Prehospital Emergency Care最新文献

{"title":"Hospitals Infrequently Receive EMS Patient Care Reports in the Era of Electronic Medical Records: A Preliminary Report.","authors":"John Shanley, Joseph Marcero, Robert Swor","doi":"10.1080/10903127.2024.2438392","DOIUrl":"https://doi.org/10.1080/10903127.2024.2438392","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency Medical Services (EMS) patient care reports (PCRs) are an important component for the transfer of patient care from EMS systems to hospitals and a foundational element of EMS quality improvement (QI). The PCR may serve as the only objective source of information for EMS patient presentation. Surprisingly little data, either objective or anecdotal, exists regarding the reliability of this process. Our objective is to describe the frequency of missing PCRs and the time of their receipt following EMS transport to hospital emergency departments (EDs).</p><p><strong>Methods: </strong>We performed a retrospective study of EMS PCR provision for patients transported to a large single eight hospital health system in Southeast Michigan from 1/1/2022 to 7/1/2023. We included agencies who transported >100 patients annually to system hospitals. All PCRs are transmitted by fax or to email server and manually uploaded into the system's EPIC^® EMR (Electronic Medical Record). We stratified agencies by whether they were primarily 9-1-1 responders or interfacility transport. The PCR receipt by hospital and time of upload were obtained from EPIC Toad Data Point^® queries. Our primary outcome was frequency of PCRs received (in aggregate and by agency) and uploaded to EPIC^®. Our secondary outcome was the interval from EMS arrival to EMR upload. We report descriptive statistics including receipt of PCR (mean, median) by hospital and agency.</p><p><strong>Results: </strong>There were 155,423 patients transported by 63 EMS agencies. Overall, receipt of PCRs varied substantially by hospital mean (SD) 50.6% (23.5), median (IQR) 44.0% (33.9, 70.2). A minority 26.3% (26.2) of these were uploaded within 120 min of hospital arrival. PCRs receipt also varied substantially by agency, with overall median (IQR) of 56.8% (17.2, 83.1).</p><p><strong>Conclusions: </strong>Many PCRs are missing after EMS transport, with marked variation in submission rates and time to upload by agency and hospital. Many PCRs were infrequently available for use in a timely manner. Further assessment is needed to quantify the degree to which the lack of transfer of documentation of EMS patient care exists across emergency care systems.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814127","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":"Smartphone-Enabled Point-of-Care Testing for Prehospital Stroke Diagnosis.","authors":"Paloma Menéndez-Valladares, Rosa M Delgado, David Núñez-Jurado, Lluis Sempere-Bordes, Anna Penalba, Leire Azurmendi, Claudio Parolo, Ana Barragán, Juan Antonio Cabezas, Carmen de Jesús Gil, José Moreno, Rafael Canto Neguillo, Roberto Valverde de Moyano, José Luis García Garmendia, Mercedes García Murillo, Ismael Muñoz Martínez, Antonia Romero Hidalgo, Francisco Aranda Aguilar, Soledad Pérez Sánchez, Jean-Charles Sánchez, Joan Montaner","doi":"10.1080/10903127.2024.2437657","DOIUrl":"10.1080/10903127.2024.2437657","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to evaluate the feasibility of point-of-care testing (POCT) devices for N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement in prehospital settings, with the aim of improving the speed and accuracy of stroke diagnosis, thereby facilitating quicker and more effective patient care.</p><p><strong>Methods: </strong>Prehospital blood samples were collected from suspected stroke patients, and NT-proBNP levels were measured using a POCT device in ambulances and hospitals. Results from the NT-proBNP POCT and smartphone images were analyzed. Plasma samples underwent Elecsys proBNP II immunoassay after storage at -80ºC.</p><p><strong>Results: </strong>A total of 121 suspected stroke patients were included in the study. The correlation between POCT measured by the POCT and immunoassay for NT-proBNP was strong (<i>R</i> = 0.926). Smartphone images also strongly correlated with POCT values at 10 min (<i>R</i>²=0.9716) and 15 min (<i>R</i>²=0.9405). Stability analysis of samples showed consistent NT-proBNP results and a high correlation (<i>R</i> = 0.907) was observed between plasma and whole blood samples for NT-proBNP POCT.</p><p><strong>Conclusions: </strong>This study highlights the potential of NT-proBNP POCT devices in ambulances to expedite stroke diagnosis and management within 10 min. Smartphone integration further enhances efficiency, adding advancement in prehospital stroke management.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771646","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":"An Analysis of 24-Hour Survival Based on Arrival by Atypical Ground Transport Versus Ground Emergency Medical Services.","authors":"Spencer M Knierim, Ian L Hudson, David A Wampler, Rachel M Ely, Andrew D Fisher, Julie A Rizzo, Michael D April, Steven G Schauer","doi":"10.1080/10903127.2024.2436048","DOIUrl":"10.1080/10903127.2024.2436048","url":null,"abstract":"<p><strong>Objectives: </strong>Studies comparing police, privately owned vehicle (POV), and ground Emergency Medical Services (GEMS) trauma transports reveal mixed results. It remains unclear whether using nonstandard transport methods may be beneficial in the setting of certain injuries. We sought to determine 24-h survival after transport by police or POV when compared to GEMS.</p><p><strong>Methods: </strong>We analyzed data from the Trauma Quality Improvement Program datasets from 2020 to 2022 for patients arriving from scene by POV, police, or GEMS. The primary outcome was 24-h survival. Multivariable logistic regression models were used to adjust for confounders. Further stratification was performed by mechanism. We used abbreviated Injury Severity Score (ISS) by body region to assess those with and without penetrating torso trauma.</p><p><strong>Results: </strong>Patients arriving by POV had a lower median age than those arriving by GEMS and a higher proportion of pediatric patients. This group exhibited a lower incidence of blunt trauma but a higher incidence of penetrating trauma, along with fewer serious injuries across all body regions. Across all adjusted models, arrival by POV was associated with higher odds of 24-h survival, except for cases of penetrating torso trauma among pediatric patients. Patients arriving by police also had a lower median age but a reduced proportion of pediatric patients. This group showed a higher proportion of penetrating trauma and serious injuries to the thorax and abdomen. Police arrivals with blunt trauma had higher odds of 24-h survival, while those with penetrating trauma had lower odds of 24-h survival, a pattern consistent when stratifying by ISS greater than 15.</p><p><strong>Conclusions: </strong>This study highlights a survival advantage for trauma patients transported by POV compared to GEMS. Limitations include a lack of prehospital transport time and intervention data. While police transport showed improved survival for blunt trauma, it was associated with worse outcomes for penetrating trauma. These findings suggest that nontraditional transport methods may be beneficial in certain scenarios. Future research should aim to refine transport protocols, investigate the impact of nontraditional methods on transport time, and better understand the impact of prehospital interventions on patient outcomes.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786758","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":"Key Takeaways and Progress on Leveraging EMS in Overdose Response Among Five Learning Collaborative States.","authors":"Erin Daneker, Stephen Murray, Xenya Poole, Marianne Gibson, Dia Gainor","doi":"10.1080/10903127.2024.2432510","DOIUrl":"10.1080/10903127.2024.2432510","url":null,"abstract":"<p><p>The National Governors Association (NGA) Center for Best Practices, in partnership with the National Association of State Emergency Medical Services Officials (NASEMSO), supported five states-Kentucky, Ohio, South Carolina, Vermont, and Wisconsin-in developing and implementing action plans to expand the role of EMS to help prevent overdose events and support individuals with substance use disorders. States undertook initiatives such as pilot programs for EMS-initiated buprenorphine, development of statewide naloxone leave-behind programs, and changes to EMS protocols that enable agencies and clinicians to use evidence-informed best and promising practices that utilize harm reduction strategies and provide opportunities for linkages to treatment.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716705","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 Trauma Compendium: Fluid Resuscitation in Trauma - a Position Statement and Resource Document of NAEMSP.","authors":"Jason McMullan, B Woods Curry, Dustin Calhoun, Frank Forde, J Jordan Gray, Thomas Lardaro, Ashley Larrimore, Dustin LeBlanc, James Li, Sean Morgan, Matthew Neth, Woodrow Sams, John Lyng","doi":"10.1080/10903127.2024.2433146","DOIUrl":"10.1080/10903127.2024.2433146","url":null,"abstract":"<p><p>Fluid resuscitation choices in prehospital trauma care are limited, with most Emergency Medical Services (EMS) agencies only having access to crystalloids. Which solution to use, how much to administer, and judging the individual risks and benefits of giving or withholding fluids remains an area of uncertainty. To address the role of crystalloid fluids in prehospital trauma care, we reviewed the available relevant literature and developed recommendations to guide clinical care. The topic of prehospital blood product administration is covered elsewhere.NAEMSP recommendsIsotonic crystalloid solutions should be the preferred fluids for use in prehospital trauma management. Specific choice of isotonic crystalloid solutions may be driven by medication compatibility and other operational issues.Permissive hypotension is reasonable in patients without traumatic brain injury (TBI).Avoiding or correcting hypotension in polytrauma patients with TBI may be a higher priority than restricting fluid use.Large volume crystalloid resuscitation should be generally avoided.Developing processes to administer warmed intravenous (IV) fluids is reasonable.Risks of IV fluid use, or restriction, in trauma resuscitation should be weighed against possible benefits.Strategies to reduce the need for IV fluids should be considered.A standard trauma resuscitation curriculum for prehospital providers should be developed to improve evidence-based delivery of IV fluids in trauma.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687574","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 Trauma Compendium: Traumatic Pneumothorax Care: Position Statement and Resource Document of NAEMSP.","authors":"John W Lyng, Caitlin Ward, Matthew Angelidis, Amelia Breyre, Ross Donaldson, Kenji Inaba, Maria J Mandt, Nichole Bosson","doi":"10.1080/10903127.2024.2416978","DOIUrl":"10.1080/10903127.2024.2416978","url":null,"abstract":"<p><p>Emergency medical services (EMS) clinicians manage patients with traumatic pneumothoraxes. These may be simple pneumothoraxes that are less clinically impactful, or tension pneumothoraxes that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Furthermore, there is also ambiguity regarding EMS management of open pneumothoraxes. To provide evidence-based guidance on the management of traumatic pneumothoraxes in the EMS setting, the National Association of EMS Physicians (NAEMSP) performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-21"},"PeriodicalIF":2.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583950","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":"Sublingual Sufentanil Tablet for Analgesia in Emergency Medical Services and Search and Rescue Agencies.","authors":"Hunter Albert McWilliams, Lindsey Fell, Albert Mason Wheeler, Emad Awad, Albert Richard Wheeler, William R Smith, Scott E McIntosh","doi":"10.1080/10903127.2024.2431579","DOIUrl":"10.1080/10903127.2024.2431579","url":null,"abstract":"<p><strong>Objectives: </strong>Pain management in the potentially austere search and rescue (SAR) and emergency medical services (EMS) environments can be challenging. Intravenous (IV) and intramuscular (IM) routes of administration may be less practical. This study assesses the efficacy and safety of the sublingual sufentanil tablet (SST) in prehospital settings and hypothesizes that its use will reduce pain while maintaining a reasonable safety profile.</p><p><strong>Methods: </strong>This was a retrospective case analysis examining patient records from Teton County Search and Rescue, Grand Teton National Park EMS, and Jackson Hole Fire/EMS from 2021-2023, based on the criteria that they were administered SST in a prehospital setting. Cases in which SST was used were examined to assess patient characteristics, injury classification, patient reported pain scale before and after SST, other medications administered, and vital signs.</p><p><strong>Results: </strong>Seventy patients met the inclusion criteria. Six individuals were excluded due to missing one or more of the key variables, and the analysis was carried out with the remaining (<i>N</i> = 64 cases). The mean pain score decreased from 8.0 ± 1.9 before medication administration to 5.5 ± 2.5 after administration, reflecting a statistically significant difference of 2.6 ± 2.1 (<i>p</i> < 0.001).  The results also revealed statistically significant reductions in heart rate (HR) and systolic blood pressure (SBP) following SST administration (mean HR dropped by 4.2 ± 9.1 beats/min, <i>p</i> = 0.004, and mean SBP dropped by 11.1 ± 21.8 mmHg, <i>p</i> = 0.01). Changes in vital signs, although statistically significant, were not clinically significant and did not necessitate additional monitoring or intervention in any patients.</p><p><strong>Conclusions: </strong>Our study demonstrated that SST administration led to a significant reduction in pain scores and exhibited a favorable safety profile regarding vital signs, including SBP, HR, respiratory rate (RR), and O₂ saturation. These findings support the utilization of SST for pain management in the prehospital setting, particularly in austere environments where traditional routes of administration may be impractical.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-5"},"PeriodicalIF":2.1,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676628","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":"Barriers and Enablers in Prehospital Pediatric Analgesia.","authors":"Hoi See Tsao, Tanya Sutcliffe, Charles Wang, Sara E Vargas, Chelsea Day, Linda L Brown","doi":"10.1080/10903127.2024.2431586","DOIUrl":"10.1080/10903127.2024.2431586","url":null,"abstract":"<p><strong>Objectives: </strong>Children make up 5-10% of emergency medical services (EMS) transports and are at risk for under-recognition and under-treatment of pain. Prior studies have identified enablers to pediatric analgesia including EMS pediatric analgesia education, agency leadership support, the availability of assistive guides and having positive relationships with online medical control. Prior barriers identified were intravenous (IV) line insertion pain, caregiver concerns, difficulty assessing pain, pain medication safety concerns, unfamiliarity with pediatrics, unwanted attention from authority figures and perceived superiority of hospital care. This study's objective was to evaluate enablers and barriers to prehospital analgesia for children presenting with traumatic pain after the introduction of intranasal (IN) fentanyl into EMS protocols.</p><p><strong>Methods: </strong>Focus groups with EMS clinicians were used to elicit perspectives on pediatric analgesia. EMS clinicians discussed transports of children in pain, decision-making regarding analgesic administration, available resources to treat pain including EMS protocols, patient and family reactions, and ways to improve pediatric oligoanalgesia. Themes were explored until thematic saturation was reached using a deductive approach with open-ended yet structured questions.</p><p><strong>Results: </strong>Enablers for pediatric analgesia included longer transports, desire to stabilize the patient, vital signs or injuries suggestive of severe pain, and clinician comfort with and availability of IN pain medication. Barriers to analgesia included concerns that the child was not stable enough for pain medication, avoiding masking symptoms prior to hospital arrival, lack of pediatric experience, lack of access to opiates in some ambulances, poor suspension in ambulances causing difficulty with IV access, patient refusal for an IV, caregivers' discomfort with opiates and caregivers' lack of knowledge of available prehospital medications. Focus group themes identified were that there was a lack of experience with pediatric patients, medical control was a helpful resource and training that approximated real-world situations was important.</p><p><strong>Conclusions: </strong>New enablers for pediatric analgesia identified were longer transports and EMS clinician comfort with IN pain medications. While many barriers to pediatric analgesia persist, new barriers identified were poor suspension in ambulances causing difficulty with IV access and caregivers' lack of knowledge of available prehospital medications. Additional EMS pediatric training and experience may improve pediatric oligoanalgesia.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676610","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":"Correlation Between EtCO₂ and PCO₂ in Patients Undergoing Critical Care Transport.","authors":"Christian Martin-Gill, Bradley J Wheeler, Francis X Guyette, Sarah E Wheeler","doi":"10.1080/10903127.2024.2430394","DOIUrl":"10.1080/10903127.2024.2430394","url":null,"abstract":"<p><strong>Objectives: </strong>End-tidal carbon dioxide (EtCO₂) monitoring is widely used as a surrogate for the partial pressure of carbon dioxide (PCO₂) in critically ill patients receiving manual or mechanical ventilation in prehospital, emergency, and critical care settings. Specific targets for ETCO₂ are a key component of Emergency Medical Services (EMS) protocols, especially for specific patient groups such as those with traumatic brain injury. However, the correlation between EtCO₂ and venous or arterial PCO₂ is uncertain. We aimed to assess the correlation between EtCO₂ and PCO₂ in intubated patients undergoing critical care transport (CCT), and in specific subgroups of patients.</p><p><strong>Methods: </strong>We performed a retrospective review of patients undergoing emergency transport by a multi-state CCT agency. Patients were included if they had an advanced airway and both an EtCO₂ and PCO₂ reading within 5 min of each other. We obtained data on patient demographics, transport characteristics, medical categories, vital signs, lab values, and specific interventions. We performed univariable and multivariable binary logistic regression to assess the association between delta PCO₂ and these characteristics.</p><p><strong>Results: </strong>We included 6,459 patients (mean age 58.4 years [SD 18.5], 57.1% male), of which a subset of 551 patients had multiple EtCO₂-PCO₂ measurements within 5 min. The median (IQR) initial delta PCO₂ was 12.9 mmHg (7.1, 21.9). 3,967 (61.4%) patients had a delta PCO₂ >10 mmHg and 1,843 (28.5%) had a delta PCO₂ >20 mmHg. We identified an independent association between delta PCO₂ >10 mmHg and age, male sex, interfacility transport, venous sampling site, respiratory rate, hypotension, hypoxia, and thoracostomy. In patients with multiple blood gas measurements, 76% had delta PCO₂ >10 mmHg over the duration of the transport.</p><p><strong>Conclusions: </strong>We identified substantial differences between EtCO₂ and PCO₂ across patients with medical and traumatic conditions undergoing critical care transport. The PCO₂ assessment should be strongly considered as part of ventilatory management in patients encountered in emergency and critical care settings.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639603","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":"Uses of Fibrinogen Concentrate in Management of Trauma-Induced Coagulopathy in the Prehospital Environment: A Scoping Review.","authors":"Nura Khattab, Fayad Al-Haimus, Teruko Kishibe, Netanel Krugliak, Melissa McGowan, Brodie Nolan","doi":"10.1080/10903127.2024.2425819","DOIUrl":"10.1080/10903127.2024.2425819","url":null,"abstract":"<p><strong>Objectives: </strong>Trauma-induced coagulopathy remains a significant contributor to mortality in severely injured patients. Fibrinogen is essential for early hemostasis and is recognized as the first coagulation factor to fall below critical levels, compromising the coagulation cascade. Recent studies suggest that early administration of fibrinogen concentrate is feasible and effective to prevent coagulopathy. We conducted a scoping review to characterize the existing quantity of literature and to explore the usage of prehospital fibrinogen concentrate products in improving clinical outcomes in trauma patients.</p><p><strong>Methods: </strong>A search strategy was developed and underwent Peer Review of Electronic Search Strategies (PRESS) review in consultation with an information specialist. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus from inception to May 6, 2024. English studies evaluating prehospital civilian and military usage of fibrinogen concentrate in trauma patients were included. Studies were assessed by three independent reviewers for meeting inclusion and exclusion criteria. A hand search of the reference lists of included articles was conducted to identify additional studies meeting inclusion criteria. Clinical endpoints regarding fibrinogen were extracted and synthesized.</p><p><strong>Results: </strong>The literature search returned 1,301 articles with six studies meeting the inclusion criteria. Five studies (83%) were conducted in civilian settings and one study (17%) was conducted in a military setting. Of the included studies, two related studies (29%) utilized a randomized control trial design. We identified five outcomes that compared fibrinogen concentrate to a placebo group. The outcomes included thromboembolic events, clotting time, maximum clot firmness, clot stability at emergency department (ED) admission, and fibrinogen concentration at ED admission. Apart from thromboembolic events, all other reported outcomes showed statistically significant differences in group comparisons, determined using p values. The four (67%) non-clinical studies underscored the robustness, practicality, and degree of fibrinogen concentrate utilization in military environments and retrieval services.</p><p><strong>Conclusions: </strong>Preliminary research suggests that prehospital fibrinogen concentrate administration in traumatic bleeding patients is both feasible and effective, improving clotting parameters. While implementing a time-saving and proactive approach with fibrinogen holds potential for enhancing trauma care, the current evidence is limited. Further studies in this novel field are warranted.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604056","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}