Prehospital Emergency Care最新文献

{"title":"Incidence of Adverse Events with Prehospital Use of Droperidol for Nausea or Vomiting.","authors":"Aleksander W Keller, Michael P Galie, Benjamin J Miller, Christian Martin-Gill","doi":"10.1080/10903127.2026.2677850","DOIUrl":"10.1080/10903127.2026.2677850","url":null,"abstract":"<p><strong>Objectives: </strong>In 2019, droperidol was re-introduced for the treatment of nausea or agitation among emergency medical services (EMS) agencies. Despite a reduced dose used for nausea/vomiting compared to agitation, patients may still experience unwanted sedation. Some protocols recommend an even lower dose for certain patients, such as older adults (age ≥65 years), to avoid oversedation. However, there are limited data to support this practice. We aimed to identify the incidence of adverse events following the use of droperidol for nausea and vomiting and secondarily whether older patients had an increased likelihood of adverse events.</p><p><strong>Methods: </strong>We performed a retrospective observational cohort study of a convenience sample of patients treated by 29 EMS agencies for nausea/vomiting with droperidol and transport to one of 9 hospitals between March 2022 and December 2023. We identified the incidence of adverse events including hypotension (systolic blood pressure <90mmHg), hypoventilation (respiratory rate <10 or end tidal carbon dioxide >50mmgHg), hypoxia (pulse oximetry <90% or need for supplemental oxygen), or decreased mental status (GCS <15) either prehospital or in the emergency department. Additionally, we performed a multivariable logistic regression to evaluate the association of adverse events with older age, controlling for sex, weight, route of administration, and if any other sedative was given.</p><p><strong>Results: </strong>A total of 284 cases were included and most (90.1%) received a dose of 1.25 mg. At least one adverse event was experienced by 44 (15.5%) patients, most commonly decreased mentation (GCS <15; <i>n</i> = 24, 8.5%). Hypoxia was experienced by 19 (6.7%) patients, mostly in older adults (<i>n</i> = 12, 13.2%) while hypotension or hypoventilation was experienced by <5%. In multivariable analysis, older patients had a similar odds of adverse events compared to other adults (OR 1.79, 95% CI 0.91-3.51).</p><p><strong>Conclusions: </strong>We identified an adverse event in about 15% of prehospital patients receiving droperidol for nausea and vomiting, most commonly mild sedation, with very limited serious adverse events. Incidence of sedation was similar among older patients and other adults. Further investigation is warranted to evaluate effectiveness versus adverse events with different droperidol doses and compared to other antiemetics.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043179","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":"External Validation of the SCARE Score for Predicting Acute Myocardial Infarction in Patients Calling Emergency Medical Communication Centers: A Prospective Multicenter Study.","authors":"Vincent Garrouste, Audrey Guerineau, Jeremy Guenezan, Thomas Moumneh, Sophie Narcisse, Paul Louis Martin, Olivier Giovannetti, Florie Bouvier, Romain Jouffroy","doi":"10.1080/10903127.2026.2677853","DOIUrl":"10.1080/10903127.2026.2677853","url":null,"abstract":"<p><strong>Objectives: </strong>Chest pain triage during emergency medical dispatch must balance early identification of acute myocardial infarction (AMI) with appropriate allocation of prehospital resources. Our objectives were to externally validate the SCARE score for discrimination of hospital-diagnosed AMI among adults hospitalized after Emergency Medical Communication Center (EMCC) calls for non-traumatic chest pain and to evaluate performance by sex.</p><p><strong>Methods: </strong>This prospective observational multicenter study included adults hospitalized after an EMCC call for non-traumatic chest pain in four French physician-staffed EMCCs between October 2019 and February 2020. During calls, clinicians prospectively recorded standardized variables used to reconstruct the SCARE score retrospectively; the score was unavailable in real time and did not influence dispatch decisions. The primary analysis assessed the SCARE score's ability to discriminate hospital-diagnosed AMI adjudicated from hospital records according to the Fourth Universal Definition of Myocardial Infarction. Discrimination was assessed using the AUROC, with sex-stratified analyses as a secondary objective, and threshold-based test characteristics were additionally reported for the pre-specified high-risk threshold of >35 points. Calibration was explored using the Hosmer-Lemeshow test and Brier score.</p><p><strong>Results: </strong>Among 2,042 analyzed patients, 265 (13.0%) had AMI. The SCARE score showed good discrimination, with an AUROC 0.85 (95% CI 0.82-0.87). Calibration appeared acceptable (Hosmer-Lemeshow <i>p</i> = 0.637; Brier score = 0.095). At the prespecified high-risk threshold of >35 points, sensitivity was 73.6% (95% CI 67.9-78.5), specificity 75.3% (95% CI 73.2-77.2), positive predictive value 30.8% (95% CI 27.3-34.5), and negative predictive value 95.0% (95% CI 93.7-96.0). AMI increased from 2.4% in the low-risk category to 31.0% in the high-risk category. In sex-stratified analyses, AUROC was 0.84 (95% CI 0.81-0.86) in men and 0.89 (95% CI 0.86-0.92) in women (DeLong <i>p</i> = 0.006).</p><p><strong>Conclusions: </strong>In this multicenter cohort of patients hospitalized with chest pain after calling a French EMCC, the SCARE score showed good discrimination for hospital-diagnosed AMI and may support prioritization of advanced prehospital resources. However, it should not be used as a stand-alone rule-out tool and does not address other life-threatening causes of chest pain. Prospective validation in all chest pain callers and in non-physician dispatch systems is needed.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056447","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 Outcomes Associated with an Initial Strategy of Intranasal versus Intramuscular Naloxone Administration by EMS Clinicians: A Nationwide Cohort Study.","authors":"Tanner Smida, Remle Crowe, Melody Glenn, Anjni Joiner, James Bardes","doi":"10.1080/10903127.2026.2673361","DOIUrl":"10.1080/10903127.2026.2673361","url":null,"abstract":"<p><strong>Objectives: </strong>Previous studies have suggested that intranasal (IN) naloxone is less effective than intramuscular (IM) naloxone at reversing opioid toxicity but may result in a lower prevalence of precipitated withdrawal. Because limited real-world comparisons have been performed, we aimed to compare initial strategies of IM or IN naloxone administration by emergency medical services (EMS) clinicians using a nationwide dataset.</p><p><strong>Methods: </strong>We included all adult (>18 years of age) patients in the 2023-2024 ESO Data Collaborative research datasets who received intranasal or intramuscular (IN or IM) naloxone from EMS following a 9-1-1 call. We used multilevel mixed-effects logistic regression with EMS agency as a random intercept to estimate the association between initial naloxone route and the outcomes of post-naloxone cardiac arrest, hypoxia (SpO₂ < 90%), additional naloxone dosing, return to a respiratory rate >12, return to a Glasgow Coma Scale (GCS) >12, treatment for nausea/vomiting or agitation, and EMS transport. We included age, sex, race/ethnicity, time to naloxone (dispatch to drug administration), overdose location, documented history of intravenous drug use, and treatment year in our regression models.</p><p><strong>Results: </strong>We analyzed 16,550 patients treated by 1,481 EMS agencies, of whom 3,286 (20%) received their first dose of naloxone <i>via</i> the IM route. In comparison to patients treated with an initial strategy of IN administration, patients who received IM naloxone had lower odds of receiving additional naloxone (aOR: 0.39 [0.35, 0.44]), lower odds of receiving EMS transport (aOR: 0.82 [0.71, 0.95]), and higher odds of returning to a GCS >12 (aOR: 1.15 [1.01, 1.30]). The initial route of naloxone administration was not associated with the odds of cardiac arrest (aOR: 0.84 [0.57, 1.26]), hypoxia (aOR: 0.90 [0.80, 1.00]) return to a respiratory rate >12 (aOR: 1.02 [0.83, 1.26]), or treatment for nausea/vomiting (aOR: 0.97 [0.80, 1.17]) or agitation (aOR: 1.06 [0.81, 1.39]).</p><p><strong>Conclusions: </strong>In this large cohort, initial IM naloxone administration was associated with more favorable physiologic and operational outcomes compared with an initial IN strategy. Importantly, IM administration was not associated with increased EMS treatment for agitation or nausea/vomiting, which suggests no observed increase in precipitated withdrawal in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974596","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":"Development and Institutional Implementation of a Prehospital Emergency Care Protocol for Individuals with Autism Spectrum Disorder.","authors":"Nathan S Colonetti, Maiara A Costa, Henrique P Silveira, Ana Paula S Freitas, Cinara L Gonçalves","doi":"10.1080/10903127.2026.2680994","DOIUrl":"10.1080/10903127.2026.2680994","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital emergency environments are characterized by high sensory load, time pressure, and unpredictable dynamics - conditions that may exacerbate distress and behavioral dysregulation in individuals with Autism Spectrum Disorder (ASD). Despite increasing emergency service utilization among individuals with ASD, structured prehospital protocols tailored to their needs remain limited. To describe the development and institutional implementation of a prehospital emergency care protocol adapted for individuals with ASD within a state-level emergency medical service system.</p><p><strong>Methods: </strong>A structured, multi-stage protocol development process was conducted between September 2023 and OCTOBER 2024. The process included (1) targeted literature review on ASD-specific emergency care (2), interdisciplinary expert meetings involving a psychologist, physician, ASD researcher, and emergency medical services trained firefighter, and (3) iterative refinement of operational procedures adapted from existing institutional standard operating protocols. Consensus was reached through structured discussions until full agreement was achieved among panel members. The final protocol was formally approved and implemented by the Santa Catarina Military Fire Department (Brazil) as an official Standard Operating Procedure (No. 03/2024).</p><p><strong>Results: </strong>The resulting protocol provides operational guidance across five stages of prehospital care: emergency call triage, approach to scene, on-scene primary and secondary assessment, in-ambulance management, and transfer of care. Key components include sensory load reduction strategies, structured communication guidance, caregiver involvement, behavioral crisis management considerations, and environmental adaptations during transport. Institutional adoption enabled integration into routine training activities and operational workflows.</p><p><strong>Conclusions: </strong>To our knowledge, this study presents the first institutionally implemented state-level prehospital protocol in Brazil specifically designed for individuals with ASD. The protocol offers a structured, operationally feasible framework to improve safety, reduce sensory distress, and support emergency responders in managing neurodivergent patients. Future research should evaluate its impact on responder confidence, care quality, and patient-centered outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042850","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":"Use of Double Sequential External Defibrillation in the United States Before and After the DOSE VF Randomized Clinical Trial.","authors":"Tanner Smida, Remle Crowe, Ian R Drennan, Jefferson G Williams, Damon C Scales, José G Cabañas, Jonathan R Studnek, Andrew W Godfrey, Aadil Bharwani, Sheldon Cheskes","doi":"10.1080/10903127.2026.2674263","DOIUrl":"10.1080/10903127.2026.2674263","url":null,"abstract":"<p><strong>Objectives: </strong>The Double Sequential External Defibrillation for Refractory Ventricular Fibrillation (DOSE VF) trial demonstrated improved outcomes for patients randomized to double sequential external defibrillation (DSED) in comparison to standard defibrillation, yet large-scale data on prehospital DSED use remain limited. We evaluated prehospital DSED use before and after publication of DOSE VF.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of adult (>18 years of age) non-traumatic out-of-hospital cardiac arrest (OHCA) patients who had an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia and at least 4 successive defibrillation attempts in the ESO Data Collaborative from 2018-2024. We excluded patients with return of spontaneous circulation prior to the fourth defibrillation, resuscitation-limiting advanced directives, or OHCA due to drowning or overdose. To minimize the influence of agencies joining the Collaborative during the study period, we excluded agencies that did not contribute data during the first study year. We identified DSED using three methods: 1.) documentation of <i>\"Dual Sequence Defibrillation (DSD)</i>\", 2.) defibrillation at a 400 J or 720 J energy setting, or 3.) two defibrillations within 5 s. The DOSE VF trial was published in November 2022, and Q4 2022 was used as a washout period. We classified patients as treated pre-DOSE VF if treated before Q4 2022, and post-DOSE VF if treated after Q4 2022. We compared pre- and post-DOSE VF use of DSED using Pearson's 𝜒² test and an interrupted time-series analysis using segmented Poisson regression with 3-month non-overlapping segments.</p><p><strong>Results: </strong>We identified 16,450 DSED-eligible patients treated by 906 emergency medical services agencies. Estimates of DSED use varied by ascertainment method (Method 1: 3.7%, Method 2: 1.8%, Method 3: 4.4%, any method: 7.6%). The use of DSED detected by any method increased post-DOSE VF (pre vs. post: 822/11,228 (7.3%) vs. 381/4,625 (8.2%), <i>p</i> = 0.048). Segmented Poisson regression suggested an increase in the rate of DSED use (slope change) after DOSE VF (RR: 1.09 (1.04, 1.14) per quarter).</p><p><strong>Conclusions: </strong>Our findings suggest an increasing rate of DSED use after publication of DOSE VF, but the proportion of eligible patients receiving DSED remains low. Limitations include the potential for patient misclassification by our DSED ascertainment methods.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147974670","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":"Professionalism in Emergency Medical Services: A People-Centered Approach to Prehospital Care-A Position Statement and Resource Document.","authors":"Marianne Gausche-Hill, Martin Pelletier, Beth Adams, Bijan Arab, Jonathon W Jenkins, Adam Kipust, James Li, Leah Colucci, Elizabeth Fagan, Kevin F Jura, Mark Sparkman, Thomas E Platt, Chris Warrick","doi":"10.1080/10903127.2026.2669615","DOIUrl":"10.1080/10903127.2026.2669615","url":null,"abstract":"<p><p>Professionalism is an important construct in emergency medical services (EMS) clinical practice. It encompasses a broad range of characteristics in the affective domain and is critical to the creation of effective EMS clinical and administrative teams. Prehospital clinicians play a unique role on the health care team. They are called to a variety of locations for serious illness or injury at a time a patient or a family member is experiencing a crisis in their lives. Patients trust EMS professionals to enter their home, to respect their autonomy, to provide expert medical care, and to transport them to the right place at the right time.</p><p><p>Patient-centered care is the 'north star' for EMS clinicians and maintaining professionalism is the core value that allows for quality care of all patients 24/7/365. Under stressful conditions, EMS personnel must manage their attitudes, skills, and abilities to advocate for patients and provide the right interventions. Professional behavior at all levels of the EMS organizational structure leads to confidence in the system, support of the professionals providing care, promotion of teamwork within the health care continuum, public trust, a capable and sustainable workforce, and delivery of excellent patient care.</p><p><p>The National Association of EMS Physicians (NAEMSP) recommends: Professionalism should be a core competency of EMS practice for EMS clinicians, educators, medical directors, administrators, and support staff (\"EMS personnel\").Professionalism should provide the framework for prehospital clinical care and builds public trust in EMS systems.Professionalism should be incorporated in initial training and in continuing education for all levels of EMS professionals.Professional behaviors should be modeled by EMS administrative staff, educators, and medical directors.Professionalism should be incorporated into daily interactions of the EMS workforce with staff, colleagues, patients and families.Professionalism should be measured and incorporated into quality and performance improvement plans within EMS systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875471","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":"Factors Associated with the Application of Automated External Defibrillators to Out-of-Hospital Cardiac Arrest Patients in Japan - A Nationwide Cross-Sectional Study.","authors":"Hinata Kijima, Koshi Nakagawa, Daigo Morioka, Ryu Kimura, Hiroyuki Takahashi, Hideharu Tanaka","doi":"10.1080/10903127.2025.2598838","DOIUrl":"10.1080/10903127.2025.2598838","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of this study were to evaluate factors associated with automated external defibrillator (AED) application to out-of-hospital cardiac arrest (OHCA) patients.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the All-Japan Utstein and Emergency Transport Registries for 2021. The application of AED was classified according to the bystander defibrillation field in the Utstein data. Cases where an AED was applied and the AED pads were attached were defined as \"AED applied\" and those with unknown AED application as \"AED not applied.\" Multivariable logistic regression was used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors related to AED applied.</p><p><strong>Results: </strong>A total of 117,790 patients were analyzed (AED applied, <i>n</i> = 12,354 [10.5%]; AED not applied, <i>n</i> = 105,436 [89.5%]). Factors associated with AED applied included daytime occurrence (AOR [95%CI], 1.14 [1.08-1.20] vs. nighttime), conventional cardiopulmonary resuscitation (CPR) (2.29 [2.09-2.50] vs. hands-only CPR), dispatcher assistance (2.02 [1.92-2.12]), and occurrence in a school (3.53 [2.58-4.82] vs. public place). Factors associated with AED not applied included age ≥65 years (0.92 [0.84-0.99] vs. 19-64 years), witnessed by family members (0.55 [0.48-0.64] vs. unwitnessed), no bystander CPR (0.28 [0.26-0.30] vs. hands-only CPR), and occurrences in a home (0.01 [0.01-0.01] vs. public place).</p><p><strong>Conclusions: </strong>The application of AED was associated with patient age, witness status, bystander CPR, and incident location. These findings should inform the placement of AEDs and educational strategies.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213955","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 Role of Emergency Medical Services in Addressing Opioid Use Disorder-A Position Statement and Resource Document of NAEMSP.","authors":"Melody J Glenn, Mary P Mercer, Angela Murrell, Nicholas Simpson, Mary C Knotts, Remle Crowe, Benjamin W Weston, Jose G Cabañas, Todd M Cage, Meredith Hickerson, Anjni P Joiner","doi":"10.1080/10903127.2026.2668009","DOIUrl":"10.1080/10903127.2026.2668009","url":null,"abstract":"<p><p>Opioid overdose remains one of the most urgent public health crises in the United States, and for many individuals, the first and sometimes only encounter with health care comes through emergency medical services (EMS). As a result, the role of EMS has evolved far beyond reversing overdoses in the moment. Opioid use disorder (OUD) is a treatable medical disease with effective treatment, and EMS agencies are uniquely positioned to partner with local community resources and hospitals to combine efforts in implementing harm-reduction and treatment strategies. This document provides specific guidance for EMS agencies seeking to build or expand comprehensive programs addressing OUD through a variety of evidence-based approaches.</p><p><p>The National Association of EMS Physicians recommends:State and local EMS oversight entities should ensure that EMS clinician scope of practice allows for administration of medications for opioid use disorder (MOUD), specifically buprenorphine.EMS Systems should establish low-barrier program and protocols for prehospital administration of medications for opioid use disorder (MOUD), specifically buprenorphine, and integrate the program with available community resources.EMS Medical Directors should collaborate with other system leaders to implement validated protocols for the treatment and safe disposition of patients including navigation of patients to alternate destinations or treatment in place.EMS Systems should collaborate with other system leaders on harm reduction strategies, including opioid education and naloxone distribution.EMS Systems should consider community engagement and input into the design, implementation, and quality improvement efforts for programs to address opioid use disorder, andEMS clinicians should receive comprehensive and adaptive education programs that address the pharmacological and biopsychosocial aspects of OUD and reducing stigma.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875477","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":"Health and Medical Preparedness and Response to the 2024 Republican National Convention.","authors":"Tom Grawey, J Marc Liu, Thomas Engel, Dan Pojar, Michael Cieciwa, Richard Boeshaar, Mike Totoraitis, David Hensley, Benjamin Weston","doi":"10.1080/10903127.2026.2650540","DOIUrl":"10.1080/10903127.2026.2650540","url":null,"abstract":"<p><strong>Objectives: </strong>Every four years, the Republican National Convention (RNC) is hosted, selecting the party's nominee for president. In 2024, this event brought 50,000 people to Milwaukee, Wisconsin. This required significant preparation and planning between local, state and federal leaders to ensure the safety of the attendees while minimizing impact on health care delivery to the community. The planning and outcomes of this National Security Special Event are described.</p><p><strong>Methods: </strong>We used an observational study design of EMS patient care records documented by Milwaukee County EMS agency from July 15^th, 2024 to July 18^th, 2024. Descriptive analysis was performed based on event leadership recollection, correspondence and meeting notes in preparation for and during the event. Preparedness plans, staffing documents, prehospital treatment guidelines and patient care data from the event were gathered and utilized to describe event operations with attention to successes and areas for improvement.</p><p><strong>Results: </strong>Substantial collaboration and preparation led to a safe and successful event. Local and regional health resources provided emergency medical services, medical aid stations, and other health related planning and implementation. There were no mass casualty incidents, mass arrests, public health emergencies, or staffing crises. The event served as an opportunity to review and exercise local disaster preparedness plans. A combination of low patient presentation rates and advanced prehospital care on scene at the event minimized the impact on local health systems.</p><p><strong>Conclusions: </strong>Multi-disciplinary collaboration was essential for this event, which required substantial financial, operational and personnel resources. As experts in their communities, local health care leaders must work collaboratively with federal assets in the planning and event implementation. A lack of funding for health care resources meant in kind contributions were required, with many individuals volunteering their time. In the future, dedicated funding for health and medical preparedness may strengthen a community's response to such a large event.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147514297","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":"Can a Large Language Model Grounded in Text-Based Agency-Specific Prehospital Protocols Provide Accurate Care Recommendations?","authors":"Colin G Wang, Nichole Bosson, Rombod Rahimian, Shira Schlesinger, Denise Whitfield, Jake Toy","doi":"10.1080/10903127.2026.2668008","DOIUrl":"10.1080/10903127.2026.2668008","url":null,"abstract":"<p><strong>Objectives: </strong>Large language models (LLMs) using a retrieval-augmented generation (RAG) approach have the ability to respond to user queries with answers grounded in specific sources. We conducted an exploratory evaluation of the accuracy of a RAG-based LLM to provide care recommendations for prehospital scenarios based on the emergency medical services (EMS) policies and treatment protocols (TPs).</p><p><strong>Methods: </strong>We conducted a non-human, simulation-based experimental study by uploading all text-based policies/TPs from a single large EMS system into Google's NotebookLM platform, which uses a RAG-based LLM (Gemini 2.5 Flash) framework to generate grounded responses. We developed six clinical scenario prompts, including adult patient scenarios (i.e., ventricular fibrillation out-of-hospital cardiac arrest [OHCA], blunt head trauma, stroke, hazardous materials exposure mass-casualty incident) and pediatric patient scenarios (i.e., pulseless electrical activity OHCA, traumatic penetrating extremity hemorrhagic shock). For each scenario, we used all relevant policies/TPs to create a specific set of expected patient care actions. We categorized actions as procedures/interventions, medications, and destination guidance. Medication grading included dose/route for all patients and weight-based dosing for pediatrics. After providing the LLM with the prompts, two investigators independently graded the LLM responses and evaluated for LLM \"hallucinations.\" Missing actions were categorized by investigators based on applicability to the case and potential safety risk (e.g., \"non-applicable,\" \"minor miss,\" \"major miss\"). The primary outcome was model recommendation accuracy, defined as the percentage of all actions correctly provided in the model's response. We reported descriptive statistics.</p><p><strong>Results: </strong>The LLM recommended 127 (75%) of 169 patient care actions across all cases. There were 42 missed actions. Nine of the 169 actions (5%) were categorized as \"major misses,\" 13 (8%) as \"minor misses,\" and 20 (12%) as non-applicable to the specific case. Five of nine major misses occurred during the pediatric OHCA case; the majority of these resulted from failure to prompt for evaluation of secondary treatable causes. We identified 12 hallucinations; none were judged to endanger patient safety.</p><p><strong>Conclusion: </strong>We found that a RAG-based LLM demonstrated 75% accuracy across various prehospital scenarios when providing responses grounded in the policies/TPs of a single large EMS agency.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841929","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}