ABSTRACT The aim of this study was to determine if correlations exist between certain social determinants of health (SDoH) and drug overdose events occurring in the city of Great Falls, Montana, between 2019 and 2022. Emergency Medical System data about suspected overdose events were collected from the Montana Department of Public Health and Human Services (DPHHS). Statistical analysis was completed to determine risk ratios according to zip code of the overdose event, patient demographics and mental health history. Chi-square analysis was used to determine if statistically significant differences existed among certain populations. This study found significant association of zip code with increased risk of overdose; however, small sample size in the “highest risk” zip code influences the data, suggesting need for greater data collection. Analysis did suggest increased risk of overdose among Native American residents, but this may be explained by under-enumeration of Great Falls’ Native American population in Census Bureau data. Finally, 0–17-year-olds and those with mental health history had significantly increased risk of experiencing intentional self-harm related overdose events. Understanding overdose as a mental health issue can inform targeted, preventative interventions moving forward.

Individuals who decline transport to the hospital following an opioid overdose represent a vulnerable subgroup at increased risk for subsequent overdoses. This study describes a unique joint overdose response model implemented by an emergency medical service provider and a community-based organization to connect overdose survivors to medication for opioid use disorder and services. Qualitative interviews were conducted with emergency medical system employees (n = 7), community-based organization staff (n = 3), and program clients (n = 20). A qualitative descriptive method was applied for thematic analysis to understand participants' experiences with this coresponse model, particularly navigating clients to health and opioid treatment services. Thematic analysis identified three themes: (a) Outreach workers perceived as part of the community describes why clients trusted the community outreach workers and coresponse acceptability; (b) in coresponse team emphasized personal empowerment, clients described how the coresponse team provided postoverdose and follow-up services, which promoted their self-efficacy to address health and substance use priorities; (c) service uptake and challenges include difficulties with linking clients to evidence-based opioid use disorder treatment with medications for opioid use disorder and follow-up interactions with community outreach workers for wraparound services to facilitate linkage to opioid treatment services. This is among the first partnerships that allowed community responders to arrive at the scene of an overdose. This program attempts to connect trusted partners to people who recently survived an overdose and immediately begin support and service navigation. Clients were enthusiastic about the services provided by the community outreach workers to initiate and maintain their connection to essential social and treatment services. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Prehospital Management of Traumatic Cardiac Arrest: A Narrative Review of Evidence and Implications for Emergency Nursing.

The rapid growth in wellness tourism increases the need to ensure the safety of visitors and the quality of service while promoting sustainability. This study proposes an intelligent digital ecosystem unifying emergency medical systems, standardized wellness services and smart tourism technologies, artificial intelligence, internet of things devices, data platforms, geographic information systems, and mobile applications for enhancing safe and sustainable wellness tourism in Chiang Mai, Thailand, with global applicability. A mixed methods approach to designing a Safe & Sustainable Wellness Tourism Ecosystem using geospatial analysis of wellness infrastructure, surveys, and stakeholder interviews. Results indicated that multilingual notifications, health surveillance, and geographical mapping have a positive impact on emergency response time, coordination, quality, and tourist confidence in Chiang Mai's emergency response. While it is shown that rural providers were supported in implementing safety planning based on evidence, the gap in certification and quality of services between urban and rural providers suggest policy interventions, capacity development and partnerships are needed. Theoretically, it contributes to the integration of digital infrastructure, tourism management, and public health for the resilience of destinations after the pandemic. It provides a replicable template for the use of internet-enabled ecosystems for safe and sustainable wellness tourism. Future research needs to be tested for transfer across contexts, the long-term impact needs to be studied, and emerging technologies should be explored.

Training paramedics within the emergency medical care system requires a comprehensive understanding of the morphological basis of pathological processes underlying critical conditions. Knowledge of pathomorphology fosters the ability to assess the severity of injuries, predict the course of pathological changes, and make clinically sound decisions under time constraints and uncertainty.Objective – to substantiate the importance of pathomorphology in developing the professional competencies of paramedic students and to identify effective pedagogical approaches to teaching the discipline.Material and methods. The content of the discipline “Pathology”, particularly its module “Pathomorphology”, was analyzed in the context of the educational and professional program “Emergency Medicine / Paramedic”. Methods of pedagogical observation, generalization of educational experience, and analysis of educational and methodological materials were applied.Results. It was established that mastering the morphological basis of pathological processes enables understanding the mechanisms of emergency conditions and the pathogenetic relationships between structural damage and clinical manifestations. Teaching pathomorphology promotes the development of integral competence (the ability to act responsibly and make decisions under uncertainty), general competencies (communication, critical thinking, professional ethics, lifelong learning), and professional competencies (analysis of morphological changes, their causal relationships, and clinical relevance). Learning efficiency is enhanced through the integration of traditional and innovative methods – demonstration of macropreparations, use of digital resources, clinical problem-solving, and pathomorphological case analysis.Conclusions. The study of pathomorphology ensures the formation of integral, general, and professional competencies defined by the higher education standard for the specialty “Paramedic”. The discipline serves as an integrating link between fundamental and clinical training, shaping clinical and morphological thinking, responsibility, and readiness for professional actions in emergency situations.

We aimed to compare the 72-hour survival of the endotracheal intubation (ETI) with video laryngoscope (VL), ETI with direct laryngoscope (DL), and supraglottic airway (SGA) in out-of-hospital cardiac arrest (OHCA) patients in Korea. This study included adult OHCA patients who received advanced airway management by designated response teams for severe disease, using a nationwide OHCA registry in South Korea from July 2019 to December 2021. The primary outcome was 72-hour survival, and secondary outcomes were survival to hospital discharge and good neurological recovery. Multivariable logistic regression was used, adjusted for confounders, to compare the outcomes among the three airway management methods. Among 77,629 OHCA cases, 10,857 were included. SGA was attempted in 9,379 cases, ETI with DL in 493 cases, and ETI with VL in 985 cases. The rates of any prehospital ROSC and 72-hour survival were 13.3% and 11.0% for SGA, 16.0% and 11.4% for ETI with DL, and 18.2% and 11.9% for ETI with VL. Compared to SGA, ETI with VL was significantly associated with 72-hour survival: adjusted odds ratio (OR) [95% confidence interval (CI)] 1.34 (1.06-1.70) for ETI with VL and 1.13 (0.81-1.56) for ETI with DL). There was no significant association between the type of AAM and survival to discharge or good neurological recovery. In an emergency medical service system staffed by advanced emergency medical technician-level providers, ETI with VL might be associated with improved 72-hour survival compared to SGA. However, this short-term benefit did not extend to survival to hospital discharge.

Mechanical thrombectomy access (MTA) for large vessel occlusion stroke varies and is limited globally. While regional studies have suggested rurality as a barrier to MTA, the magnitude and variability of this effect across countries remain unknown. This study evaluates the association of country-level rural population proportion with mechanical thrombectomy (MT) access. We conducted an online survey of 75 countries through the Mission Thrombectomy (previously MT2020+) global professional peer network between November 22, 2020, and February 28, 2021. Surveys were distributed by regional committee chairs and completed by stroke-focused neurologists and neurointerventional physicians within the regional committees. Questions covered country-level availability of MT centers, operators, procedures, reimbursement, emergency medical services, cultural barriers, and other factors affecting stroke systems of care. MTA was defined as the estimated proportion of patients with thrombectomy-eligible large vessel occlusions receiving MT in each region annually. We used World Bank data to obtain each country's income class based on per capita gross national income and the proportion of rural population expressed as a percentage of the total population of each country. In the final analysis, 60 countries were included. We used multivariable generalized linear models with a logit link to evaluate the association of rural population proportion with MTA. The median country-level rural population proportion among 60 countries was 30.7% (interquartile range, 16.3%-45.9%). In univariate generalized linear models, each 5% increase in country-level rural population proportion was associated with 22% lower odds of MTA (odds ratio, 0.78 [95% CI, 0.70-0.86]; P<0.001). After adjusting for differences in country-level health care gross domestic product, reimbursement for MT, country income class, availability of prehospital emergency medical services, training, and triage systems, each 5% increase in rural population proportion was associated with 13% lower odds of MTA (odds ratio, 0.87 [95% CI, 0.78-0.96]; P=0.006). Country-level rural population proportion is an independent negative predictor of access to MT. The unique challenges that rural populations experience within countries should be carefully studied to strategize and align global efforts to bridge thrombectomy access gaps and address rural-urban disparities.

Japan and South Korea, two advanced East Asian nations with universal health coverage and similar demographic challenges, have developed markedly different emergency medical services (EMS) systems. Despite growing interest in international benchmarking, structured, comparative studies that yield policy-relevant insights remain limited. We conducted a multisource comparative health-systems analysis using statutory laws, government publications, academic society reports, peer-reviewed literature, and national statistics. Key domains included EMS governance, workforce, prehospital organization, hospital-based emergency care, legal obligations for EMS patient transport and hospital acceptance, and governance and quality assurance mechanisms. Data were synthesized in comparative tables and narrative summaries to highlight structural and operational differences. Japan's EMS operates under decentralized municipal control through 722 fire departments, serving 4,100 designated emergency institutions with 6,139 board-certified emergency physicians. In 2023, over 6.64 million ambulance dispatches occurred, and 8.6% were classified as critical cases (1.3% death and 7.3% severe). Korea's EMS is centrally governed with 412 designated facilities in a tiered system and 2,464 specialists. Annual ambulance activations exceeded 3.5 million, with severe cases accounting for approximately 5% to 10%. Japan employs dual statutory frameworks (Fire Service Act and Medical Practitioners Act), allowing clinical discretion, whereas Korea enforces unified regulations with stricter obligations and criminal penalties for hospital refusal of emergency patients. The contrasting systems suggest that hybrid governance that combines centralized standard settings with local operational flexibility may optimize EMS performance. These findings provide lessons for EMS reform, cross-border collaboration, and disaster preparedness in high-income nations facing similar demographic and healthcare challenges.

Building a sustainable and resilient humanitarian logistics system is essential for reducing disaster losses and supporting long-term socio-economic recovery. Following a major disaster, rapidly organizing casualty evacuation while maintaining system robustness is a fundamental component of sustainable emergency management. This study develops a two-stage robust optimization model for designing a sustainable humanitarian logistics network that simultaneously accounts for two critical post-disaster uncertainties: (i) interruption risks at temporary medical points and (ii) uncertain casualty demand. By explicitly differentiating deprivation costs between mild and serious injuries, the model quantifies human suffering in monetary terms, thereby integrating social and economic sustainability considerations into the optimization framework. A customized column-and-constraint generation (C&amp;CG) algorithm with proven finite convergence is proposed to ensure tractability and practical applicability. Using the 2008 Wenchuan earthquake as a real-world case study, involving 10 affected areas and 10 candidate temporary medical points, the results demonstrate that the proposed approach yields evacuation plans that remain feasible under all tested worst-case realizations, substantially reducing deprivation costs compared with existing benchmarks. The findings highlight that strategically increasing the capacity of key temporary medical nodes enhances the sustainability and resilience of the emergency medical system, offering evidence-based insights for designing sustainable and robust disaster-response strategies.

Evaluation of the effectiveness of emergency medical rescue equipment system based on cloud model

The impact of the AIRWAYS-2 randomised controlled trial on clinical practice in out-of-hospital cardiac arrest in England: A registry-based cohort study.

Rural America faces significant trauma outcome disparities, primarily driven by limited access to timely and appropriate care. Undertriage (UT) or the failure to transport severely injured patients to higher-level trauma centers further exacerbates these inequities. This study investigates the role of social determinants of health in influencing UT, hypothesizing that increased social deprivation correlates with higher UT rates. Retrospective cohort study of injured patients transported by emergency medical services in Pennsylvania between 2000 and 2020 who met physiologic or anatomic National Field Triage Guidelines criteria for transport to a trauma center. Undertriage was defined as patients not initially transported to a level I or II trauma center. Logistic regression determined the association between the social deprivation index (SDI) and UT at both the patient and zip code levels. In addition, we applied Bayesian spatial models to explore regional patterns and influences on UT. The cohort included 166,632 trauma patients, with 29% experiencing UT. At the patient level, a 10-point increase in SDI (more deprivation) was associated with a 1.4% rise in the odds of UT (adjusted odds ratio, 1.014; 95% confidence interval, 1.002-1.026; p = 0.025). At the zip code level, SDI emerged as a significant predictor of UT rates (coefficient, 0.380; 95% CI, 0.0165-0.0595; p = 0.001), with spatial autocorrelation observed (Moran's I = 0.732, p < 0.0001). Bayesian spatial models revealed an association between regional SDI and UT, reinforcing the role of geographic and socioeconomic factors. Undertriage was linked to increased mortality, higher complication rates, and prolonged hospital stays (p < 0.05). Undertriage is associated with more disadvantaged social determinants of health. This work highlights a critical opportunity to mitigate trauma disparities. Policy efforts should prioritize disseminating standardized triage guidelines, leveraging geospatial data for targeted interventions, and exploring air medical transport to improve access to care without overburdening ground emergency medical services systems. Epidemiological; Level IV.

Background: In Japan, emergency medical technicians (EMTs) are not permitted to terminate resuscitation for patients with out-of-hospital cardiac arrest (OHCA), even if the patient has a do-not-attempt-resuscitation (DNAR) order. To address this issue, a new protocol allowing EMTs to terminate resuscitation for OHCA patients with DNAR orders has been implemented. However, the effectiveness of this DNAR protocol remains unclear. Methods: We conducted a population-based analysis in Kobe, Japan, to investigate the current situation about DNAR and assess whether the newly introduced DNAR protocol reduces EMS activity time and the use of medical resources, based on emergency medical system records. The primary outcome was the duration of various EMT activities, including the time from call to dispatch, dispatch to departure from the scene, and call to return to the local department. Secondary outcomes included the proportion of medical interventions such as advanced airway placement, intravenous access, adrenaline administration, and defibrillation. Results: Of 2,023 OHCA cases, 1,686 cases were included in the analysis (93 in the DNAR group and 1,593 in the non-DNAR group). EMT activity time was not shorter in the DNAR group [96 minutes (IQR: 78–117) vs. 83.5 minutes (IQR: 69–98); p &lt;0.01]. However, when termination of resuscitation was successfully completed, the time from dispatch to return to the local department was reduced [87 minutes (IQR: 68.5–107) vs. 79 minutes (63–97); p=0.04]. The proportion of defibrillation did not significantly differ between the groups [13.3% (211/1,593) vs. 11.7% (11/93); p =0.67]. In contrast, the use of advanced airway devices [66.3% (1,056/1,593) vs. 13.8% (13/93); p &lt;0.01], intravenous access [54.1% (861/1,593) vs. 5.3% (5/93); p &lt;0.01], and adrenaline administration [24.4% (388/1,593) vs. 2.1% (2/93); p &lt;0.01] was significantly higher in the non-DNAR group. Conclusions: The DNAR protocol is effective in reducing EMS activity time when termination of resuscitation is successfully carried out. Otherwise, EMS activity duration is not shortened. The use of medical resources for prehospital care differ significantly between the two groups except for defibrillation.

Introduction: Understanding the epidemiological patterns of poisoning cases in specific regions is essential for health authorities to implement preventive measures and strategic planning. This study aimed to describe the epidemiologic characteristics of acute poisoning cases registered in Tehran province’s emergency medical services (EMS).Methods:This retrospective cross-sectional study was conducted on all registered acute poisoning cases from 2022 to 2024 in the Asayar database of Tehran Province’s EMS. The cases were included through census sampling and descriptive analysis was used for evaluating the epidemiologic characteristics of registered cases.Results:76,113 acute poisoning cases were registered by Tehran Province EMS during the study period. The mean age of cases was 34.3 ± 15.0 years (59.1% male). The most frequent method of poisoning was oral, with 71,521 (94.0%) cases, and inhalational, with 3,236 (4.2%) cases. The highest number of cases was reported in the eastern region of Tehran with 15,058 cases. Seasonal distribution of poisonings was as follows: 20,201 (26.6%) cases in summer, 21,322(28.0%) cases in winter, 21,105 (27.7%) cases in autumn, and 13,485 (17.7%) cases in spring. Most poisonings occurred in residential settings, accounting for 72,194 (94.9%) cases. The most frequent used antidote was naloxone, in 12,662 (16.6%) cases, and atropine, in 961 (1.3%) cases.Conclusion:Based on the findings of this study, the most vulnerable population groups to the poisoning were young individuals, males, and those with a history of psychiatric illness and substance abuse, predominantly affected by oral route. The geographical and temporal distribution of poisonings highlights the need for targeted preventive interventions, public education, and enhancement of prehospital emergency service infrastructure in high-risk areas.

The aging society and increasing prevalence of single-person households have led to delayed emergency reporting, resulting in an increased incidence of dead-on-ambulance-arrival (DOAA) cases. This study aimed to analyze the status of DOAA patients in the Busan region and identify the factors influencing their occurrence, providing foundational data for establishing an emergency medical system that reflects local characteristics. Multiple and multilevel logistic regression analyses were performed on 5,671 out-of-hospital patients with cardiac arrest in Busan. Among the study population, 1,532 patients (27.0%) were classified as DOAA, corresponding to an incidence of 45.5 per 100,000 population, with Jung-gu District exhibiting the highest rate. Multilevel analysis demonstrated that the DOAA risk was higher among individuals aged &lt;60 years (odds ratio [OR] = 3.334), during weekday incidents (OR = 1.206), and in areas with greater ambulance deployment (OR = 1.372). Conversely, a lower risk was observed among males (OR = 0.875), incidents occurring in public places (OR = 0.487), and calls made outside rush hour (OR = 0.865). This study demonstrated regional disparities in DOAA incidence attributable to both individual- and area-level factors. These findings underscore the need to establish community-specific early detection systems and strategically reallocate ambulance resources.

Survey of the situation of the prehospital emergency medical services system in Iran

Abstract Effective emergency medical response depends critically on accurate and timely allocation of scarce ambulance resources. This paper investigates the efficiency costs associated with informational frictions in the localization of patients during emergency calls. Using detailed administrative data from the Emergency Medical System of Liguria, Italy, I document systematic misallocations in ambulance dispatch, primarily driven by difficulties in pinpointing patient locations. Exploiting plausibly exogenous variation in call origin characteristics and dispatcher behavior, I estimate that localization frictions lead to substantial increases in response times, which in turn are correlated with adverse clinical outcomes. The analysis highlights the behavioral and organizational dimensions of emergency response systems, and quantifies the welfare implications of reducing information asymmetries in high-stakes public service delivery.

Chronic refractory wounds have emerged as a significant public health challenge that needs to be addressed urgently in China, necessitating strengthened construction of wound repair discipline. Since the National Health Commission of China officially encouraged medical institutions to establish specialized wound repair discipline in 2019, diverse regional models of specialized discipline have emerged nationwide, effectively advancing the construction and development of wound repair discipline system in China. Leveraging Hainan's unique regional characteristics, the First Affiliated Hospital of Hainan Medical University has innovatively integrated the wound repair discipline into the construction of the emergency medical rescue system, successfully creating the distinctive "Hainan Model" for specialized wound repair discipline. This model not only addresses the wound treatment needs of local populations, but also provides robust support for the implementation of national strategic initiatives, achieving dual value in both disciplinary development and social benefits and highlighting its core strengths and advantages. This paper systematically elaborates on the developmental trajectory of Hainan's wound repair system and the exploration of the "Hainan Model" in construction of specialized wound repair discipline, aiming to offer valuable reference for building a China-specific wound repair discipline system and promote its high-quality development.

How a system saves lives: Results of Luxembourg’s nationwide cardiac arrest project

BackgroundThe Saitama Tone Health and Medical Care Region Medical Collaboration Promotion Council has established a regional medical network system (Patient-Centered Digital Health Records, Tonetto) that shares medical information among healthcare facilities and provides medical services to Tonetto users. This system has facilitated the sharing of medical information between core hospitals, general hospitals, and clinics, thereby contributing to improved medical care. Furthermore, Tonetto has facilitated the availability of patient information for emergency transport. This study aimed to evaluate the impact of Tonetto on emergency transportation times for older patients.MethodsThe study population consisted of 1,820 older patients (aged 65 and over) among 2,542 emergency patients transported to East Saitama General Hospital between January and December 2023. Based on their registration status in the Tonetto system, the patients were divided into two groups: a Tonetto-registered group (n = 319) and a Tonetto-nonregistered group (n = 1,501). Statistical analysis was performed using a general linear model that included main effects and interaction terms for the three categories of transport distance (< 5, 5–10, and ≥ 10 km) and two categories of Tonetto registration status. The difference in transport time was estimated based on Tonetto registration status for each transport distance category. To control for confounding variables, the model included severity, age, sex, and transport distance as covariates.ResultsThe difference in transport time (minutes) between the Tonetto-nonregistered group and the Tonetto-registered group (95% confidence interval) was − 0.3 (− 3.0, 2.4), − 3.5 (− 8.9, 1.9), − 24.3 (− 38.3, − 10.2), respectively. A reduction of 24 min in transport time was observed in the Tonetto-registered group for distances of 10 km or more (p = 0.001).ConclusionsTonetto registration was associated with a substantial reduction in emergency transport time for older patients over long distances. These findings demonstrate the potential of regional medical information networks to improve the efficiency of emergency care and support the development of a nationwide emergency medical information system in Japan.