Scandinavian Journal of Trauma Resuscitation & Emergency Medicine最新文献

{"title":"Beyond the evidence: The cervical collar as cultural artefact.","authors":"Tim Nutbeam","doi":"10.1186/s13049-026-01600-w","DOIUrl":"10.1186/s13049-026-01600-w","url":null,"abstract":"<p><strong>Background: </strong>Cervical collar application remains prevalent in trauma care despite the absence of evidence of neurological benefit from spinal immobilisation. Clinical behaviour in this area has proven resistant to change, and the persistence of the collar requires explanation beyond the evidential debate alone. The fear of cervical injury has origins that predate clinical practice. Neurobiological preparedness theory suggests that threat associations linked to survival-relevant stimuli are more rapidly acquired and more durably maintained than other learned fears; the cervical region is a plausible candidate for this form of prepared response. This disposition has been reinforced by centuries of cultural practice: capital punishment across civilisations has concentrated on the neck, and its apparatus has entered clinical language through terms such as the hangman's fracture and coup du lapin. The resulting cultural weight on cervical injury shapes illness behaviour, as demonstrated by natural experiments linking whiplash outcomes to compensation context. In the clinical setting, nocebo mechanisms may cause interventions that signal severity, including the collar, to perpetuate the disability they are designed to prevent. Cognitive biases compound this: pattern-based reasoning in high-stakes situations, defensive practice, and the availability heuristic all incline clinicians towards immobilisation regardless of the evidence. The collar may therefore function, in part, as an anxiety management device for clinician and patient alike.</p><p><strong>Conclusion: </strong>Resistance to reforming immobilisation practice is unlikely to yield to evidence translation alone. Effective change requires explicit engagement with the evolutionary, historical, linguistic, and cognitive determinants of cervical injury fear, alongside the evidential case for gentle patient handling.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692746","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":"Sonorheometry to detect traumatic induced coagulopathy during initial management of trauma patients: an observational, multi-center study.","authors":"Gary Duclos, Pierre Antoine Seube Remy, Mathieu Willig, Mohamed Boucekine, Charles Deregnaucourt, Charlotte Grosdidier, Paul Leblanc, Delphine Garrigue, Marc Leone","doi":"10.1186/s13049-026-01610-8","DOIUrl":"10.1186/s13049-026-01610-8","url":null,"abstract":"<p><strong>Background: </strong>In severe trauma 30% of the patients develop a trauma-induced coagulopathy (TIC), which is associated with higher mortality, massive transfusion and prolonged intensive care stay. Conventional coagulation assays present limitations to detect TIC, primarily due to delayed turnaround time. To enhance early management of TIC viscoelastic tests have been included into guidelines as a standard of care. The Quantra device, based on sonorheometry analysis, offers a rapid bedside assessment of coagulation but lacks validation in a trauma population. The aim of this study was to validate Quantra to detect TIC compared with standard blood coagulation test in severe trauma patients.</p><p><strong>Methods: </strong>We performed a multicenter analysis of prospectively collected data (January 1, 2022-December 31, 2024) across four level-1 trauma centers. Trauma patients > 16 years underwent simultaneous Quantra and standard laboratory testing at hospital admission. Diagnostic performance for prespecified thresholds-activated partial thromboplastin time (aPTT) ratio > 1.5, prothrombin time ratio (PTr) > 1.5, fibrinogen ≤ 1.5 g/L, and platelet concentration ≤ 50, ≤ 100, and ≤ 150 G/L-was assessed by receiver operating characteristic curves in a derivation cohort, with Youden-optimized cutoffs applied to an external validation cohort to determine their specific positive and negative predictive values.</p><p><strong>Results: </strong>The derivation and validation cohorts included 285 and 219 patients, respectively. In the derivation cohort, the areas under the curve (AUCs) were 0.91 [0.84-0.98] for clot time to predict an aPTT ratio > 1.5 with a best cutoff of 144.5s; 0.82 [0.75-0.90] for clot stiffness to predict a PTr > 1.5 (best cutoff 15.4hPa); 0.87 [0.81-0.93] for fibrinogen contribution to clot stiffness to predict a fibrinogen concentration < 1.5g/L (best cutoff 1.1hPa); 0.90 [0.84-0.95] for platelet contribution to clot stiffness to predict a platelets count ≤ 100G/L (best cutoff 12.4hPa). In the validation cohort, positive predictive and negative predictive values for best cutoffs were 0.67 [0.50-0.80] and 1.00 [0.98-1.00] for clot time, 0.50 [0.39-0.61] and 0.88 [0.80-0.93] for clot stiffness, 0.58 [0.44-0.70] and 0.91 [0.85-0.95] for fibrinogen contribution to clot stiffness, 0.13 [0.24-0.99] and 0.99 [0.96-1.00] for platelets contribution to clot stiffness.</p><p><strong>Conclusion: </strong>Early Quantra analysis seems to provide rapid and reliable exclusion of TIC. Prospective investigations remain required to determine usefulness in TIC management.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13191944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693101","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":"Future perspectives in prehospital emergency medicine.","authors":"Åke Erling L Andresen, Ulf-Erik Kongsgaard, Thomas Kristiansen, Hans Morten Lossius","doi":"10.1186/s13049-026-01590-9","DOIUrl":"10.1186/s13049-026-01590-9","url":null,"abstract":"","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693067","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":"Intra-aortic adrenaline titration during cardiac arrest.","authors":"James E Manning, Ed B G Barnard, Jon Barratt, Paul S C Rees","doi":"10.1186/s13049-026-01609-1","DOIUrl":"10.1186/s13049-026-01609-1","url":null,"abstract":"<p><p>Adrenaline has been the principal vasoactive drug in cardiac arrest for decades. It reliably increases return of spontaneous circulation but has not shown a consistent improvement in long-term survival with favourable neurological outcome. High cumulative doses are associated with poorer neurological outcomes among survivors. Unreliable systemic delivery of intravenous adrenaline during the low-flow state of cardiopulmonary resuscitation (CPR) may be responsible for this disconnect. When return of spontaneous circulation follows multiple doses, abrupt mobilisation of accumulated adrenaline may be deleterious and contribute to post-resuscitation shock. We describe the \"Adrenaline Dilemma\": patients with the lowest coronary perfusion pressure are most in need of vasoconstriction to improve blood flow, yet they are also those in whom intravenous adrenaline is least likely to circulate promptly; conversely, patients with adequate coronary perfusion pressure may be exposed to excessive dosing. Thoracic aortic catheterisation via femoral arterial access provides rapid systemic arterial drug delivery and real-time haemodynamic feedback. Continuous aortic pressure monitoring allows optimisation of CPR mechanics and rapid titration of intra-aortic adrenaline as small, diluted boluses or continuous infusion targeting an observed physiological endpoint. Preclinical experiments and early prehospital clinical experience have shown favourable results. Haemodynamically guided intra-aortic adrenaline administration during CPR is a plausible, testable endovascular adjunct and warrants prospective evaluation within modern resuscitation pathways.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693030","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":"''Sugar for the Heart'', a bitter pill for tenecteplase: the crystallisation trap of pre-hospital fibrinolysis.","authors":"Thibaut Prevautel, Alisson Adet, Guillaume Michoud","doi":"10.1186/s13049-026-01594-5","DOIUrl":"10.1186/s13049-026-01594-5","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that empiric prehospital administration of tenecteplase in out-of-hospital cardiac arrest is associated with decreased survival and lower rates of return of spontaneous circulation. While diagnostic uncertainty is a primary factor, operational hazards in austere environments must also be examined. This comment explores an underappreciated and potentially lethal operational hazard: the immediate chemical incompatibility between tenecteplase and dextrose-containing solutions. In chaotic pre-hospital settings, clinicians often rely on the cognitive heuristic of using dextrose lines to limit sodium intake, especially during cardiac emergencies. However, mixing tenecteplase with dextrose triggers instant crystallization and line occlusion. This effectively denies the patient the fibrinolytic agent while simultaneously compromising a critical intravenous access. To mitigate this risk, we propose three clinical safety barriers: physical segregation of dextrose from acute coronary syndrome kits, the mandatory implementation of a 20-mL normal saline flush before and after administration, and the use of point-of-care cognitive aids on drug packaging.</p><p><strong>Conclusion: </strong>Addressing the complex outcomes of prehospital thrombolysis requires mitigating simple, yet catastrophic, chemical errors. Environmental design and strict operational protocols are essential to ensure the safe delivery of tenecteplase in the field.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"34 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693111","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":"Fentanyl or Morphine? a qualitative investigation of solo responding paramedics´ decision-making in prehospital care.","authors":"Andreas Gustavsen, Randi Simensen","doi":"10.1186/s13049-026-01608-2","DOIUrl":"10.1186/s13049-026-01608-2","url":null,"abstract":"<p><strong>Background: </strong>Solo responding unit (SRU) paramedics at Oslo University Hospital (OUH) can administer either morphine or fentanyl for prehospital pain management. Although both opioids are available, the choice between them is made by individual clinicians in time-critical situations, often with limited information, variable transport conditions, and minimal organisational feedback. Existing research has primarily focused on comparative efficacy and safety, while less attention has been paid to how paramedics reason in practice. This study explores the clinical, logistical, and organisational factors that influence SRU paramedics' opioid selection, how advantages and disadvantages of morphine and fentanyl are perceived, and how local norms and decision-making support shape practice.</p><p><strong>Methods: </strong>This qualitative descriptive study employed three face-to-face focus groups with a total of 11 participants. The sessions were recorded, transcribed, and analysed thematically. The first author's dual role as an SRU paramedic was acknowledged and used reflexively to enhance the interpretation of the findings.</p><p><strong>Results: </strong>The participants (1 female, 10 male, mean age 42 years, mean 19.6 years of ambulance experience from urban and rural regions within OUH) emphasised the role of personal experience and intuitive judgement in selecting between morphine and fentanyl. Fentanyl was favoured for rapid onset in acute traumatic pain or short transports, while morphine was selected for its longer duration in frail patients or lengthy transports. \"Ambulance truths\", informal, station-specific beliefs, filled gaps where formal guidance was lacking. Safety concerns existed for both drugs, although severe adverse events were rarely experienced by participants.</p><p><strong>Conclusion: </strong>SRU paramedics' opioid selection is shaped by an interplay of pharmacological reasoning, familiarity, organisational protocols, and cultural norms. The findings suggest that formalised training, streamlined documentation, and structured feedback mechanisms may support more consistent decision-making in prehospital analgesia.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13109881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693103","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":"Risk assessment reasoning and decision-making by ambulance professionals in patients with a transient loss of consciousness: a qualitative study.","authors":"Lucia G Uit Het Broek-Creemers, Lilian C M Vloet, Hester Vermeulen, Sivera A A Berben","doi":"10.1186/s13049-026-01598-1","DOIUrl":"10.1186/s13049-026-01598-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with a transient loss of consciousness (T-LOC) present a complex clinical situation for ambulance professionals. The challenge arises from the complexity of the diverse aetiologies associated with T-LOC and the demanding nature of the pre-hospital work environment. Insights into the experiences, dilemmas, and challenges faced by ambulance professionals in the risk assessment and decision-making in this patient category could help to understand the support they need. Our study aimed to explore the risk assessment reasoning and decision-making process of ambulance professionals in patients with a T-LOC in current practice.</p><p><strong>Methods: </strong>We conducted a qualitative study with focus group interviews in an emergency medical services (EMS) organisation in the Netherlands. Through purposive sampling, ambulance professionals were recruited for two online focus group interviews. An interview guide, based on literature and preliminary individual interviews, was used. The focus group interviews were transcribed verbatim and analysed using thematic analysis.</p><p><strong>Results: </strong>A total of eleven participants participated in two focus group interviews. Three main themes emerged: (1) Clinical reasoning covering the (initial) approach of ambulance professionals on scene, the T-LOC specific assessment, complexity of the aetiology of T-LOC, and the medical conveyance decision, (2) Collaboration describing the difficulties and facilitating factors in the interprofessional collaboration with other healthcare professionals in the chain of emergency care (e.g., general practitioners, emergency physicians, etc.) and the involvement of patients and relatives, (3) Professionalism describing the influence of professionals' experiences (e.g. professional maturity), the sense of responsibility and accountability of the ambulance professional, and their subsequent need for reflection.</p><p><strong>Conclusion: </strong>Ambulance professionals follow a structured approach for the clinical assessment of a patient with a T-LOC. In addition to their professional experience, the complexity of the symptom and the patient's context play a crucial role in the risk assessment reasoning and decision-making process. Ambulance professionals collaborate with other healthcare professionals to enhance their process, with varying experiences. There is a delicate balance between professionals' sense of responsibility and accountability. A non-conveyance decision is considered precarious by professionals, and adequate support from management, education and interprofessional collaboration is required to feel confident in their decision-making.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640392","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":"Collaboration among emergency first responders at major incidents - an explorative focus group study.","authors":"Andreas Rantala, Anna Conradsson, Jonathan Adamsson, Lena Forsell, Jonas Wihlborg","doi":"10.1186/s13049-026-01606-4","DOIUrl":"10.1186/s13049-026-01606-4","url":null,"abstract":"<p><strong>Background: </strong>In the event of a major incident, collaboration between the ambulance service, fire brigade and police is common. Effective collaboration requires teamwork, with communication between the three organisations being crucial. Leadership functions should be integrated in a way that leverages organisation-specific capabilities, enabling interprofessional collaboration where diverse professional roles complement each other. The aim of this study is to explore the experiences of collaboration among emergency first responders during major incidents.</p><p><strong>Methods: </strong>Data were collected through four focus group interviews involving ambulance nurses, firefighters and police officers, each with a minimum of one year of operational experience. The data were analysed using content analysis inspired by Krueger and Casey.</p><p><strong>Results: </strong>Three categories emerged from the analysis; Coordinated communication as a foundation for collaboration, Structured interprofessional collaboration through leadership and shared understanding and Relational conditions for sustained interprofessional collaboration. Each category comprises two subcategories that reflect the participants' experiences.</p><p><strong>Conclusion: </strong>The findings highlight that collaboration among emergency first responders during major incidents is shaped by coordinated communication, structured leadership and mutual understanding of organisational roles. Communication challenges, leadership demands and safety considerations in complex incidents were described as influencing collaboration. Joint training and interprofessional interaction may support preparedness and strengthen collaboration across emergency service organisations.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13081618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595863","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":"Exploring enablers and barriers to the use of chest compression feedback devices in advanced life support: a qualitative study.","authors":"Øystein Myrlund Hansen, Charlotte Björk Ingul, Benjamin Stage Storm, Rita Solbakken","doi":"10.1186/s13049-026-01607-3","DOIUrl":"10.1186/s13049-026-01607-3","url":null,"abstract":"<p><strong>Background: </strong>In sudden cardiac arrest, high-quality chest compressions are crucial for survival with favorable neurological outcomes. Chest compression feedback devices improve chest compression quality and the likelihood of achieving return of spontaneous circulation. However, implementation remains challenging. Understanding enablers and barriers is essential to inform implementation strategies and device design.</p><p><strong>Methods: </strong>We conducted a qualitative exploratory study using semi-structured interviews with 15 healthcare professionals from pre- and in-hospital advanced life support settings in Norway and Denmark. Data were analyzed using reflexive thematic analysis to identify patterns of meaning related to enablers and barriers to device use.</p><p><strong>Results: </strong>Data analysis led to the construction of four themes: (1) The CPR sensor-a key physical interaction point, where usability was shaped by ergonomics, as well as challenges related to sensor positioning and detachment. The sensor created a physical buffer that reduced the discomfort of feeling rib and sternum fractures and skin damage during compressions, helping providers maintain focus and perform compressions consistently. (2) Feedback-Device-to-rescuer communication, where visual feedback was preferred and considered informative, while audio feedback was often seen as disruptive and difficult to perceive during compressions. (3) Organizing cardiac arrest treatment, where team structure, leadership roles and protocol integration influenced device use. Clear assignment of responsibility and predefined equipment layout supported consistent use. (4) Perceived usefulness-an important enabling factor, where feedback was especially valued in supervisory roles, supporting clinical oversight and decision-making, leading to device integration into team workflows. In the pre-hospital setting, the device supported effective guidance for bystanders. The device's inability to provide physiological feedback raised questions about its future relevance.</p><p><strong>Conclusions: </strong>Successful implementation of chest compression feedback devices in advanced life support depends on user-centered design, role-sensitive feedback, and integration into clinical protocols. Key enablers included sensor ergonomics, visual feedback, and structured team roles, while barriers such as sensor detachment and disruptive audio feedback hindered sustained use. Future development should focus on multimodal feedback tailored to team functions and support physiology-guided resuscitation.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595978","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 versus GROUND emergency medical services in mountainous trauma care: a comparative cohort study on time efficiency, golden hour achievement, and clinical outcomes in the Qinba region.","authors":"Yong Bai, Kai Yang, Jing Gao, Wenping Guo","doi":"10.1186/s13049-026-01604-6","DOIUrl":"10.1186/s13049-026-01604-6","url":null,"abstract":"<p><strong>Objective: </strong>To compare the time efficiency and clinical outcomes of helicopter emergency medical services (HEMS) versus ground emergency medical services (GROUND) for severe trauma in the mountainous Qinba region, with a focus on achieving the \"golden hour\" and its impact on patient prognosis.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included severe trauma patients (Injury Severity Score [ISS] ≥ 16) transported by HEMS or GROUND between January 2018 and September 2025. Propensity score matching (1:1) was performed using age, sex, APACHE II, and ISS scores to control for confounding. The primary outcome was a composite of major in-hospital complications. \"Golden hour\" compliance was defined as completion of critical imaging (FAST/CT) and admission to the operating room or intensive care unit within 60 min of the emergency call. Time metrics, mortality, organ dysfunction (SOFA), length of stay, and discharge neurological status (GOS) were compared.</p><p><strong>Results: </strong>After matching, 77 well-balanced pairs were formed. HEMS achieved a significantly higher golden hour compliance rate than GROUND (71.43% vs. 2.60%, p < 0.001). HEMS significantly reduced transport time (median 15 vs. 105 min, p < 0.001) and total call-to-hospital arrival time (46 vs. 158 min, p < 0.001). Clinically, HEMS was associated with lower 24-h mortality (1.30% vs. 10.39%, p = 0.039), lower composite major complication rate (7.88% vs. 26.33%, p = 0.026), lower SOFA scores (median 12 vs. 20, p < 0.001), shorter ICU (5.62 vs. 9.78 days, p < 0.001) and hospital stays (13.44 vs. 21.34 days, p < 0.001), and higher GOS scores at discharge (4.0 vs. 2.64, p < 0.001). Multivariable Cox regression identified HEMS as an independent protective factor for better outcomes. ROC analysis showed perfect discrimination of HEMS vs. GROUND by transport time and total arrival time (AUC = 1.000).</p><p><strong>Conclusion: </strong>In mountainous regions, HEMS markedly improves golden hour attainment, translating into reduced early mortality, fewer complications, milder organ dysfunction, shorter hospitalizations, and better neurological recovery. These findings support the integration of HEMS into trauma systems in geographically challenging areas.</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582863","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}