Prehospital and Disaster Medicine最新文献

{"title":"Defining the \"Critical Casualty\" through Reference-Standard Constructs, Reporting Completeness, and Reproducibility in Mass-Casualty Incident Triage Research: Methodology Scoping Review.","authors":"Özgün Aran, Ruşen Koray Eyison, Denizhan Kılınç, Onur Genç, Hakan Işık","doi":"10.1017/S1049023X2610908X","DOIUrl":"10.1017/S1049023X2610908X","url":null,"abstract":"<p><strong>Introduction/study objective: </strong>Mass-casualty incident (MCI) triage algorithms are evaluated against reference standards that operationally define the \"critical casualty,\" yet the constructs underlying these standards and the completeness of their reporting have not been systematically characterized.</p><p><strong>Methods: </strong>A PRISMA-ScR methodology scoping review was conducted using a pre-registered Open Science Framework (OSF) protocol; MEDLINE, Scopus, Web of Science, and CINAHL were searched on May 5, 2026 for English-language full-text sources that described, derived, validated, or applied a reference standard for distinguishing critical from non-critical casualties in MCI triage. Reference standards were classified using a pre-specified taxonomy, and reporting completeness was assessed with the eight-item Reference Standard Reporting Index for MCI Triage (RSRI-MCI), developed a priori for this review and not externally validated. Two reviewers independently classified and coded all sources.</p><p><strong>Results: </strong>Sixty sources published from 2001 through 2025 were included. Operationalized reference standards clustered around four foundational methodological sources, while only five sources (8%) analyzed retrospective data from actual MCIs. Five reference-standard families were identified: Life-Saving Intervention (LSI)-Based (38%), Composite/Hybrid (30%), Expert Panel (15%), Outcome/Resource (12%), and Anatomic Severity (5%); LSI-Based and Composite constructs together accounted for approximately two-thirds of the field. Reporting was asymmetric: definition (98%), components (97%), and rationale (88%) were reported almost universally, whereas time window (40%), dead/expectant handling (57%), binary mapping (65%), missing-data handling (58%), and reference-standard limitations (58%) were reported less consistently. Inter-rater agreement was substantial overall (83%) and for family classification (93%; Gwet's Chance-Corrected Agreement Coefficient [AC1] = 0.919; 95% CI, 0.837-0.980).</p><p><strong>Conclusion: </strong>Mass-casualty incident triage studies routinely report what their reference standard is but inconsistently report how it is operationalized, particularly its time window. Five reporting recommendations are proposed for future MCI triage validation research.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e23"},"PeriodicalIF":4.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmaceutical Coordination in the Ishinomaki Zone after the 2011 Great East Japan Earthquake Improved the Disaster Health Management.","authors":"Yoshiro Tanno, Shinichi Egawa, Ryutaro Arita, Shin Takayama, Motohiro Tsuboi, Hyejeong Park, Hiroyuki Sasaki, Takeshi Kanno, Tadashi Ishii","doi":"10.1017/S1049023X26109042","DOIUrl":"10.1017/S1049023X26109042","url":null,"abstract":"<p><strong>Introduction: </strong>On March 24, thirteen days after the 2011 Great East Japan Earthquake (GEJE), the Ishinomaki Zone Joint Relief Team (IZJRT) started the Melon Pan System - an ad hoc pharmaceutical coordination system - for the first time in Japan to efficiently prescribe, dispense, deliver, and explain medication to patients in evacuation centers and at their homes. The Japan Red Cross (JRC) Ishinomaki Hospital, a disaster base hospital (DBH), serves as a coordination hub for emergency medical teams (EMTs), pharmacists, and medication supplies.</p><p><strong>Study objective: </strong>This study aimed to retrospectively examine trends in medication needs and delivery before (Phase A: March 11 to March 23; 13 days) and after (Phase B: March 24 to April 5; 13 days) the system's implementation.</p><p><strong>Methods: </strong>Using an anonymized disaster medical record (DMR) database, patient characteristics, number of new and returning patients, prescription numbers, prescribed medications, and prescription durations in Phase A and Phase B were compared. The locations of the evacuation centers with significant improvements in Phase B were identified on a map.</p><p><strong>Results: </strong>There were 3,830 new patients in Phase A and 6,984 in Phase B. The number of returning patients increased significantly during Phase B. The overall number of prescriptions increased 2.6-times (353.7/day versus 935.2/day) and the number of prescribed medications increased 3.1-times (764.1/day versus 2,367.8/day) in Phase B. The median prescription duration of anti-hypertensive drugs increased from seven days (95% confidence interval [CI], 2-14 days) in Phase A to nine days (95% CI, 3-30 days) in Phase B (P < 0.0001), suggesting that medication was efficiently delivered to people in need. The effect of the system was more prominent in evacuation centers located within the tsunami-inundated areas or remote areas (>10km from the JRC Ishinomaki Hospital), considering that 33 (89.2%) of the 37 evacuation centers where prescriptions increased more than three-fold and 39 (94.9%) of the 41 evacuation centers where the prescription started in Phase B were located in such areas.</p><p><strong>Conclusion: </strong>The ad hoc pharmaceutical coordination system was effective and necessary, enabling EMTs to focus on patient care and pharmacists to provide personalized pharmaceutical assistance, especially in evacuation centers with limited access. The Melon Pan system was the first pharmaceutical coordination model to be developed in Japan to improve disaster health management.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e22"},"PeriodicalIF":4.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contingency Methods for Cleaning Single-Use Medical Equipment in Crisis, Disaster, or War.","authors":"Karl Chevalley, Knut Taxbro, Sara Mernelius, Peter Sigfridsson, Göran Sandström","doi":"10.1017/S1049023X26109066","DOIUrl":"10.1017/S1049023X26109066","url":null,"abstract":"<p><strong>Background: </strong>Shortages of disposable medical equipment can critically impair health care delivery during disasters or armed conflict. Although reprocessing single-use medical devices (SUDs) may represent the only feasible option under such conditions, evidence supporting simple, field-adapted cleaning methods is limited.</p><p><strong>Methods: </strong>In this exploratory study, 90 clinically used SUDs - endotracheal tubes (ETT), laryngeal mask airway (LMA), intravenous administration sets (IVS), syringes (SYR), indwelling urinary catheters (IDC), and nasogastric tubes (NGT) - were collected after surgery in a regional hospital. Devices were randomly allocated to cleaning with peracetic acid (PAA), 70% ethanol, or dishwashing detergent. Each item was brushed, immersed for ten minutes, and then air-dried. Microbiological sampling included pre-cleaning and post-cleaning cultures, and airway devices underwent Polymerase Chain Reaction (PCR) testing for 28 respiratory pathogens. Functional integrity was assessed after cleaning.</p><p><strong>Results: </strong>All three cleaning agents achieved statistically significant reductions in bacterial load (P < 0.05) with no difference between methods. The PCR testing detected <i>Hemophilus influenzae</i> (H. influenzae) and <i>Staphylococcus aureus</i> (S. aureus) among other pathogens in 47% of airway devices before cleaning; all post-cleaning samples were negative. No structural or functional damage was observed.</p><p><strong>Conclusion: </strong>Basic cleaning procedures with commonly available agents substantially reduced microbial contamination without impairing device function. These methods cannot replace validated sterilization but may serve as the only viable option when medical supply is critically constrained, such as in disasters or in armed conflict. Preparedness planning should encompass strategic stockpiling, surge production capacity, and resilient supply chains, together with rationing and substitution strategies, and - only as a last resort - protocols for cleaning and reusing single-use medical equipment.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e21"},"PeriodicalIF":4.1,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes to the Number and Profile of Attendances to a Civilian Emergency Department Following Ceasefire to a Conflict: An Interrupted Time-Series Analysis.","authors":"Ryan McHenry, Yahya Wj Elbasyouni, Husam Mh Abuasaker, Ahmed Nk Hajjaj, Mohammed Qandil","doi":"10.1017/S1049023X26109030","DOIUrl":"10.1017/S1049023X26109030","url":null,"abstract":"<p><strong>Introduction: </strong>Conflict brings excess and changing demands to local civilian health care resources. While conflict-related needs are often easily identifiable, in the aftermath of disaster or conflict, health care systems may struggle to identify changing needs, and humanitarian actors may initiate responses targeted to traumatic injuries while facing different operational realities.</p><p><strong>Aim: </strong>This study aims to quantify the immediate changes in, and short-term trends of, Emergency Department (ED) patient profiles following a break in conflict, informing humanitarian intervention and the prioritization of local health care resources in future contexts.</p><p><strong>Methods: </strong>A single center, retrospective Interrupted Time Series (ITS) analysis was undertaken comprising of every patient attendance to the Nasser Medical Complex (Gaza Strip) ED from September 1, 2025 through November 30, 2025, inclusive, to evaluate the impact of the ceasefire on October 10, 2025. Binomial and negative binomial regression was used, adjusting for day-of-week confounding, with Newey-West robust standard errors. Coefficients were exponentiated to Incidence Rate Ratios for interpretation as the percentage change in the relevant presentations numbers or trend and were presented with 95% Confidence Intervals (95%CI).</p><p><strong>Results: </strong>There were 107,631 presentations over the study period, a median of 1,217 (IQR 1,120-1,291) per day prior to, and 1,202 per day (IQR 1,083-1,356) following, the ceasefire. There was no significant step-change in total presentation to the ED following ceasefire, but thereafter, relative to the pre-ceasefire trajectory, attendances experienced a sustained decrease of two percent per day (95%CI, 1.0% to 2.0% reduction; P < 0.001).There were observed changes to the profile of attendances by diagnostic group, with step-change reductions in trauma admissions, gastrointestinal, and pediatric presentations. There were daily trend reductions for multiple diagnostic groups, including traumatic injuries discharged from the ED, respiratory infections, gastrointestinal presentations, and other medical emergencies.</p><p><strong>Discussion: </strong>This study demonstrates that the implementation of a ceasefire has the potential to change presentation patterns to a civilian ED in a conflict area. While there was no step-change following the ceasefire, there was a reversal of the previous trend of rising daily presentations. It should be noted that most presentations both before and after the ceasefire were for non-traumatic events. These findings highlight the need to continue support and resource for the non-traumatic workload of emergency care during crises, a pattern described in other contexts.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e20"},"PeriodicalIF":4.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Pediatric-Inclusive Biocontainment Transport Model: Evaluation of the US Portable Biocontainment Unit during the Tranquil Passport Exercise.","authors":"Tress Goodwin, Casey Walther, Tschuna Patterson, Abigail Lowe, Joseph Lamana","doi":"10.1017/S1049023X26109017","DOIUrl":"10.1017/S1049023X26109017","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric patients present distinct developmental, psychosocial, and clinical challenges during high-consequence infectious disease (HCID) transport. Despite these differences, national biocontainment transport systems have historically been designed around adult patients, resulting in limited pediatric-specific guidance and operational experience.</p><p><strong>Objective: </strong>The aim of this study was to describe pediatric-specific observations from the inaugural deployment of the US Department of Health and Human Services' (HHS) Portable Biocontainment Unit (PBCU) during a national full-scale exercise and to identify considerations relevant to pediatric-inclusive HCID transport.</p><p><strong>Methods: </strong>A qualitative, observational evaluation was conducted during the 2025 Tranquil Passport Full-Scale Exercise. Data sources included structured interviews with pediatric actors and caregivers, evaluator observations, and facilitated multi-disciplinary debriefings. Pediatric participants simulated biocontainment transport scenarios within the PBCU across multiple sites and phases of care.</p><p><strong>Results: </strong>Pediatric transport within the PBCU required advance planning to address developmental, psychosocial, and physiologic needs distinct from adult care. Pediatric participants frequently described confusion or anxiety related to noise, vibration, movement, and the appearance of personnel in personal protective equipment (PPE). Communication challenges associated with masked voices were reported. Caregiver separation due to infection-control requirements was consistently described as stressful. Clinical teams identified benefits of pediatric-specific medication dosing guides and essential medication sets within the confined biocontainment environment.</p><p><strong>Conclusions: </strong>This inaugural deployment of the PBCU with pediatric participants identified key operational and psychosocial considerations relevant to pediatric-inclusive HCID transport. Findings supported the need for deliberate integration of pediatric-specific planning, communication strategies, and resources within biocontainment transport systems. These observations may also inform pediatric HCID transport planning in international settings where similar challenges are encountered.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e18"},"PeriodicalIF":4.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hotel-to-Hospital Conversion as an Alternate Care Facility Strategy for Large-Scale Medical Surge: Development, Validation, and Operational Framework of the Hotel2Hospital Guidebook.","authors":"Jason Persoff, Jenny Schmitz, Megan Nies, Ryan Schultz, Amy Herron, Elaina Huffman, Ann Adams, Emily Johns, Jessica Ryder, Charles Little","doi":"10.1017/S1049023X26109029","DOIUrl":"10.1017/S1049023X26109029","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Large-scale medical surges (whether arising from mass-casualty incidents [MCIs], pandemic disease, or wartime casualty repatriation) can rapidly overwhelm traditional hospital capacity. Alternate care facilities (ACFs) have been used to decompress hospital systems, yet prior configurations such as convention centers exhibit significant clinical and patient-experience limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study objective: &lt;/strong&gt;This paper describes the development, proof-of-concept validation, and operational framework of the Hotel2Hospital (H2H) Conversion Guidebook, a comprehensive resource enabling hospital emergency management professionals to rapidly convert a suitable hotel into a functional ACF capable of providing hospital-level care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The H2H Guidebook was developed by Team Colorado, comprising emergency, hospitalist, and virtual medicine physicians, emergency management professionals, medical subject matter experts, architects, engineers, and regulatory specialists from the University of Colorado Hospital (UCH) and All Clear Emergency Management Group, funded under a Defense Health Agency (DHA) National Disaster Medical System (NDMS) Capability Pilot. The framework was informed by operational experience from COVID-19 ACF deployments in Colorado (USA). A proof-of-concept exercise conducted in 2025 at the Hyatt Regency Denver-Aurora Conference Center physically converted portions of a hotel into functional hospital spaces and validated clinical workflows through multi-disciplinary \"Day-in-the-Life\" simulations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The proof-of-concept demonstrated that hotels can be successfully converted to provide general Med-Surg and intensive care unit (ICU)-level capacity within four weeks. Key advantages over traditional ACFs included private patient rooms capable of a high level of infection prevention measures, individual heating, ventilation, and air conditioning (HVAC) control, in-room bathrooms with showers, and existing hotel infrastructure supportive of hospital operations while being comprehensive enough to provide full Med-Surg and most ICU-level care. Clinical services including laboratory point-of-care testing, portable radiology, pharmacy, respiratory therapy, telehealth/virtual ICU, and electronic medical record (EMR) integration in the \"live\" environment were all demonstrated as operationally feasible. A wireless mesh network with cellular, cable, and satellite capabilities was successfully deployed to provide seamless information technology (IT) connectivity with UCH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hotel conversion represents a viable, scalable ACF strategy for prolonged medical surge events. The H2H Conversion Guidebook provides a structured, reproducible framework addressing activation, operations, and demobilization. Hospital emergency management professionals, public health agencies, and defense medical planners should consider incorporating ","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e19"},"PeriodicalIF":4.1,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Accuracy of Scoring Indices Assessment for Massive Transfusion in Trauma (SIAM-T): A Five-Year Retrospective Cohort Study.","authors":"Sorawich Watcharakitpaisan, Chaiyaporn Yuksen, Satariya Trakulsrichai, Pungkava Sricharoen, Chetsadakon Jenpanitpong","doi":"10.1017/S1049023X26109005","DOIUrl":"10.1017/S1049023X26109005","url":null,"abstract":"<p><strong>Introduction: </strong>Hemorrhagic shock represents a major cause of preventable mortality following trauma. Identifying shock early on the scene is critical for survival, particularly within resource-limited settings like Thailand, where prehospital blood products are unavailable. Although several scoring tools exist, uncertainty remains regarding which tool offers the optimal diagnostic accuracy for predicting massive transfusion (MT) and early death in this specific setting.</p><p><strong>Study objective: </strong>This research aimed to compare the predictive performance of five prehospital scoring tools - Shock Index (SI), Reverse Shock Index multiplied by Glasgow Coma Scale (rSIG), National Early Warning Score (NEWS), Assessment of Blood Consumption (ABC), and Revised Assessment of Bleeding and Transfusion (RABT) - for predicting MT and 24-hour mortality.</p><p><strong>Methods: </strong>This retrospective prognostic accuracy study included adult trauma patients transported by Emergency Medical Services (EMS) to a university-affiliated Level 1 Trauma Center in Bangkok from January 2019 through December 2024. The primary endpoint was MT; the secondary endpoint was 24-hour mortality. Area Under the Receiver Operating Characteristics (AUROCs) assessed discrimination and the DeLong test compared performance among scores.</p><p><strong>Results: </strong>A total of 584 eligible patients were included, of whom 63 (10.8%) required MT. The NEWS demonstrated the highest discriminatory power for MT (AUROC 0.84; 95% CI, 0.79-0.90), followed by rSIG (AUROC 0.83; 95% CI, 0.76-0.90) and SI (AUROC 0.78; 95% CI, 0.72-0.86). In contrast, trauma-specific scores showed lower performance, with AUROCs of 0.69 for ABC and 0.74 for RABT. For 24-hour mortality, NEWS and rSIG demonstrated excellent discrimination (AUROCs of 0.93 and 0.91, respectively). At a cut-off of four or higher, NEWS showed a sensitivity of 81.0% for MT, while rSIG ≤ 16 provided a balanced sensitivity of 74.6% and specificity of 88.5%.</p><p><strong>Conclusion: </strong>Both NEWS and rSIG predicted MT and 24-hour mortality more accurately than ABC and RABT. These tools may support early pre-arrival notification and blood bank preparation without delaying rapid transport.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e17"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scalable Feedback-Enabled Cardiopulmonary Resuscitation Training Model and Early Attainment of Guideline-Consistent Compression Skills: A Quasi-Experimental Study.","authors":"Sho Nachi, Keiko Suzuki, Kenji Hayashi, Akio Suzuki, Nobuyuki Tetsuka, Senji Kasahara, Tomoaki Yoshimura, Hideshi Okada","doi":"10.1017/S1049023X26108991","DOIUrl":"10.1017/S1049023X26108991","url":null,"abstract":"<p><strong>Introduction: </strong>Survival after out-of-hospital cardiac arrest (OHCA) depends on the immediate provision of high-quality bystander cardiopulmonary resuscitation (CPR) during the prehospital phase. In many community settings, repeated training opportunities are not guaranteed, making early attainment of guideline-consistent CPR skills during a single training exposure particularly important.</p><p><strong>Study objective: </strong>This study evaluated whether a scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-recommended chest compression metrics compared with conventional instruction.</p><p><strong>Methods: </strong>A quasi-experimental study was conducted among medical students who received CPR instruction during two consecutive teaching periods (2014-2015, conventional instruction [CONV]; 2016-2017, simplified feedback-enabled kit [SIM]). Overall CPR performance was assessed at three pre-defined time points: pre-Basic Life Support (BLS), immediate post-BLS, and delayed follow-up (two-to-twelve months post-BLS). The primary outcome was attainment of the target compression rate (100-120 compressions/minute). Mixed-effects regression models were used to account for repeated measurements and to evaluate group × assessment interactions.</p><p><strong>Results: </strong>A total of 334 students were included: 171 in the CONV group and 163 in the SIM group. At the pre-BLS assessment, students in the SIM group demonstrated higher odds of achieving the target compression rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.13-5.71), target compression depth (OR, 2.65; 95% CI, 1.24-5.64), and complete chest recoil (OR, 1.71; 95% CI, 1.05-2.78). Mixed-effects modeling demonstrated that the between-group difference in target compression rate changed over time, with convergence observed at delayed follow-up.</p><p><strong>Conclusion: </strong>A scalable, feedback-enabled CPR training model was associated with earlier attainment of guideline-consistent chest compression performance. These findings may support further evaluation of scalable feedback-enabled approaches in community-based or resource-limited training environments where repeated CPR instruction may not be feasible.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e16"},"PeriodicalIF":4.1,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Digital Clinical Decision Support System Increases Adherence to Provision of Evidence-Based Interventions for Elevated Intracranial Pressure During Simulated Care of Patients with Traumatic Brain Injury.","authors":"Lane L Frasier, Aaron Alindogan, Nina Hoskins, Lance McGinnis, Christopher Bennett, Krystal Delgado, Gregory Burnett, William Davis","doi":"10.1017/S1049023X26108966","DOIUrl":"10.1017/S1049023X26108966","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical decision support (CDS) tools have been demonstrated to improve patient care and outcomes yet remain under-utilized in many clinical domains, including en route care.</p><p><strong>Study objective: </strong>This study evaluated whether a decision-tree CDS tool integrated within the government-created Battlefield Assisted Trauma Distributed Observation Kit (BATDOK; AFRL) clinical care software improves adherence to Joint Trauma System (JTS) guidelines for severe traumatic brain injury (TBI).</p><p><strong>Methods: </strong>In a randomized crossover simulation of military clinicians (N = 24), paired participants managed a patient with elevated intracranial pressure (ICP) using either usual care (UC) or BATDOK with TBI CDS in a simulated fixed-wing air transport mission. Outcomes included completion of critical actions by simulation conclusion, time to completion of critical actions, adherence to tiered interventions as outlined in JTS Clinical Practice Guideline (CPG), and user evaluations of the CDS tool using the validated instrument, System Usability Scale (SUS).</p><p><strong>Results: </strong>There were no significant differences in the primary outcome, percentage of critical items completed. Teams completed a median 83.3% of the critical items in the UC scenario, compared to 91.7% in the CDS scenario (P = 0.58; median difference 4.2%, 95% CI of the difference -8.1% to 16.4%). The mean SUS score for the CDS platform was 77.6 (SD = 16.0), which is associated with a \"good\" usability rating. Most participants rated the CDS platform favorably on every item of the SUS.</p><p><strong>Conclusion: </strong>The BATDOK with TBI CDS did not statistically increase completion of critical tasks in this initial evaluation of usability. However, these data suggest that BATDOK enhanced with CDS improved tiered guideline-concordant sequencing of ICP interventions outlined by the JTS CPG and was favorably rated by users, suggesting feasibility for operational integration.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e15"},"PeriodicalIF":4.1,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Emergency Medical Response Education through Generative AI-Powered Game-Based Learning: A Retrospective Comparative Study.","authors":"Yaning Lai, Xiaoqin Lai, Hai Hu","doi":"10.1017/S1049023X26108978","DOIUrl":"10.1017/S1049023X26108978","url":null,"abstract":"<p><strong>Objective: </strong>Traditional lecture-based learning (LBL) is often insufficient for cultivating the practical decision-making skills required in high-stakes environments like Emergency Medical Response (EMR). While game-based learning (GBL) offers an immersive alternative, it can lack immediate expert guidance. This study addresses this gap by exploring the integration of generative Artificial Intelligence (AI) as an \"intelligent tutor\" within GBL. The objective was to evaluate and compare the effectiveness of LBL, GBL, and generative AI-powered game-based learning (AI-GBL) on medical students' knowledge acquisition, retention, learning motivation, and cognitive load in an EMR course.</p><p><strong>Methods: </strong>A retrospective, comparative study was conducted with 86 medical students from three consecutive cohorts (2022-2024), each exposed to one of the three teaching modalities (n = 29 LBL, n = 28 GBL, n = 29 AI-GBL). Knowledge was assessed via pre-test, post-test, and final-test scores with a maximum score of 10 points. Student feedback was collected for learning motivation, cognitive load, and technology acceptance.</p><p><strong>Results: </strong>For immediate knowledge acquisition, both GBL (mean difference = 1.124/10 points; 95% CI [0.297, 1.952]; P = 0.008) and AI-GBL (mean difference = 0.897/10 points; 95% CI [0.076, 1.717]; P = 0.033) significantly outperformed LBL. For delayed knowledge retention, the AI-GBL group demonstrated significantly superior retention compared to both the GBL group (mean difference = 0.689 points; unadjusted 95% CI [0.080, 1.299]) and the LBL group (mean difference = 1.310 points; unadjusted 95% CI [0.706, 1.915]). The AI-GBL group also reported significantly lower cognitive load than the GBL group (mean difference = -0.273 points; unadjusted 95% CI [-0.456, -0.090]). Finally, students perceived the AI-powered approach as significantly more useful than the standard game-based approach (mean difference = 0.513 points; unadjusted 95% CI [0.137, 0.889]).</p><p><strong>Conclusion: </strong>The AI-enhanced GBL model for EMR training improves knowledge acquisition and retention while reducing cognitive load, representing a promising approach for developing proficiency in complex, high-stakes medical competencies.</p>","PeriodicalId":20400,"journal":{"name":"Prehospital and Disaster Medicine","volume":"41 1","pages":"e14"},"PeriodicalIF":4.1,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}