Articles: emergency-medical-services.
-
Scand J Trauma Resus · Feb 2025
ReviewPoint-of-care tests in the emergency medical services: a scoping review.
This scoping review aimed to summarize existing research on point-of-care tests (POCTs) within emergency medical services (EMS). There is a lack of comprehensive reviews covering the breadth and scope of application of POCTs in EMS despite growing interest and potential benefits in this setting. A review of the research will inform how we target future research efforts to support effective implementation and avoid duplication. ⋯ We identified a thriving base of research on POCT in the EMS, however most studies established the diagnostic accuracy of the tests with few RCTs, economic analyses or qualitative research on acceptability. The time-lag from diagnostic accuracy to developing an RCT is considerable. Investment in funding and infrastructure is needed to support the research pathway for potential POCTs beyond diagnostic accuracy to designs able to assess clinical effectiveness, acceptability and economic effectiveness.
-
Prolonged emergency medical services' response times (EMS-RT) are associated with poorer outcomes in out-of-hospital cardiac arrest (OHCA). The patient access time interval (PATI), from vehicle stop until contact with patient, may be increased in areas with low socioeconomic status (SES). ⋯ In OHCA cases occurring in the Greater Paris metropolitan area, after adjustment for scene characteristics, EMS delays until patient contact were longer in neighborhoods of low SES, and were associated with poorer clinical outcomes.
-
Comparative Study
Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart.
Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. ⋯ Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.
-
Emerg Med Australas · Feb 2025
Adverse events and paramedic interventions during extended ground transport in a rural pharmaco-invasive STEMI program.
Although guidelines recommend angiography and coronary intervention occur within 24 h of thrombolysis when percutaneous coronary intervention (PCI) is not available within 120 min, this target is difficult to achieve in rural and remote areas of New South Wales (NSW), Australia. ⋯ The primary study showed a significant reduction in time from first clinical contact to arrival at the PCI hospital. In this secondary analysis, we demonstrate that the rate of adverse events during long-distance road transport is low, the adverse events are mostly minor in nature and are within the scope of paramedic practice to manage.
-
Improved understanding of the deteriorating patient in the pre-hospital setting may result in earlier recognition and response. Considering the effects of undetected deterioration are profound, it is fundamental to report the prevalence of pre-hospital clinical deterioration to advance our understanding. The present study investigated the prevalence of pre-hospital clinical deterioration and adverse events (AEs) within 3 days of the pre-hospital episode of care. ⋯ The present study found the prevalence of pre-hospital clinical deterioration and AEs subsequent to pre-hospital episodes of care to be low. Future research should prioritise using standardised criteria to define pre-hospital clinical deterioration and evaluate the performance of early warning scores.