorter than the 400/800 m real-life run and significantly different (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Barriers to mobility, like traffic lights, motor vehicles, weather conditions, and pedestrians, have significant impacts on how long it takes for an AED to be retrieved and returned to the patient's side. Using these simulation runs, we demonstrated that short AED retrieval distances are likely necessary to impact survival. When compared to our national EMS first response times, only the 200/400 m retrieval distance would likely provide sufficient time for a responder to retrieve, arrive at the patient's side and utilize an AED prior to EMS arrival.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692967","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}