Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"'We feel abandoned out here': teamwork dilemmas among rural health professionals in distributed emergency settings.","authors":"Hanna Morian, Magnus Hultin, Johan Creutzfeldt, Hanna Dubois, Maria Härgestam","doi":"10.1186/s13049-026-01639-9","DOIUrl":"10.1186/s13049-026-01639-9","url":null,"abstract":"<p><strong>Background: </strong>In rural northern Sweden, community hospitals serve as essential first-response centres. During emergencies, general practitioners remotely collaborate on-call with on-site nurses via videoconferencing. This setup of geographically distributed teams enables healthcare delivery across long distances. However, little is known about how healthcare professionals make sense of and negotiate roles and responsibilities in such distributed emergency settings. Hence, the aim of this study was to analyse how healthcare professionals position themselves and others in interprofessional teams when collaborating in distributed emergency settings in rural areas.</p><p><strong>Methods: </strong>Interprofessional focus group interviews (n = 17) were conducted with staff (one nursing assistant, one registered nurse and one physician per focus group) at community hospitals in rural northern Sweden, following full-scale, simulated, in-situ team training. The analysis was inspired by Billig's concept of ideological dilemmas and Wetherell's concept of interpretative repertoires.</p><p><strong>Results: </strong>Participants drew on three interpretative repertoires-Involvement, Responsibility and competence, and Control and dependency-to account for teamwork in distributed emergency settings. Across these repertoires, participants accounted for involvement as both enabled and difficult to sustain, responsibility as not readily transferred, and control as limited and dependent on others' accounts. These ways of accounting reflected ongoing dilemmas, as professionals positioned themselves in relation to competing demands when acting under conditions of distance, uncertainty and mediated access to the clinical situation.</p><p><strong>Conclusions: </strong>Distributed teamwork reshapes the conditions for collaboration in emergency care, as roles and responsibilities become continuously negotiated in relation to tensions concerning involvement, responsibility and control. As a result, collaboration is unevenly achieved and cannot be taken for granted.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13281583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of pre-hospital time and Glasgow Coma Scale on drowning outcome: a linked data analysis from New South Wales.","authors":"Josefine Jonsson, Edwina Mead, Laura Pompermaier, Pooria Sarrami, Brian Burns, Amy E Peden","doi":"10.1186/s13049-026-01650-0","DOIUrl":"https://doi.org/10.1186/s13049-026-01650-0","url":null,"abstract":"<p><strong>Background: </strong>Drowning is a serious public health issue with more than 300,000 annual fatalities occurring globally. Within Australia, a leader in drowning prevention, the state of New South Wales (NSW) records the highest number of drownings, due in part to its large population and extensive waterways. The emergency medical services (EMS) system plays an important role in the survival chain; however, little is known about how EMS time intervals impact drowning outcome. The aim of this study was therefore to investigate how total prehospital time and its components affect drowning mortality in NSW, Australia.</p><p><strong>Methods: </strong>Individuals attended by NSW ambulance and transported to the Emergency Department (ED) for drowning between 1 January 2010 and 30 June 2022 were included. Age, sex, incident remoteness, Glasgow Coma Scale (GCS) score, and prehospital time intervals were analysed using a linked dataset comprising ambulance, emergency department, and death data. The primary outcome was 30-day mortality. Multivariable binary logistic regression identified predictors related to mortality.</p><p><strong>Results: </strong>A total of 1686 patients were included, and 81 patients (4.8%) died at hospital within 30 days of the incident. Most incidents (n = 1005, 59.6%) occurred in major cities. For patients with initial GCS of 3, each minute increment from emergency call receipt to ambulance arrival was associated with 5% increased odds of mortality (adjusted odds ratio; aOR 1.05, 95% confidence interval; CI 1.00-1.10). For patients with initial GCS greater than 3, each 5-year increase in age was associated with higher odds of mortality (aOR 1.23, 95% CI 1.04-1.45), but longer time to ambulance arrival was associated with lower odds of mortality (aOR 0.78, 95% CI 0.61-1.00). Time from scene departure to hospital was not associated with mortality.</p><p><strong>Conclusions: </strong>Patients with low initial GCS scores had higher mortality, and odds of survival were higher with faster ambulance response times. Patients with higher initial GCS had higher odds of survival with longer times to ambulance arrival, likely due to triage decisions. Further research is needed to elucidate interactions between factors.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Low dOse Evaluation on morphine consumption in traumatic patients: study protocol for a randomized, double-blind, placebo-controlled trial (KLOE-Trial).","authors":"Gary Duclos, Noémie Resseguier, Charlotte Arbelot, Bruno Pastene, Laurent Zieleskiewicz, Marc Leone","doi":"10.1186/s13049-026-01649-7","DOIUrl":"10.1186/s13049-026-01649-7","url":null,"abstract":"<p><strong>Background: </strong>Severely injured trauma patients frequently experience intense acute pain, are highly exposed to opioids during early intensive care, and remain at risk for opioid-related adverse events and persistent pain. Although multimodal analgesia is recommended, regional analgesia may be limited in patients with multiple injuries, coagulopathy, or limited local expertise. Low-dose intravenous ketamine is an attractive opioid-sparing strategy because of its analgesic properties and favourable safety profile at analgesic doses. However, prospective randomized evidence for ketamine used specifically as an analgesic adjunct in critically ill trauma patients remains scarce.</p><p><strong>Methods: </strong>KLOE is a single-centre, randomized, double-blind, placebo-controlled trial with co-primary objectives of superiority for opioid reduction and non-inferiority for analgesic efficacy. Adult trauma patients with at least two traumatic lesions in two different body regions and at least two regional injuries with an Abbreviated Injury Scale score greater than 1 are randomized 1:1 to receive ketamine or placebo. The intervention consists of ketamine 0.1 mg/kg over 30 min followed by 0.15 mg/kg/h for 48 h; the control group receives volume-matched 0.9% sodium chloride. Study treatment must be started within 12 h after ICU admission. All patients receive protocolized multimodal analgesia. The superiority co-primary endpoint is cumulative opioid consumption at 48 h, expressed as intravenous morphine equivalents. The non-inferiority co-primary endpoint is mean pain intensity over the first 48 h assessed by visual analogue scale, with a non-inferiority margin of 10 mm. The planned sample size was 140 patients.</p><p><strong>Discussion: </strong>This trial will provide prospective randomized evidence on whether early low-dose ketamine infusion can safely reduce opioid exposure in severely injured trauma patients without compromising analgesia. At the time of manuscript submission, recruitment and follow-up have been completed, while data cleaning, blinded data review, database lock, and final statistical analyses are ongoing. Publication of this protocol is intended to ensure transparency of the pre-specified methodology before reporting the main trial results.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04833816. First submitted on 5 April 2021; first posted on 6 April 2021. EudraCT 2020-004812-81.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical care delivery models in emergency departments: a systematic review of the literature and meta-analysis of related outcome effects.","authors":"Matthias Noitz, Steven A Ilko, Martin W Dünser, Wilhelm Behringer, Brigitte Wildner, Harald Herkner","doi":"10.1186/s13049-026-01647-9","DOIUrl":"10.1186/s13049-026-01647-9","url":null,"abstract":"<p><strong>Background: </strong>Critical care delivery in the emergency department (ED) may improve selected patient- and system-relevant outcomes. However, it remains unclear which organisational models to deliver critical care in the ED (CC-ED) have been implemented and what their outcome effects are.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis including studies describing organisational approaches to deliver CC-ED. Delivery models were categorised and described qualitatively. For studies reporting comparable outcomes, random-effects meta-analysis was performed to estimate pooled effects and 95% confidence intervals. Outcomes included mortality, intensive care unit (ICU) admission rates, ICU length of stay (LOS), hospital LOS, and cost of care.</p><p><strong>Results: </strong>Of 4,967 records, 67 were included into the qualitative assessment and 11 studies into the quantitative analysis, respectively. We identified five models to deliver CC-ED. These consisted of dedicated critical care areas in the ED (n = 49/67, 73.1%), placement of critical care staff in the ED (n = 5/67, 7.5%), deployment of critical care teams to the ED (n = 5/67, 7.5%), telemedical support of ED staff by critical care teams (n = 5/67, 7.5%), and implementation of protocols to accelerate ICU admission (n = 3/67, 4.5%). Mortality was not different versus usual care in any of the CC-ED models. CC-ED models had variable effects on the ICU admission rate, hospital and ICU LOS. Dedicated critical care areas in the ED were associated with lower ICU admission rates [OR 0.83 (0.76-0.91), p < 0.001], and shorter hospital LOS [mean difference - 0.31 (-0.59 to -0.03) days, p = 0.03], but longer ICU LOS [mean difference 0.45 (0.31-0.6) days, p < 0.001]. Reported cost of care did not differ between CC-ED and usual care.</p><p><strong>Conclusions: </strong>We identified five different organisational model categories to deliver CC-ED. Dedicated critical care areas such as ED-ICUs was the model category most frequently published. Our quantitative meta-analysis suggests that compared with other CC-ED delivery models, dedicated critical care areas in the ED may reduce both ICU admission rates and hospital LOS of critically ill ED patients.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How productive emergency physicians work: a qualitative interview study of clinical workflow in the emergency department.","authors":"Moa Berglund, Leila Piroozam, Joëlle Golmann, Katarina Bohm, Malgorzata Kopaczek-Styczen, Li Jin Yang, Anders Sondén, Jenny Liu, Kristian Ängeby","doi":"10.1186/s13049-026-01638-w","DOIUrl":"10.1186/s13049-026-01638-w","url":null,"abstract":"<p><strong>Background: </strong>Operational efficiency in the emergency department (ED) is crucial for minimizing patient wait times, preventing overcrowding, and optimizing resource utilization. Although systemic inefficiencies in ED operations have been extensively studied, the understanding of individual physician-level work practices that support high productivity is limited. This study aimed to explore how productive emergency physicians structure their work in order to provide insights into physician-level practices that may support clinical workflow and overall departmental efficiency.</p><p><strong>Methods: </strong>This study employed a thematic analysis informed by Braun and Clarke's reflexive approach to analyze semi-structured interviews with eight high-throughput emergency physicians at Stockholm South General Hospital (Södersjukhuset) in Stockholm, one of Sweden's largest emergency hospitals, between March and May 2021. Five predefined topic areas (prioritization, communication, examination, laboratory and imaging modalities and medical record management), guided data collection and the initial organization of the dataset, after which themes were developed inductively through an iterative and collaborative analytic process.</p><p><strong>Results: </strong>Thematic analysis developed six themes characterizing how productive emergency physicians structured their workflow: initial situational awareness, parallel progression, cognitive offloading, anticipatory communication, selective resource utilization and pragmatic responsiveness.</p><p><strong>Conclusion: </strong>This study provides insights into work practices that may enhance productivity in emergency medicine, with the potential to be reinforced through targeted training. Integrating these approaches into physician education could help reduce patient wait times, prevent overcrowding, and optimize resource utilization, thereby improving overall workflow. Further research is needed to explore their broader implications for clinical decision-making, healthcare efficiency, and patient safety.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An inter-rater reliability study of a modified version of SATS as a prehospital triage tool.","authors":"Louise Deshayes, Magnus Andersson Hagiwara, Andreas Wladis, Denise Bäckström","doi":"10.1186/s13049-026-01648-8","DOIUrl":"10.1186/s13049-026-01648-8","url":null,"abstract":"<p><strong>Background: </strong>Triage systems play an essential role in allocating patients to an appropriate level of care. Several triage systems are used worldwide, all of which require scientific evaluation of their reliability and validity. Evidence regarding prehospital triage systems remains limited. The South African Triage Scale (SATS) has been adapted for local use in several regions, but modified versions require independent evaluation. The objective of this study was to examine the reliability of a modified version of the triage system, SATS, when it is used in the emergency medical services (EMS) in a region in Sweden. The study also investigated whether triage performance differs among registered nurses with varying experience and competence levels.</p><p><strong>Methods: </strong>This prospective cross-sectional inter-rater reliability study included 34 registered nurses (RNs) working in the regional EMS. The participants independently triaged 30 prehospital case vignettes via a digital questionnaire, resulting in 1,010 triage assessments. Descriptive data were used. Inter-rater reliability was assessed via Krippendorff's alpha (α) and percentage agreement. Mixed effects logistic regression was performed to explore associations between triage assignment and RN characteristics, including gender, years of experience and specialist education.</p><p><strong>Results: </strong>This study indicated insufficient inter-rater agreement when a modified version of SATS was used in a prehospital setting. Krippendorff's α was 0.60, suggesting poor agreement when triage levels were treated as ordinal data. Full agreement was observed in three case vignettes, whereas agreement across the remaining cases ranged from 32% to 94%. Manual up-triage occurred in 25 of the 30 vignettes, with frequencies ranging from 6% to 74%. No associations were found between assigned triage level and gender, years of EMS experience or specialist education.</p><p><strong>Conclusion: </strong>This modified version of SATS demonstrated low inter-rater reliability when applied in a prehospital setting. Agreement varied substantially across patient scenarios, particularly in cases characterized by nonspecific symptoms and near-normal vital signs. These findings underscore the importance of systematic evaluation of modified triage systems to support consistent decision-making and patient safety in prehospital care.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the 2022 German trauma team activation criteria: a national registry study with focus on geriatric-specific modifiers.","authors":"P Faul, P Hagebusch, R Lefering, U Schweigkofler, M Münzberg, T Jakobi, D A Koch","doi":"10.1186/s13049-026-01641-1","DOIUrl":"10.1186/s13049-026-01641-1","url":null,"abstract":"<p><strong>Background: </strong>The 2022 revision of the German Trauma Society's (DGU) trauma team activation (TTA) criteria introduces geriatric-specific modifiers to enhance the sensitivity of risk stratification in older (elderly) trauma patients. This study evaluates the validity of these updated criteria using national registry data, with particular focus on mortality gradients across activation levels and the prognostic value of newly incorporated modifiers.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis of patients aged ≥ 60 years, defined as elderly trauma patients, from the TraumaRegister DGU^® (TR-DGU) between 2018 and 2023. Cases were stratified according to TTA status based on both the 2016 and 2022 DGU guidelines: high risk of severe injury (HRSI), moderate risk of severe injury (MRSI), or None (provider decision). The primary outcome was in-hospital mortality. Subgroup analyses examined the impact of pre-injury anticoagulation, systolic blood pressure (SBP) 91-100 mmHg, Glasgow Coma Scale (GCS) 13-14, and multiple serious injuries, defined as Abbreviated Injury Scale (AIS) ≥ 3 in two or more body regions.</p><p><strong>Results: </strong>Among 66,273 elderly trauma patients, mortality according to the 2022 criteria showed a consistent risk gradient: 20.2% (high risk of severe injury, HRSI), 9.0% (moderate risk of severe injury, MRSI), and 4.2% (None). In contrast, the 2016 criteria yielded inconsistent patterns, including higher mortality in the \"None\" category. New modifiers were strongly predictive of mortality: multiple serious injuries in ≥ 2 regions (16.7% vs. 6.7%), SBP 91-100 mmHg (13.1% vs. 7.3%), and GCS 13-14 (12.5% vs. 5.6%). Pre-injury anticoagulation was associated with increased mortality across all subgroups (29.3% vs. 20.3%).</p><p><strong>Conclusion: </strong>The 2022 TTA criteria improve the alignment between triage criteria and observed mortality risk, particularly among elderly patients. The addition of geriatric-specific modifiers enhances predictive accuracy and clinical applicability. Future work should quantify implications for overtriage and resource allocation to support evidence-based trauma system optimization.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13261963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of body temperature trajectories from emergency department arrival to intensive care unit admission - insights from the TraumaRegister DGU^®.","authors":"Jan Stein, Friederike Weidemann, Rolf Lefering, Thomas A Schildhauer, Oliver Cruciger, Uwe Hamsen, The TraumaRegister Dgu","doi":"10.1186/s13049-026-01642-0","DOIUrl":"10.1186/s13049-026-01642-0","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia is a significant and independent predictor of mortality in patients with severe trauma and constitutes a key component of the trauma-related lethal triad, along with acidosis and coagulopathy. While the prognostic impact of hypothermia at isolated time points is well established, the clinical relevance of dynamic body temperature changes during the early in-hospital phase remains poorly understood. This study aims to evaluate the association between body temperature trajectories from emergency department (ED) admission to intensive care unit (ICU) transfer and clinical outcomes in major trauma patients.</p><p><strong>Methods: </strong>Retrospective data from the TraumaRegister DGU^® (TR-DGU) for the period 2015-2023 were analysed. Inclusion criteria comprised an Injury Severity Score (ISS) ≥ 9, ICU admission following ED care, and documented core body temperatures at both ED and ICU. Hypothermia was defined as a body temperature ≤ 35 °C. Patients were stratified into four groups based on the presence or absence of hypothermia at each time point. Further subgroup analysis assessed temperature trends (decreasing vs. stable/increasing) and their associations with mortality, coagulopathy, transfusion requirements, and sex distribution.</p><p><strong>Results: </strong>A total of 34,877 patients met the inclusion criteria (mean age 54.2 ± 20.9 years; 71.6% male; mean ISS 22.8 ± 11.5). Hypothermia was present in 10.7% upon ED admission and 9.7% of patients at ICU transfer. Persistent hypothermia was associated with the highest mortality (43.5%), coagulopathy (28.2%), and transfusion rates (31.8%). New onset of hypothermia in the ICU was also linked to poor prognosis (mortality 31.9%). Patients with a temperature decrease (11.2%) had significantly higher injury severity and mortality compared to those with stable or rising temperatures. Female patients were disproportionately represented in hypothermic ICU groups (38%).</p><p><strong>Conclusion: </strong>Hypothermia-particularly when persistent or newly acquired-emerges as a strong predictor of adverse outcomes in trauma patients. Dynamic temperature monitoring between ED and ICU provides critical prognostic insights that extend beyond static measurements. Early identification and management of thermal dysregulation, including sex-specific considerations, should be integral components of contemporary trauma care protocols.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13255213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helicopter emergency medical services for interfacility transfers: an Italian expert consensus.","authors":"Giuseppe Accurso, Luca Carenzo, Marco Palmeri, Daniela Maria Palma, Andrea Mina, Paolo Isoni, Andrea Paoli, Giovanni Sbrana, Sara Borga, Fabio Genco, Massimo Lombardo, Antonino Giarratano, Elena Giovanna Bignami, Santi Maurizio Raineri","doi":"10.1186/s13049-026-01636-y","DOIUrl":"10.1186/s13049-026-01636-y","url":null,"abstract":"<p><strong>Background: </strong>Helicopter Emergency Medical Services (HEMS) play a pivotal role in time-dependent interfacility transfers; however, the absence of standardized activation criteria in Italy contributes to heterogeneous decision-making and variable resource utilization. This expert consensus aimed to develop structured, context-informed recommendations to support appropriate HEMS activation for secondary transfers within the Italian EMS-HEMS system.</p><p><strong>Methods: </strong>A multidisciplinary panel of Italian clinicians with expertise in prehospital emergency medicine, critical care, and HEMS operations conducted a modified Delphi process. Clinical domains were structured using the PICO framework. A PICO-specific scoping review (2010-2026) was performed across MEDLINE, EMBASE, Cochrane Library, and major international guideline repositories to inform deliberations. Evidence was narratively synthesized and integrated with expert judgment. Statements were subjected to anonymous voting using a 1-9 Likert scale, with a predefined consensus threshold of ≥ 80% agreement.</p><p><strong>Results: </strong>Consensus-based statements were developed across major time-critical domains, including acute coronary syndromes, stroke, traumatic injuries, aortic emergencies, cardiac tamponade, toxicological conditions, and hyperbaric emergencies. HEMS was considered most appropriate when transfer time reduction is clinically meaningful and when advanced in-transit care may improve stabilization. The panel proposed the RATIONAL-HEMS model, integrating clinical priority (A-C classification) with logistical and system-level constraints to guide transparent and reproducible decision-making.</p><p><strong>Conclusions: </strong>This Italian expert consensus provides a structured framework for secondary HEMS activation tailored to the national organizational context. The proposed model emphasizes time to definitive care, resource stewardship, and adaptability, and may support regional harmonization and future prospective validation studies.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative models of consent in out-of-hospital transfusion trials: a CAN-PATT position statement supporting exception from prospective consent with opt-out notification.","authors":"Michael Peddle, Adam Greene, Jan Trojanowski, Andrew W Shih, Eddie Chang, Susan Nahirniak, Dallas Pearson, Oksana Prokopchuk-Gauk, Doug Martin, Charles Musuka, Cindy Seidl, Yulia Lin, Scott MacDonald, Lindsay Richards, Michael Farrell, Damien Miller, Melissa McGowan, Brodie Nolan","doi":"10.1186/s13049-026-01635-z","DOIUrl":"10.1186/s13049-026-01635-z","url":null,"abstract":"<p><p>Out-of-hospital blood transfusion (OHBT) trials in trauma face unique ethical and operational challenges. Patients are often incapacitated, time-critical interventions preclude traditional consent, and surrogate decision-makers are rarely accessible in the out-of-hospital environment. The Canadian Prehospital and Transport Transfusion Network (CAN-PATT) supports the use of alternative models of consent to enable rigorous evaluation of OHBT strategies. This position statement outlines the ethical and regulatory justification for an exception from prospective consent with opt-out notification model used in the SWiFT Canada (Study of Whole Blood in Frontline Trauma) pilot randomized controlled trial. Grounded in the Tri-Council Policy Statement 2 (TCPS2) Article 3.8 governing research in medical emergencies, the SWiFT Canada model uses multi-modal notification and post-enrollment withdrawal options to balance feasibility with respect for autonomy. We argue this approach is essential to advance evidence-based transfusion practice in Canadian out-of-hospital care and serves as a national template for emergency research.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 Suppl 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}