Traumatic haemorrhage is a leading cause of preventable injury-related deaths. Tranexamic acid (TXA) has demonstrated a 38% all-cause mortality reduction when administered to severe haemorrhagic shock patients in South Africa (SA). Yet its prehospital utilisation in SA remains limited owing to prehospital provider qualification restrictions, despite the region's high trauma burden. Among the 4% of prehospital providers licensed to administer TXA, prehospital eligibility and TXA administration is poorly reported. This utilisation gap suggests multifactorial barriers beyond the current scope of practice restrictions that impede effective implementation of this evidence-based intervention. To assess patterns of TXA administration and omission during prehospital emergency care in the Western Cape Province, SA. This is a secondary analysis from the EpiC prospective multicentre study. The current study examined 4 094 patients at risk of haemorrhage in the Western Cape from August 2021 to December 2024. First, we assessed patient and injury characteristics as well as prehospital and hospital treatments among three prehospital treatment groups: those who received TXA; those who received a lifesaving circulation intervention and no TXA; and those who received neither. Second, a subset of patients was selected for three clinical scenarios: patients with moderate to severe risk of shock; those with severe shock meeting TXA eligibility criteria; and those requiring hospital-based interventions for haemorrhage. Prehospital provider qualifications, clinical interventions and outcomes were assessed using descriptive statistics, and Sankey diagrams were used to visually depict the quantity and flow of prehospital trauma patients stratified by prehospital provider qualification. Only 2.8% (n=116) of all haemorrhage-risk patients received prehospital TXA despite 82% (n=3 325) presenting within the 3-hour window for administration. Among eligible patients with severe risk of shock who were managed by an advanced prehospital provider (n=161), only 19% (n=30) received TXA. Basic and intermediate prehospital providers, who cannot administer TXA under current regulations, managed 67% (n=326) of these patients. These providers frequently delivered other life-saving circulatory interventions (70 - 79%). This study reveals that only a small percentage of eligible trauma patients receive TXA despite its established mortality benefit. The principal barrier identified is the current scope-of-practice restriction preventing basic and intermediate prehospital providers from administering TXA, despite managing two-thirds of eligible patients and possessing the knowledge and skills to deliver TXA. We strongly recommend that the scope of TXA be extended to intermediate prehospital providers in SA.
Prehospital drug administration is crucial for improving resuscitation efforts in emergency departments (EDs) and enhancing survival rates for out-of-hospital cardiac arrest (OHCA) patients. While evidence supports the prehospital use of life-saving medications like epinephrine, the effects of prehospital vascular access routes remain under-researched. This study collects two years of data on adult patients with non-traumatic OHCA transported by Taoyuan Emergency Medical Services (EMS), aiming to evaluate how prehospital vascular access impacts resuscitation success and survival outcomes. This was a retrospective study conducted by the Taoyuan Fire Department and Taoyuan General Hospital. Data were collected from January 1, 2023 to September 30, 2024. The inclusion criteria consisted of adult patients experiencing non-traumatic OHCA who had established vascular access at the scene. Exclusion criteria were those with missing data and EMS-witnessed OHCA enroute. The outcome measurements aimed to assess whether establishing vascular access from prehospital improves the efficiency of epinephrine administration in the ED and enhances survival rates among OHCA patients. Data were collected using the Electronic Patient Care Report. A total of 185 cases were included in the analysis, consisting of 97 males (52.4%) and 88 females (47.6%), with an average age of 71 years. When comparing the 95 cases with vascular access to the 90 cases without vascular access, the overall time from arrival in the emergency room to the administration of epinephrine was significantly shorter for those with vascular access, averaging 2 minutes compared to 4 minutes for those without (p < 0.001). Additionally, the cumulative time-event analysis using the Kaplan-Meier method showed a significant reduction in the time to epinephrine administration (p < 0.001). Establishing prehospital vascular access significantly enhances ED resuscitation efficiency in non-traumatic OHCA. These findings support integrating vascular access protocols into prehospital care practices to improve outcomes for cardiac arrest.
In-hospital use of non-invasive ventilation improves outcomes in patients with acute respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease. Prehospital use of non-invasive ventilation is uncommon due to diagnostic uncertainty and logistical constraints. We hypothesised that prehospital non-invasive ventilation guided by arterial blood gas analysis would improve early physiological outcomes compared with standard medical treatment alone. This investigator-initiated, multicentre trial randomised patients with suspected acute respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease with respiratory acidosis defined as pH < 7.30 and PaCO2 > 6.0 kPa to standard medical treatment alone or standard medical treatment plus non-invasive ventilation. Patients were attended by prehospital physician-manned emergency care units and enrolled without prior consent under emergency trial approval. The primary outcome was the change in arterial pH from enrolment to hospital arrival. The trial was terminated early due to low recruitment. Out of 111 screened patients, 16 were randomised and 14 were included in the analysis. The median prehospital pH change was 0.09 (interquartile range 0.02-0.12) in the non-invasive ventilation + standard medical treatment group and 0.02 (0.01-0.03) in the standard medical treatment alone group. Median on-scene time was 32 min in the non-invasive ventilation + standard medical treatment group versus 28 min in the standard medical treatment alone group. Recruitment was limited by strict inclusion criteria, procedural complexity and challenges related to the implementation of prehospital arterial blood gas analysis and trial procedures. Missing data further limited the assessment of in-hospital outcomes. The clinical effect of prehospital non-invasive ventilation could not be determined due to early termination. This trial highlights important challenges relevant to future clinical trials in the prehospital setting, including patient selection, diagnostic requirements and implementation of complex interventions. NCT06211920.
Blood transfusion is increasingly recognized as a critical component of prehospital resuscitation. However, Canada's vast geography, environmental extremes, and regional variation in health systems present unique challenges to standardized implementation of prehospital hemorrhage protocols (PHPs). The 2025 Canadian Prehospital Transfusion Summit (CPTS), convened by the Canadian Prehospital and Transport Transfusion (CAN-PATT) network, sought to develop consensus-driven best practices for prehospital transfusion strategies across diverse transport environments. A structured roundtable consensus process was held at CPTS 2025, bringing together over 50 subject matter experts from eight provinces, six different services/systems and a variety of operational roles to discuss the past, present and future direction of out-of-hospital blood transfusion in Canada. Key domains included: activation criteria, prioritization of blood components and adjuncts, product logistics, and rural/remote applicability. Recommendations were synthesized through iterative discussion, evidence review, and thematic analysis. Each recommendation was then voted upon until consensus was reached through all participants. Consensus was reached on core components of a national PHP. Red blood cells and tranexamic acid were identified as foundational therapies. Freeze-dried plasma and whole blood offer logistical and clinical advantages, particularly in rural and remote areas, while fibrinogen concentrate and prothrombin complex concentrate are valuable adjuncts when plasma is unavailable. Calcium supplementation and active hypothermia prevention were emphasized as essential. Barriers to implementation included short product shelf-life, storage infrastructure, and regulatory constraints. The group recommended development of a standardized Canadian prehospital transfusion dataset and national data registry. The panel produced 12 consensus statements based on the available evidence and expert opinion including activation criteria, prioritization of blood products and adjuncts, product logistics, and rural/remote applicability. These consensus statements establish the basis for safe and effective PHP practices in Canada.
Early identification of critically ill patients in prehospital emergency settings is essential for timely triage, resource allocation, and destination planning in emergency medical services (EMS). Although several early warning scores have demonstrated utility in emergency department and in-hospital settings, their applicability in prehospital EMS environments remains limited because of operational complexity, variable resource availability, and differences in EMS systems across healthcare settings. This study aimed to develop and internally validate a multivariable prehospital prediction score for critical illness progression and 30-day mortality among non-traumatic EMS patients. This retrospective single-center cohort study included patients aged ≥18 years with non-traumatic illnesses transported by the Vajira Emergency Medical Service to the Faculty of Medicine Vajira Hospital between January 1, 2019 and December 31, 2024. The primary outcome was illness progression during hospitalization, defined as the requirement for mechanical ventilation, vasopressor and/or inotrope administration, intensive care unit admission, or 30-day mortality. Multivariable logistic regression was used for model development. Internal validation was performed using receiver operating characteristic (ROC) analysis and area under the curve (AuROC), with optimal cut-off determined by Youden's index. Survival analysis using parametric Weibull regression was conducted to assess prediction of 30-day mortality. A total of 700 patients were included, of whom 272 (38.9%) developed critical illness. Independent predictors included respiratory rate ≥25 breaths/min, shock index ≥0.9, Glasgow Coma Scale ≤9, endotracheal intubation, and oxygen supplementation. The model demonstrated good discrimination (AuROC 0.765). A cut-off score of 7 stratified patients into low- and high-risk groups, with sensitivity of 63.2% and specificity of 79.7%. Patients in the high-risk group had a 3.44-fold higher risk of 30-day mortality compared with the low-risk group. The model showed strong prognostic performance for mortality (Harrell's C = 0.855). This multivariable prehospital prediction score may support risk stratification, EMS triage prioritization, destination planning, and resource allocation, potentially improving operational efficiency and patient outcomes in high-acuity prehospital settings.
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. 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. 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). 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. The study was registered retrospectively in the German Clinical Trials Register (DRKS00036944) on 27 August 2025.
The number of patients with implantable cardioverter-defibrillators (ICDs) is steadily increasing, making encounters with ICD-related emergencies more frequent in prehospital care. Paramedics are often the first healthcare professionals to manage these situations; however, data on their exposure to ICD-related emergencies and access to appropriate equipment remain limited. This study aimed to describe Polish paramedics' self-reported experience with ICD-related emergencies and the availability of ICD deactivation magnets in prehospital settings. A descriptive cross-sectional survey was conducted among Polish paramedics between April and November 2024 using an anonymous online questionnaire. The survey assessed demographic and professional characteristics, self-reported exposure to ICD-related emergencies, perceived familiarity with selected ICD-related concepts, and access to ICD deactivation magnets. Data were analyzed descriptively, with exploratory subgroup analyses performed for selected variables. A total of 340 paramedics participated in the survey. Most respondents reported having assisted patients experiencing ICD discharges, including during cardiopulmonary resuscitation. Self-reported familiarity with ICD-related terminology and ECG features varied across items. Only 7.93% of respondents reported access to an ICD deactivation magnet in their ambulance, most often self-provided rather than officially supplied. Greater professional experience was associated with more frequently reported exposure to ICD-related emergencies. Our study suggests that ICD-related emergencies are commonly encountered in prehospital practice, while access to ICD deactivation magnets remains limited. The findings reflect self-reported experience and perceived familiarity rather than objectively assessed competence and highlight potential system-level considerations for prehospital emergency care.
Timely prehospital management is critical to improve acute stroke outcomes by minimising time to reperfusion. Despite Stroke Fast-Track pathways, reductions in system response times remain limited. This study aimed to describe system response times from emergency call to hospital arrival within the Portuguese nationwide Stroke Fast-Track pathway and to identify patient-level, geographic, and structural determinants of prehospital timeliness. In this cross-sectional study, data from the National Prospective Stroke Fast-Track Registry (Portugal), 2017 to 2023, were analysed. Cases meeting stroke pathway activation criteria were included to assess the interval between emergency call and hospital arrival (system response time). Associations between demographic, clinical, geographic, structural, temporal factors and system response time were evaluated using multivariable generalised linear models; results reported as adjusted estimates with 95% confidence intervals (CIs). A total of 32,506 patients were included. Median system response time was 61 minutes (IQR 49-77); only 48% of cases met the national target of call-to-hospital arrival within 60 minutes. Paradoxically, lower emergency vehicle density and lower stroke unit availability per 100,000 inhabitants were independently associated with shorter adjusted system response times (reductions of 4-8 minutes and 5 minutes, respectively, compared with highest-availability categories). Higher population density was also independently associated with shorter times (1minute reduction per unit increase in log population/km²; 95% CI: -1.68 to -0.42; p = 0.001). These inverse associations suggest that, in high-resource settings, dispatch complexity may offset proximity advantages. In a nationwide stroke network, simple resource availability does not predict faster prehospital response. Operational factors may influence prehospital stroke performance. Pathway optimisation should address emergency network organization.
Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, where timely diagnosis is critical. Prehospital assessment is challenging due to limited diagnostic resources and high clinical uncertainty. Artificial intelligence (AI) has emerged as a potential tool to support early diagnosis, risk stratification, and triage. This scoping review aimed to map the current evidence on AI applications in the prehospital assessment of suspected ACS and to identify existing knowledge gaps. A scoping review was conducted in accordance with PRISMA-ScR guidelines. A comprehensive search of PubMed, Scopus, Web of Science, and Embase was performed up to May 2026. Studies evaluating AI-based models using prehospital data for ACS diagnosis, prediction, or triage were included. 19 studies involving 319,709 patients were included. AI-based models, particularly ECG-based deep learning and multimodal approaches, demonstrated promising diagnostic performance, with AUC values generally ranging from approximately 0.81 to 0.99, sensitivity from 73% to 94%, and specificity from 56% to 99%. These models improved sensitivity, reduced diagnostic variability, and enhanced triage efficiency in some settings. Risk prediction models showed moderate to good performance (AUC ~ 0.71-0.95) but were more variable. Emerging applications extended beyond diagnosis to risk stratification and decision support, including prediction of cardiogenic shock and need for revascularization. AI shows considerable potential to improve prehospital assessment of suspected ACS, particularly through enhanced ECG interpretation and multimodal data integration. However, current evidence remains limited by methodological constraints. Future prospective, multicenter studies with standardized approaches are essential to support clinical implementation.
Early hospital arrival is essential for timely reperfusion therapy in acute stroke. This study aimed to identify clinical, symptom-related, and prehospital factors associated with delayed hospital arrival among patients with first-ever acute stroke, with particular focus on the 4.5-hour therapeutic window. This prospective single-center observational study was conducted at a comprehensive stroke center in Istanbul, Türkiye, between December 2023 and October 2024. Among 362 patients screened for suspected acute cerebrovascular events, 205 adults with first-ever acute ischemic stroke, intracerebral hemorrhage, or transient ischemic attack managed through the acute stroke pathway were included. Data were collected using a structured clinical form and a questionnaire on barriers to accessing acute stroke treatment, administered through face-to-face interviews with patients' relatives. Prehospital delay was defined as the interval from last known well (LKW) to hospital arrival. Patients were analyzed according to arrival within 1 hour, 2 hours, 3 hours, and 4.5 hours, using appropriate comparative statistical tests. The mean LKW-to-arrival time was 338.66 ± 345.67 minutes, with a median (IQR) of 240 (90-720) minutes. Overall, 29.3% of patients arrived within 1 hour, 41.0% within 2 hours, 48.3% within 3 hours, and 58.5% within 4.5 hours. Facial droop was consistently associated with earlier hospital arrival across multiple time thresholds (p ≤ 0.004), and syncope was more frequent among early presenters (p = 0.001). Conversely, visual symptoms were associated with delayed presentation, including vision loss after 3 hours and diplopia beyond 4.5 hours (p = 0.042 for both). Diabetes mellitus was associated with delayed arrival at the 1-hour and 2-hour thresholds, while hypertension was more common among patients arriving after 4.5 hours. Prehospital delay remains a substantial barrier to timely acute stroke care. Recognizable symptoms such as facial droop may facilitate earlier presentation, whereas less typical symptoms, particularly visual disturbances, may contribute to delayed arrival. These findings support locally tailored public awareness strategies and optimized prehospital stroke pathways that emphasize both typical and atypical stroke symptoms.
Social risk factors (SRF), or adverse social drivers of health, have become an increased area of focus in health care, particularly among Emergency Medical Services. Prehospital identification and response to SRFs have been reported, most notably among mobile-integrated models, such as Community Paramedicine. Incorporating SRF screening within routine EMS practice is not standard, despite reports of willingness to do so among clinicians. Therefore, it was the aim of this study to evaluate the integration of a prehospital SRF documentation tool. A 14-item prehospital SRF documentation tool derived from the World Health Organization's social determinants of health categories was integrated into our EMS agency's patient charting platform as a required field on July 11, 2024. We conducted a retrospective cohort study of all adult emergency and non-emergency calls from the start of integration to January 11, 2025 to evaluate overall identification and prevalence of reported SRF. Descriptive statistics were used to characterize the study sample. Bivariate statistics were used to evaluate differences across demographic and encounter level variables and SRF type using Chi-Square tests and Wilcoxon rank-sum tests, where appropriate. Covariates were further evaluated by whether they had a documented SRF or not. A total of 57,899 encounters were identified, with 4.0% having at least one documented SRF (n = 2,326); the remaining sample had no SRFs documented. The SRF sample overall was 66.9% male, 28.9% White and median age of 50 years (IQR: 36-66), and 30.8% had more than one SRF identified. There were 116 individuals that had more than one encounter during the study time period. The most frequently reported SRFs were substance use (31.3%), housing instability (25.7%) and disability (25.4%). Over 75% of encounters were low acuity. Compared to encounters with no SRFs documented (n = 55,573), patients were older and female (p-values >0.05). Identified SRFs were low among our sample, highlighting the need to determine the barriers preventing recognition and reporting. Young males are a high-risk group, particularly for repeated encounters. There is a need to identify improved mechanisms for EMS clinicians to document and communicate pertinent SRF information, particularly to Emergency Department teams.
Pediatric emergencies constitute a small proportion of prehospital cases yet pose unique diagnostic and therapeutic challenges for emergency physicians due to age-specific physiological differences, limited exposure, and infrequent opportunities for skill acquisition. Competency-based medical education frameworks and entrustable professional activities (EPAs) may offer suitable concepts to structure pediatric emergency training. This mixed-methods study combined a retrospective analysis of 9,409 prehospital emergency physician protocols (2012-2021) with a survey assessing self-perceived competence and training needs among emergency physicians. Pediatric emergency characteristics, clinical management, and utilized interventions were analyzed. Survey data captured demographic characteristics, perceived competency across defined scenarios, sources of knowledge acquisition, and perceived gaps in pediatric emergency preparedness. Among all prehospital missions, 606 pediatric emergencies (6.45%) were identified, predominantly involving adolescents with any condition, and any age with trauma and neurological conditions. Invasive interventions such as intubation, cardiopulmonary resuscitation, or intraosseous access were rarely needed. Survey responses (n = 437) revealed heterogeneous self-perceived competencies: seizures, anaphylaxis, and hypoglycemia were associated with high confidence, whereas neonatal care, pediatric polytrauma, and cardiopulmonary resuscitation demonstrated markedly lower confidence levels. Knowledge was primarily acquired during the initial emergency physician qualification training period, as well as through subsequent clinical exposure in routine practice, with limited engagement in ongoing pediatric-specific training. More than 70% of participants advocated for structured, mandatory, and simulation-based pediatric training. Pediatric emergencies in the prehospital setting are uncommon yet challenging, revealing gaps between training expectations, clinical exposure, and perceived competencies. Strengthened pediatric emergency training-particularly simulation-based practice and EPA-based curricular elements-may enhance preparedness, standardize entrustment decisions, and improve patient safety. Future work should operationalize nested pediatric EPAs and evaluate competency outcomes prospectively. IRB-2023-06.
Rural residents are more likely to suffer moderate and severe traumatic brain injury (TBI) and experience delay to definitive care than urban patients. Prior studies comparing these populations were based on hospitalised patients only. We examined TBI outcomes incorporating pre-hospital mortality to determine the association between location of injury and mortality risk. Twelve-month (2019) retrospective cohort study was performed on all adult patients with TBI within one Trauma System. Demographics, geographical location of injury, mechanism, scene vital parameters and interventions, injury severity, polytrauma status, TBI morphology and outcomes were collected for all hospital and prehospital deaths. Uni- and multivariate analysis was conducted including binary logistic regression to examine associations between mortality and potential confounders of mortality. 266 patients (145 hospitalised and 121 prehospital deaths) with median age 53.6 years (18-98), 72.6% males, scene Glasgow Coma Scale (GCS) < 14 (48.3%), were included. Ninety-four (36%) patients were urban and, 167 (64%) were regional, rural or remote. Rural compared to urban patients had higher risk of death (adjusted OR 1.934, 95% CI 1.07-3.49) without differences in GCS, pupillary status, injury pattern, radiological TBI severity or initial management. The strongest risk factor for mortality was polytrauma (adjusted OR 7.804, 95% CI 4.155-14.62, p < 0.01). Comprehensive assessment of TBI mortality indicates that rurality is associated with mortality and polytrauma status is a profound risk factor. These findings highlight that prehospital mortality is essential to monitor and optimisation of polytrauma care is a potential modifiable factor in TBI outcomes.
Post-traumatic stress disorder (PTSD) is a well-documented consequence of combat-related trauma. While tourniquet application is a cornerstone of hemorrhage control in military settings, its mental health consequences have not been explored. We aimed to assess the association between prehospital tourniquet application and subsequent PTSD among military personnel with extremity injuries. In this retrospective cohort study, we utilized linked military and national trauma registries to identify military personnel with extremity injuries and Injury Severity Score (ISS) ≤8 between 2006 and 2021. Participants were grouped based on documented prehospital use of tourniquets. Service-connected PTSD diagnoses were retrieved from the Ministry of Defense Rehabilitation Department disability claim records and validated by the PTSD Checklist for DSM-5 (PCL-5). Logistic regression models were used to assess associations between tourniquet use and PTSD, adjusting for confounders including injury mechanism, event type, head injury, number of injured persons, and hospitalization status. During 31,690 person-years of follow-up, a total of 2,876 military personnel met the inclusion criteria, of whom 123 (4.3%) received a tourniquet. PTSD was diagnosed in 244 (8.5%) of all casualties, with a prevalence of 30.9% (n=38) among those who received a tourniquet, compared with 7.5% (n=206) among those who did not (p<0.0001). In unadjusted analyses, tourniquet use was strongly associated with increased odds of PTSD (odds ratio, 5.53; 95% confidence interval, 3.64-8.26). After adjusting for confounders, tourniquet use remained significantly associated with PTSD (odds ratio, 1.70; 95% confidence interval, 1.07-2.66). Tourniquet use was associated with increased odds of PTSD, even after accounting for key confounders. While essential for hemorrhage control, this association should be interpreted with caution, as it may reflect underlying injury context, operational intensity, or other unmeasured confounders rather than a direct causal effect. Tourniquet use was associated with increased odds of PTSD; however, this association should not be interpreted as causal and does not support changes to current point-of-injury tourniquet guidelines. Rather, it may reflect underlying injury context, operational intensity, or other unmeasured confounders. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Prognostic/epidemiological, Level III.
This study aims to describe the gradient and the frequency with which the end tidal carbon dioxide (EtCO2) misclassifies the arterial carbon dioxide (PaCO2) in the prehospital environment. This retrospective observational study included 53 adult patients (aged ⩾ 18 years) who underwent prehospital arterial catheterisation following a traumatic mechanism who were conveyed to the regional Major Trauma Centre (MTC), 01.02.2015-17.04.2023. The PaCO2-EtCO2 gradient was more than >1 kPa difference in most patients (43/53 (81.1%)) and the ETCO2 misclassified the PaCO2 in over two-thirds of patients (38/53 (71.7%)). Overall, EtCO2 is not a reliable surrogate for PaCO2 during trauma.
Racial and ethnic disparities in health care, including surgery, are well-documented and linked to worse outcomes for minority groups. Social determinants of health-such as living environment, access to care, and prehospital factors-play a significant role in shaping surgical risk and recovery. Neighborhood socioeconomic status, built environment, pollution, and health literacy all contribute to disparities, with disadvantaged communities facing higher rates of advanced disease, complications, and worse perioperative outcomes. Geographic and infrastructure barriers further limit access to specialized care. These environmental and social factors often interact, compounding risks and perpetuating inequities in surgical care and outcomes.
Peripheral intravenous catheters (PIVC) are widely used clinical devices for administering fluids or essential drugs to patients. The failure rate of PIVC remains high and Emergency Medicine has been shown to be a risk factor for dislodgement. When the skin is moist from sweat or fluids, standard intra-hospital dressings and securements fail. In emergency situations, a failed catheter can then critically delay intravenous therapies. The most effective dressing to prevent accidental removal of a prehospital PIVC remains unclear. It was the aim of this study to compare the force required to dislodge a PIVC with four different methods of securing PIVCs used in emergency medicine. In addition, the costs were calculated. Artificial sweat was applied to the skin of 180 volunteers. PIVCs were attached onto the forearm using four different securements (elastic gauze, cohesive gauze, clingfilm and a velcro securing device). Continuously increasing traction force was applied until dislodgement of the respective securement. For statistical tests, either Friedman's test or repeated measures ANOVA was used. Clingfilm showed the greatest resistance to increasing pulling force with cohesive bandages as close second. The velcro securing device was strongest at resisting low level of forces but fell off sharply at higher force. Elastic bandages were the weakest in both categories. Clingfilm was the most cost-effective method (4ct), followed by elastic gauze (12 ct), cohesive gauze (60 ct) and the velcro device (316 ct). In situations where intravenous catheters are difficult to secure or at high risk of dislodgement either clingfilm or cohesive dressing should be used. Simple elastic bandages should not be used in any setting for securement of PIVC.
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. 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. 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. 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.
Trauma is a leading cause of preventable death and disability worldwide. Although nearly 90% of trauma-related mortality occurs in low- and middle-income countries, current reports on emergency medical care often come from high-income countries with fewer resource constraints. This scoping review investigates which geospatial variables are measured and reported in trauma networks, how they are defined, characteristics of relevant studies, analytical software used, and existing gaps in the literature. A search was conducted using PubMed, Embase, and Cochrane for studies published between 2004 and 2024. Data extracted included study characteristics, geospatial variables including prehospital time and distance, spatial access, transport modality, population measures, injury location, analytical methods, and patient outcomes such as mortality and injury severity. Descriptive analysis was performed, grouping studies according to key geospatial themes. A total of 13,908 studies were identified, of which 41 were included, spanning seventeen countries. Prehospital time was reported by nineteen studies where longer prehospital intervals, including delays in dispatch and transport, were consistently associated with worse outcomes. Fifteen studies evaluated patients beyond golden hour access to care, demonstrating increased prehospital mortality with longer transport distances, lower population densities, and limited infrastructure. Rural populations experienced reduced access and higher mortality; HEMS expanded access and was associated with improved survival. Key gaps included variations in geospatial variable definitions, limited integration of dynamic factors such as infrastructure and traffic, inconsistent reporting of location data, and unclear criteria for HEMS utilisation. Geospatial variables are strongly associated with trauma system performance where shorter prehospital times and improved spatial access were linked to reduced mortality. Standardised geospatial measures, clear transport modality guidelines, and regionally appropriate trauma network design are needed to reduce geographic inequalities and optimise patient outcomes.
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. 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. 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. 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. Not applicable.