BMC Emergency Medicine最新文献

{"title":"Evaluating the effectiveness and utilization of the primary emergency care training in Nepal: a longitudinal mixed methods study.","authors":"Rabindra Bhandari, Arpana B C Kalaunee, Archana Amatya, Yadu Chandra Ghimire, Madhab Prasad Lamsal, Deepa Chitrakar, Babu Ram Bhusal, Anjila Thapa, Abigail Knoble, Pravin Paudel, Ruma Rajbhandari","doi":"10.1186/s12873-026-01593-w","DOIUrl":"10.1186/s12873-026-01593-w","url":null,"abstract":"<p><strong>Background: </strong>Emergency care is essential for the management of the growing burden of disease and traffic injuries in low- and middle-income countries (LMICs). In Nepal, nearly one in ten deaths in 2017 were attributed to injury. The Primary Emergency Care (PEC) training package of 6 days duration was developed to equip the various health care cadres with knowledge and skills to deliver emergency response. The study evaluates the effectiveness of the training, skill utilization, and the significance of an enabling work environment on application of acquired knowledge and skills.</p><p><strong>Methods: </strong>A mixed-methods evaluation was conducted using the four-level Kirkpatrick Model (KM) to assess the PEC training. Participant details and training scores were obtained from training records of 295 training graduates for level one results. Pre/post-knowledge tests were compared using paired t-tests. Eleven health facilities were purposively selected for follow up, assessing 48 PEC graduates via knowledge assessments, structured clinical skills assessments, and simulations. Qualitative data were collected via 19 in-depth interviews, 10 key informant interviews with hospital leadership, and 11 focus group discussions (FGDs) with non-PEC-trained staff. These qualitative data were thematically analyzed using Ms-excel.</p><p><strong>Results: </strong>There was a significant 35.9% ± 17.3% increase in knowledge after the PEC training (p = 0.001), with a significant 7.2% ± 12.9% decline at study follow up (p = 0.001), although there was no significant difference by length of time since the training (p = 0.652). Paramedics showed the greatest loss in knowledge compared to other health cadres (p = 0.005). Trainees reported increased confidence, and workplace observations indicated a positive \"ripple effect\" of peer-to-peer knowledge sharing among PEC and non-PEC staff.</p><p><strong>Conclusions: </strong>The PEC training significantly improved knowledge and skills with evidence of sustained knowledge retention although a modest but significant decline was observed over time along with evidence of workplace application of skills. Limitations existed in measuring patient level outcomes as per the KM, positive spillover effects along with an enabling environment were reported in emergency departments as result of the training. The training is a feasible, low-cost approach to strengthening emergency care in resource-limited settings like Nepal.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating bystander CPR using a strict documentation-based definition: a multiregional EMS registry analysis.","authors":"Tariq H Alshahrani, Ahmed Al-Wathinani, Abdullah Mohammed Alobaid, Matteo Paganini, Mohammed A Abahussain, Krzysztof Goniewicz","doi":"10.1186/s12873-026-01635-3","DOIUrl":"10.1186/s12873-026-01635-3","url":null,"abstract":"<p><strong>Introduction: </strong>Bystander cardiopulmonary resuscitation (CPR) is a key determinant of survival after out-of-hospital cardiac arrest (OHCA), yet engagement remains low and varies across regions. Reliable estimation of bystander CPR prevalence depends on consistent documentation within emergency medical services (EMS) registries. In Saudi Arabia, national evidence on documentation-based prevalence and system-level determinants remains limited.</p><p><strong>Aim: </strong>To estimate the prevalence of strictly documented bystander CPR, assess data completeness and potential outcome misclassification, examine regional variation, and identify independent predictors of bystander CPR among OHCA cases attended by the Saudi Red Crescent Authority (SRCA).</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional analysis of the SRCA OHCA registry (January-June 2024). Bystander CPR was defined conservatively, requiring explicit documentation of CPR initiation prior to SRCA arrival by a non-SRCA individual. Cases lacking clear attribution were classified as unclassifiable. Regional variation was described, and multivariable logistic regression estimated adjusted associations with patient characteristics, witnessed status, EMS response time, and region.</p><p><strong>Results: </strong>Among 6,378 OHCA records, bystander CPR status was classifiable in 5,271 cases (82.6%), while 1,107 cases (17.4%) were unclassifiable under the strict definition. Among classifiable cases, bystander CPR was documented in 646 cases (12.3%). In the complete-case model (N = 4,267), witnessed arrest was strongly associated with higher odds of bystander CPR (aOR = 5.15, 95% CI 4.20-6.31). Longer EMS response time was associated with lower odds (aOR = 0.98 per minute, 95% CI 0.97-1.00), and male sex was associated with higher odds (aOR = 1.26, 95% CI 1.03-1.53). Significant regional disparities persisted after adjustment.</p><p><strong>Conclusion: </strong>Using a conservative documentation-based definition, bystander CPR engagement in SRCA-attended OHCA cases remains low and uneven across regions. Substantial variation in documentation completeness highlights the importance of standardized reporting for accurate surveillance and benchmarking. Strengthening dispatcher-assisted CPR, expanding population-level training, and enhancing registry harmonization may improve early resuscitation response across SRCA-attended EMS settings in Saudi Arabia.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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 NEWS2 as a triage tool for ambulance transport requests for patients assessed by healthcare professionals.","authors":"Ola Græsli, Thomas Christensen, Pieter Jelle Toussaint","doi":"10.1186/s12873-026-01626-4","DOIUrl":"10.1186/s12873-026-01626-4","url":null,"abstract":"<p><strong>Background: </strong>The National Early Warning Score (NEWS2) system, commonly used in hospitals, has shown potential to be an effective prehospital triage tool for ambulance transport requests. This study evaluates the application of NEWS2 for triaging patients in need of transport by ambulance, after assessment by a healthcare professional. The study aims to validate an electronic triage form developed at Oslo Emergency Medical Communication Center (EMCC), focusing on its correlation with patient outcomes and the impact of operator-adjusted emergency codes.</p><p><strong>Methods: </strong>A retrospective cross-sectional analysis was conducted on 36,865 ambulance transport cases documented at Oslo EMCC from December 2018 to December 2020. Data from the electronic triage form, EMCC's journal records and the Norwegian Cause of Death Registry were linked and analyzed to assess the relationship between NEWS2 scores, emergency codes and patient mortality. Associations between NEWS2 score and mortality at 1, 7 and 30 days were assessed using univariable logistic regression analyses, alongside descriptive sensitivity and specificity analyses. Operator adjustments to system-recommended emergency codes were also evaluated for their influence on outcomes.</p><p><strong>Results: </strong>Increasing NEWS2 scores were significantly associated with increased mortality at 1, 7 and 30 days, with the strongest association observed for 1-day mortality. In total 40% of cases were upgraded by either the system (17%) or the operator (23%). System-initiated upgrades effectively identified critically ill patients, while operator-initiated adjustments showed minimal impact on mortality.</p><p><strong>Conclusions: </strong>The findings support the use of NEWS2 as a reliable tool for prehospital triage, aligning with in-hospital findings and supporting consistent patient assessments. While operator discretion plays a role in refining urgency, its impact on mortality was not always significant. The results emphasize the importance of accurate triage to optimize patient outcomes and highlight the need for ongoing evaluation and integration of NEWS2 into EMCC practices. Future research should explore additional outcome measures beyond mortality to assess the broader efficacy of NEWS2 in prehospital settings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of emergency department stroke care processes with rehabilitation outcomes after first-ever stroke.","authors":"Tuba Erdem Sultanoğlu, Hasan Sultanoğlu","doi":"10.1186/s12873-026-01637-1","DOIUrl":"10.1186/s12873-026-01637-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To examine the association between emergency department (ED) processes and acute interventions after first-ever stroke and the functional and motor gains achieved by the end of a rehabilitation program in a physical medicine and rehabilitation clinic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective observational cohort study included 257 patients who presented to the ED with a first-ever stroke and subsequently underwent a rehabilitation program in a physical medicine and rehabilitation clinic. Demographic and clinical characteristics, ED process/intervention variables [large vessel occlusion (LVO), stroke code activation, intensive care unit admission, intravenous thrombolysis (IVT), endovascular therapy (EVT), initiation of antithrombotic therapy, and time metrics], and rehabilitation outcomes were extracted from electronic records. Functional and motor outcomes were assessed using the Functional Independence Measure (FIM), Functional Ambulation Scale (FAS), and Brunnstrom staging. The primary outcome was clinically meaningful functional improvement (ΔFIM ≥ 22). Secondary outcomes included ΔFIM, FIM efficiency, ΔFAS ≥ 1, independent ambulation at the end of the rehabilitation episode (FAS ≥ 4), and ≥ 1-stage gain in Brunnstrom staging for the upper extremity, hand, and lower extremity. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age was 65.02 ± 13.55 years, and 38.9% of patients were female. Significant improvement was observed across functional and motor outcomes during rehabilitation. Total FIM increased from 75.65 ± 15.90 to 96.42 ± 17.02 (ΔFIM 20.77 ± 13.70; p &lt; 0.001; Cohen's dz = 1.52), median FAS increased from 4 to 5 (p &lt; 0.001), and 78.6% of patients achieved independent ambulation at the end of the rehabilitation episode (FAS ≥ 4). Clinically meaningful functional improvement (ΔFIM ≥ 22) was observed in 45.9% of patients. Brunnstrom stages improved significantly in all domains (all p &lt; 0.001), with ≥ 1-stage gain rates of 58.6% for the upper extremity, 55.5% for the hand, and 64.5% for the lower extremity. In multivariable analyses, stroke code activation and IVT were associated with several rehabilitation outcomes, whereas LVO was associated with less favorable outcomes in selected domains. For clinically meaningful functional improvement, female sex, stroke code activation, IVT, and initiation of antithrombotic therapy were positively associated, whereas NIHSS, baseline FIM, and LVO were negatively associated. ROC analysis showed modest discrimination for the ΔFIM ≥ 22 model (AUC = 0.688) and good discrimination for the FAS ≥ 4 model (AUC = 0.878).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Emergency department organization and acute stroke care processes may be associated not only with early clinical outcomes but also with functional and motor gains achieved during rehabilitation. In particul","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variation in prehospital ACS care within a single city: a bicentric observational study (MONAH-1 subgroup analysis).","authors":"Tobias Hofmann, Peter Baumann, Martin Sauer, Thomas Schilling, Christian Breitling, Claudia Schmidt, Frank Meyer","doi":"10.1186/s12873-026-01632-6","DOIUrl":"10.1186/s12873-026-01632-6","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) is a time-critical medical emergency in which early guideline-based prehospital diagnosis and treatment are crucial for the subsequent care pathway. The aim of this study was to compare documented adherence to selected prehospital ACS process indicators between two provider structures operating within the same municipal EMS system.</p><p><strong>Methods: </strong>As part of the retrospective, bicentric observational study MONAH-1, all prehospital physician missions with typical ACS diagnoses in Magdeburg between 2014 and 2018 were analysed. This prespecified intra-urban subgroup analysis compared one EMS physician base staffed by MD1 with two EMS physician bases staffed by MD2. Because case retrieval was diagnosis-targeted from archived protocols rather than based on a prospectively maintained screening registry, a full flow diagram of all EMS missions could not be reconstructed reliably; endpoint-specific denominators are therefore reported in the text and tables. Multivariable analyses were adjusted for age and gender only and should be interpreted as partially adjusted exploratory models.</p><p><strong>Results: </strong>A total of 1,438 emergency physician interventions were evaluated (MD1: n = 661; MD2: n = 777). MD1 showed documented higher rates of 12-lead ECGs (76.9% vs. 43.5%; aOR 4.24 [95% CI 3.36-5.35]), ASA administration (91.4% vs. 70.9%; aOR 4.38 [3.19-6.00]) and heparin administration (92.6% vs. 68.0%; aOR 5.86 [4.21-8.16]). In the descriptive indication-positive subgroup with documented VAS ≥ 4, morphine was documented more often at MD1 (70.6% vs. 54.5%); the exploratory adjusted morphine model was based on missions with documented pain assessment (aOR 2.67 [2.04-3.50]). No significant differences were found for indication-based nitro-glycerine and oxygen administration. Prehospital dwell time was longer at MD1 (median 34 vs. 29 min; p < 0.001).</p><p><strong>Conclusion: </strong>Documented adherence to selected prehospital ACS process indicators differed between the two providers. MD1 showed higher documented rates for several process measures, but the retrospective design, heterogeneous documentation formats, limited case-mix adjustment, and the possibility of reverse causation for dwell time preclude causal inference or conclusions about patient benefit. The findings are hypothesis-generating and primarily relevant for local quality assurance and prospective validation.</p><p><strong>Trial registration: </strong>The study was registered retrospectively in the German Clinical Trials Register (DRKS00036944) on 27 August 2025.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13227804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment variability among low-acuity EMS patients in a university hospital ED: a retrospective registry study from Southwest Finland.","authors":"Aleksi Kasvi, Timo Iirola, Hilla Nordquist, Mika Kortelainen","doi":"10.1186/s12873-026-01614-8","DOIUrl":"10.1186/s12873-026-01614-8","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) increasingly convey patients with non-urgent conditions to emergency departments (EDs), contributing to pressure on acute care systems. In many settings, patients classified as low-acuity in the prehospital phase represent a substantial proportion of ED arrivals. This study examined characteristics and ED management patterns among low-acuity EMS conveyances to a university hospital ED in Southwest Finland.</p><p><strong>Methods: </strong>This retrospective registry-based cohort study used linked EMS and hospital data from May 2019 to December 2023. Low-acuity patients were defined as missions with a final urgency category D after on-scene EMS reassessment. In total, 34,898 category D conveyances to the university hospital ED were identified. Multivariable logistic regression analyses focused on the four most common conveyance categories-decrease in common general condition, fall, patient transport, and mental disorder-comprising 21,048 complete-case missions. Outcomes included laboratory testing, imaging, medication administration, and inpatient admission. Associations with age (≥70 vs <70 years), sex, night-time (vs daytime), and weekend (vs weekday) were examined.</p><p><strong>Results: </strong>Older age was associated with higher odds of diagnostic testing in several conveyance categories. The largest age-related odds ratios were observed in mental disorder conveyances, in which age ≥70 years was associated with higher odds of imaging (odds ratio [OR] 5.00, 95% confidence interval [CI] 3.68; 6.79) and laboratory testing (OR 4.62, 95% CI 3.59; 6.00). Night-time conveyance was associated with lower odds of medication administration across all four conveyance categories and with lower odds of imaging in three categories. In the decrease in common general condition subgroup, night-time conveyance was associated with lower odds of laboratory testing (OR 0.41, 95% CI 0.30; 0.56). In the patient transport subgroup, night-time conveyance was associated with higher odds of inpatient admission (OR 1.49, 95% CI 1.27; 1.74). Associations with sex and weekend conveyance varied across categories.</p><p><strong>Conclusions: </strong>ED management of low-acuity EMS patients varies by age, sex, time of conveyance, and conveyance category. These findings suggest that downstream hospital care for low-acuity EMS patients is shaped not only by patient characteristics but also by temporal and organizational factors. Linked prehospital and hospital registry data can provide system-level evidence to support the development of more appropriate acute care pathways.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital emergency medical service missions to nursing homes - a descriptive retrospective register-based study in Southwest Finland.","authors":"Henna Myrskykari, Timo Iirola, Hilla Nordquist","doi":"10.1186/s12873-026-01631-7","DOIUrl":"10.1186/s12873-026-01631-7","url":null,"abstract":"<p><strong>Background: </strong>Residents of nursing homes often need emergency medical services or visits to the emergency department, due to deterioration of their general condition or to trauma. However, some of these situations could be treated in nursing homes. This study examined the reason for calling emergency medical services to nursing homes and the outcomes of these missions.</p><p><strong>Methods: </strong>This was a descriptive retrospective register study of emergency medical service missions of 510 older adults in 106 nursing homes in Southwest Finland, from September 1, 2023 to January 31, 2024. Emergency medical service reports and related emergency department visits were analyzed descriptively.</p><p><strong>Results: </strong>In total, 633 emergency medical service (EMS) missions were included in the study: 581 were on-scene missions and 52 missions were managed remotely. The most common cause reported for a mission was a fall (n = 169), followed by deterioration of the patient's general condition (n = 89) and shortness of breath (n = 73). In 60.5% of EMS missions, some treatment procedures had been performed prior to the emergency call, 60.3% of patients visited the emergency department and 20.8% needed follow-up treatment.</p><p><strong>Conclusions: </strong>The majority of nursing home missions are non-urgent, and only some patients require follow-up treatment after an emergency department visit. Prospective studies are needed to determine whether outreach acute care services and mandatory advance care planning (ACP) can reduce unnecessary missions and transfers.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-hospital cardiac arrest in three EMS centers in northern and central Thailand: a mixed-methods call for a national data infrastructure.","authors":"Chanodom Piankusol, Nutcha Charoenboon, Natthanaphop Isaradech, Borwon Wittayachamnankul, Sattha Riyapan, Jirapong Supasaovapak, Robert Bonar, Bryan McNally, Wachiranun Sirikul","doi":"10.1186/s12873-026-01629-1","DOIUrl":"10.1186/s12873-026-01629-1","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in Thailand, yet national response to the issue remains fragmented and under-prioritized. There is no centralized OHCA registry, neurological outcome data are almost entirely absent, and coordination between EMS and hospitals is weak. This limits Thailand's ability to evaluate performance, guide investments, or improve survival.</p><p><strong>Methods: </strong>We conducted a convergent mixed-methods study combining retrospective analysis of OHCA registry data (n = 2,259) from three hospital sites participating in a regional OHCA registry (2017-2023) with in-depth qualitative interviews across EMS, hospital, and policy stakeholders. Quantitative data were analyzed for trends in bystander CPR, response and scene times, and outcome tracking. Qualitative data were thematically coded to identify structural and operational barriers to data use and system integration.</p><p><strong>Results: </strong>Neurological outcome data were available for only 16.4% of patients who were alive at 30 days. EMS teams had limited access to in-hospital outcome information, and hospitals did not routinely track functional recovery. One suburban-capital hospital showed measurable improvement using internal data to reduce scene times and increase bystander CPR. However, systemic fragmentation undermined scalability. Across sites, EMS and hospital data systems were not interoperable, and OHCA care was inconsistently prioritized.</p><p><strong>Conclusion: </strong>Thailand's OHCA system shows both promise and constraint. These findings highlight the need for improved data infrastructure, including standardized outcome tracking, better linkage between EMS and hospital systems, and clearer governance. Local successes can serve as models, but only with political will, shared infrastructure, and clear governance. A national OHCA data strategy is essential to improve survival and achieve equitable care.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with achieving the 10-minute scene-to-ECG transmission target in prehospital care: the role of EMS agency-level cumulative ECG transmissions.","authors":"Hiroki Sato, Kunio Yufu, Tatsunori Nakashima, Hidefumi Akioka, Ryuzo Abe, Tsuyoshi Shimomura, Naohiko Takahashi","doi":"10.1186/s12873-026-01630-8","DOIUrl":"10.1186/s12873-026-01630-8","url":null,"abstract":"<p><strong>Background: </strong>Prehospital 12-lead electrocardiogram (ECG) improves outcomes in ST-segment elevation myocardial infarction, yet meeting the 10-minute target from first medical contact remains difficult. We evaluated determinants of faster prehospital ECG performance.</p><p><strong>Methods: </strong>We analysed a prefecture-wide registry in Japan (September 2021 to August 2025) of patients with suspected acute coronary syndrome who had prehospital ECG transmission. Prehospital ECG performance was assessed using the scene-to-ECG interval, from emergency medical services (EMS) on-scene arrival to ECG transmission. The primary outcome was scene-to-ECG ≤ 10 min; the secondary outcome was interval length. Agency experience was measured by cumulative ECG transmissions. Mixed-effects logistic and linear models with agency random intercepts were used with adjustment for age, sex, and time of arrival.</p><p><strong>Results: </strong>Of 1,748 patients, 672 (38.4%) achieved ≤ 10 min; the median scene-to-ECG was 12 min (interquartile range 9 to 17). Greater cumulative transmissions were associated with higher odds of ≤ 10 min (adjusted odds ratio 1.07 per 100 cases, 95% confidence interval 1.02 to 1.14) and shorter intervals (β - 0.29 min per 100 cases, 95% confidence interval - 0.39 to - 0.19). Older age, female sex, and nighttime arrival were associated with lower odds of achieving ≤ 10 min, whereas older age and nighttime arrival were associated with longer intervals.</p><p><strong>Conclusions: </strong>At the EMS agency level, higher cumulative ECG transmissions were associated with achieving the ≤ 10-minute scene-to-ECG target. This suggests that focused onboarding and continued EMS training may enhance prehospital ECG performance. In the main analysis, older age, female sex, and nighttime arrival were associated with lower odds of achieving the target.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of emergency medical services on the prognosis in acute ischemic stroke patients receiving reperfusion therapy or usual treatment: a prospective cohort study.","authors":"Junmin Tao, Xin Pan, Furong Li, Xiaowen Sui, Lijuan Qu, Yan Gao, Jun Li, Dandan Shi, Dong Chen, Hongling Zhao","doi":"10.1186/s12873-026-01621-9","DOIUrl":"10.1186/s12873-026-01621-9","url":null,"abstract":"<p><strong>Background: </strong>The impact of Emergency Medical Service (EMS) on the prognosis of patients with acute ischemic stroke (AIS) remains controversial.</p><p><strong>Methods: </strong>This prospective cohort study enrolled AIS patients admitted to the emergency department of the Central Hospital of Dalian University of Technology between August 1, 2024, and July 31, 2025. Inverse probability weighting (IPW) adjusted for baseline characteristics, and modified Poisson regression determined the association between EMS transport and the primary outcome, defined as the modified Rankin Scale score of 0-1 at the 3-month follow-up. Post-hoc analyses compared differences in key clinical indicators between groups. Subgroup analyses for primary outcome explored variations among populations with distinct characteristics.</p><p><strong>Results: </strong>Among the 773 patients included, 236 were in the EMS-transported group and 537 in the self-transported group. There was no significant difference between the two groups regarding the possibility of good functional recovery [weighted risk ratio (RR) = 1.37, 95% confidence intervals (CI) = 0.98-1.93]. Post hoc analysis indicated shorter onset-to-door time (ODT) but longer door-to-needle time (DNT) in the EMS-transported group. Subgroup analysis revealed the lower possibility of good functional recovery in patients with a history of coronary heart disease (weighted RR = 4.74, 95% CI = 1.83-12.32; P for interaction = 0.007) and non-smokers (weighted RR = 1.63, 95% CI = 1.11-2.40; P for interaction = 0.039) via EMS transport.</p><p><strong>Conclusions: </strong>Based on IPW, EMS-transported group showed shorter ODT and longer DNT, with no significant functional improvement. Targeted pre-hospital education and risk-stratified response mechanism within hospitals may be warranted.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}