Patterns and determinants of medication use by paramedics in German prehospital emergency care: a six-year multicenter analysis.

Lung Ultrasound (LUS) is increasingly used in prehospital emergency care for acute respiratory distress. By identifying artefacts such as B-lines, clinicians can rapidly differentiate “dry” from “wet” lung patterns to guide early treatment, although adoption in the field remains uneven. We conducted a narrative literature review to assess the usefulness of LUS for prehospital evaluation of respiratory distress. A secondary aim was to examine whether focused training on B-line detection improves patient management and limits early symptom progression. Sixteen articles were included. Overall, LUS showed high diagnostic performance for the differential diagnosis of dyspnoea. Using an eight-zone scan, the presence of ≥3 B-lines in at least two thoracic zones reached 94.2% sensitivity and 77.5% specificity for acute heart failure. LUS is rapid, non-invasive, and feasible in the field when performed by trained personnel; targeted education for paramedics and nurses improved diagnostic accuracy and shortened time to therapy in several studies. LUS is a useful, feasible tool for prehospital assessment and early management of acute respiratory distress. Structured theoretical–practical training and protocolised integration of LUS into prehospital pathways are recommended.

BackgroundSignificant workforce challenges are evolving in Irish general practice, which limit all aspects of practice, especially out-of-hour care. Community Paramedics can support general practitioner (GP) out-of-hour care and potentially improve the system efficiency in Ireland.MethodsQualitative semi-structured interviews were conducted with purposively recruited participants using a schedule informed by the existing research. A thematic analysis was undertaken based on the Braun and Clarke approach and supported by the NVivo software. Themes were developed based on the concept of preliminary key model components. The study was conducted in accordance with Standards for Reporting Qualitative Research.ResultsComprehensive data analysis generated four major themes: Workforce Management, Synergies in Healthcare, Progressive Futuristic Care, and Safe Practice. These themes formed the basis for the further development of the preliminary key model components.ConclusionThis study suggests that the integration of Community Paramedics into GP out-of-hour care in Ireland can be successfully launched if workforce planning is carefully considered. The role of the Community Paramedic must be defined, regulated, and governed in conjunction with the National Ambulance Service, the Pre Hospital Emergency Care Council, and the Department of Health in Ireland. Patient care must be underpinned by safe and effective care practices that are continuously audited and evaluated, and the scope of practice must be defined and maintained by each Community Paramedic through a guided educational system that incorporates continuous professional development. GPs can provide support to community paramedics, including the use of information technology, as required. GPs and Community Paramedics can work together to synergize healthcare and provide safe and effective care to patients in the domiciliary setting during out-of-hour hours, thus reducing emergency department attendance and increasing the GP’s capacity to provide face-to-face consultations.

Feedback is a vital yet underused tool for improving clinical outcomes in prehospital emergency care. This study aimed to develop and pilot a novel, theoretically grounded feedback mechanism for helicopter emergency medical service (HEMS) clinicians involved in out-of-hospital cardiac arrest (OHCA) in the East of England, UK. Semistructured interviews were conducted in September 2022 with HEMS clinicians from Essex & Herts Air Ambulance, and the feedback process was co-designed with the Essex Cardiothoracic Centre (Essex, UK). Using the COM-B model (Capability, Opportunity, Motivation-Behaviour), we conducted qualitative interviews with prehospitalists (seven paramedics, three prehospital doctors) to explore gaps in existing feedback processes and identify their information needs, then iteratively co-developed a structured feedback proforma with stakeholders. Three themes emerged, specifically about weaknesses in current feedback and preferences for an improved system: (1) dissatisfaction with current ad hoc, 'punitive' approaches; (2) the educational and emotional importance of timely, targeted feedback; and (3) a strong preference for standardised, confidentiality-compliant delivery methods. The resulting feedback proforma included working diagnoses, key investigations completed, optimisation opportunities and patient outcomes (if already available), to be delivered within 24-48 hours of hospital admission. Our study underscores the importance of stakeholder-driven development in shaping an effective prehospital feedback mechanism for OHCA aligned to clinicians' needs. By exploring feedback preferences and mapping insights onto the COM-B model, we highlight how knowledge, context and motivation can all steer behavioural change. Further research is needed in diverse emergency medical service contexts to test its impact on clinical practice and patient outcomes.

The pre-hospital emergency care has developed from informal rescue to organized ambulance services in Nepal. The developments remain fragile without continuous learning. Continuing Professional Development (CPD) is essential to sustain competence, ensure consistent quality of care across diverse territories into the wider health system. Emergency clinical skills like airway management, hemorrhage control, pediatric resuscitation, and triage weaken without periodic rehearsal and assessment. Research demonstrates that single, time-limited training events produce important shortterm gains. It occurs unless reinforced by refresher training, simulation, and workplace-based assessment. A national CPD framework that mandates periodic competency refreshers and simulation-based practice would reduce performance drift and align field practice with emerging evidence.

Objectives Pediatric patients represent a high-risk, low frequency population in emergency medical services (EMS) systems. Quality improvement (QI) is the backbone of high-quality care delivered in EMS and engagement in pediatric-specific QI work is a core domain of the National Prehospital Pediatric Readiness Project (PPRP). There is no widely accepted set of quality measures that focus on the full scope of pediatric prehospital care. Our objective was to establish core PPRP Quality Measures for a National EMS Information System (NEMSIS)-derived pediatric prehospital dashboard to support pediatric QI initiatives. Methods We convened a 16-member technical expert panel (TEP) from national professional societies and federal entities. The TEP included physicians, nurses, EMS clinicians, federal partners, state EMS officials, and NEMSIS staff. Candidate measures were identified through a review of national resources and a survey of TEP members. The TEP employed a modified Delphi process to establish consensus priorities and scored measures based on the National Quality Forum Measure Evaluation Criteria. Candidate measures were prioritized based on scientific acceptability, importance to patient outcomes, utility in driving improvements, and feasibility of collection. Candidate measures were scored on a scale of 1 (lowest priority) to 5 (highest priority). Consensus was defined as 75% of the TEP rating a measure ≥ 4. Results The TEP identified 65 candidate measures. After three rounds of voting, consensus was achieved on 24 measures addressing a range of common pediatric prehospital conditions, including airway management (5 measures), trauma (4), pain control (3), respiratory emergencies (3), cardiac arrest (2), anaphylaxis (1), shock (1), seizures (1), hypoglycemia (1), newborn emergencies (1), non-transport (1), and safe transport (1). Thirteen (54%) of these measures apply to basic life support (BLS) teams. Common reasons for excluding measures included: limited scientific evidence, measure complexity, and redundancy. Conclusions A TEP identified 24 quality measures in pediatric EMS that emphasize foundational practice and relevance across a range of volumes and service models. Future validation of these measures with NEMSIS data are needed to establish benchmarks of care across variably resourced EMS agencies and develop effective strategies to support adherence to high-quality pediatric prehospital emergency care.

Background: Acute coronary syndrome continues to be the leading cause of mortality worldwide, making it crucial to achieve a door-to-balloon (D2B) time under 90 minutes to enhance patient outcomes. This study aims to evaluate how outcomes differ between patients who arrive via emergency medical services (EMS) and those who arrive via self-transport.Methods: This was a retrospective study conducted at a tertiary hospital in the eastern province of Saudi Arabia. The study included both Saudi and non-Saudi patients who presented to the emergency department (ED) between March 1, 2022, and November 11, 2024, with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) requiring primary percutaneous coronary intervention (PCI). Patients were divided into two groups based on their mode of transport. Collected data include age, gender, nationality, D2B and door-to-electrocardiogram (ECG) times, smoking status, chronic conditions, and peak troponin levels.Results: A total of 204 STEMI and NSTEMI infarction cases were included in this study. Most cases (172, 84.3%) arrived via self-transport, while 32 (15.7%) arrived via EMS. The EMS group demonstrated significantly shorter median times for both door-to-ECG time (3 minutes vs. 5.5 minutes; p<0.05) and D2B time (70 minutes vs. 87 minutes; p<0.05) compared to the self-transport group. In addition, the EMS group had a higher incidence of cardiopulmonary resuscitation (CPR), indicating that their initial presentation is likely to be critical.Conclusion: Our findings are consistent with existing literature, highlighting the role of EMS in reducing door-to-ECG and D2B times. The higher frequency of CPR in EMS-transported patients indicates the severity of their condition upon arrival, further emphasizing the importance of prehospital emergency care in optimizing outcomes.

ObjectiveTo systematically evaluate the risk stratification performance of four physiological scoring systems—National Early Warning Score (NEWS), Rapid Acute Physiology Score (RAPS), Glasgow Coma Scale (GCS), and Shock Index (SI)—in prehospital emergency care within resource-limited settings, and to inform evidence-based triage strategies and intervention allocation.MethodsThis retrospective population-based cohort study analyzed 15,720 prehospital emergency cases from Shaodong Emergency Medical Center (2023–2024), a county-level EMS system operating under resource-constrained conditions in southern China. A novel analytical framework, integrating “score stratification × intervention behavior,” was designed to assess the predictive consistency and clinical utility of the four scoring systems across four essential prehospital interventions: oxygen therapy, ECG monitoring, intravenous (IV) access, and fluid administration. Statistical methods included trend analysis, nonparametric effect size estimation, generalized linear mixed models (GLMMs), and an XGBoost machine learning algorithm.ResultsNEWS and RAPS demonstrated the strongest dose–response consistency in guiding intervention decisions. Although all effect sizes remained in the weak range (η² < 0.06), NEWS showed the highest trend strength for ECG monitoring (Z = 23.58, P < 0.001) and the largest effect size (η² = 0.0415), with RAPS showing a comparable value (η² = 0.0412). High-risk patients were significantly more likely to receive ECG monitoring than low-risk patients (OR = 2.691, 95% CI: 2.301–3.142). GCS was predictive primarily in patients with severe consciousness impairment (OR = 4.32, P < 0.001), while SI demonstrated minimal discriminatory value (η² < 0.01). In the XGBoost model, disease category (importance = 0.161) and NEWS (0.108) emerged as the most influential predictors of intervention intensity.ConclusionIn this real-world, resource-constrained EMS cohort, physiological scores exhibited limited discriminatory capacity. Nevertheless, NEWS and RAPS showed more consistent associations with intervention allocation than GCS or SI. Even modest stratification reduced decision variability, supporting an adjunctive role. Multicenter prospective studies are needed to establish actionable thresholds and validate their impact on intervention timeliness and patient outcomes.Trial registrationNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-026-14019-x.

Prognostic performance of STESS and qSOFA scores in pre-hospital status epilepticus: A prospective cohort study.

ABSTRACTObjectives:to build and validate technology for communication among nurses in transition of care between pre-hospital services and emergency care through a committee of experts.Methods:a methodological study with a quantitative approach to develop and validate an assistive technology. The Delphi technique was used to reach consensus among experts, employing international sampling and snowball sampling. The analysis was performed using descriptive statistics and psychometric tests.Results:in the first round, 15 experts assessed the 138 items and suggested some adjustments. In the second round, a greater consensus was achieved, with a reliability index above 0.90 and a Cronbach’s alpha of 0.93, confirming the instrument’s validity.Final Considerations:the assistive technology developed showed potential for improving communication in transition of care in the emergency room, ensuring safety, continuity of care and offering a standardized interprofessional communication strategy.

Significant workforce challenges are evolving in Irish general practice, which limit all aspects of practice, especially out-of-hour care. Community Paramedics can support general practitioner (GP) out-of-hour care and potentially improve the system efficiency in Ireland. Qualitative semi-structured interviews were conducted with purposively recruited participants using a schedule informed by the existing research. A thematic analysis was undertaken based on the Braun and Clarke approach and supported by the NVivo software. Themes were developed based on the concept of preliminary key model components. The study was conducted in accordance with Standards for Reporting Qualitative Research. Comprehensive data analysis generated four major themes: Workforce Management, Synergies in Healthcare, Progressive Futuristic Care, and Safe Practice. These themes formed the basis for the further development of the preliminary key model components. This study suggests that the integration of Community Paramedics into GP out-of-hour care in Ireland can be successfully launched if workforce planning is carefully considered. The role of the Community Paramedic must be defined, regulated, and governed in conjunction with the National Ambulance Service, the Pre Hospital Emergency Care Council, and the Department of Health in Ireland. Patient care must be underpinned by safe and effective care practices that are continuously audited and evaluated, and the scope of practice must be defined and maintained by each Community Paramedic through a guided educational system that incorporates continuous professional development. GPs can provide support to community paramedics, including the use of information technology, as required. GPs and Community Paramedics can work together to synergize healthcare and provide safe and effective care to patients in the domiciliary setting during out-of-hour hours, thus reducing emergency department attendance and increasing the GP's capacity to provide face-to-face consultations.

To systematically review the clinical efficacy of amiodarone in the treatment of myocardial infarction in prehospital emergency. Articles related to the use of amiodarone in prehospital emergency treatment of myocardial infarction were retrieved from PubMed, Cochrane Library, EMBASE, Wanfang, VIP and CNKI databases, and the retrieval time was from the establishment of the database to October 31 2024. Meta-analysis and risk bias evaluation were carried out with R 4.2.2 software, and the results were considered statistically significant when P < 0.05. A total of 16 studies involving 832 patients receiving prehospital amiodarone and 800 control patients were included in this systematic review and meta-analysis. Pooled results demonstrated that, compared to the control group, amiodarone significantly reduced the incidence of malignant arrhythmia (RR = 0.29, 95% CI: 0.22 to 0.37, P < 0.01), decreased the average number of defibrillations (MD = -2.40, 95% CI: -2.61 to -2.19, P < 0.01), improved the success rate of rescue (RR = 1.16, 95% CI: 1.12 to 1.21, P < 0.01), lowered the recurrence rate of myocardial infarction (RR = 0.22, 95% CI: 0.13 to 0.35, P < 0.01), reduced the incidence of adverse reactions (RR = 0.33, 95% CI: 0.12 to 0.87, P = 0.02), and shortened the length of hospital stay (MD = -3.81, 95% CI: -4.02 to -3.59, P < 0.01). This systematic review and meta-analysis demonstrated that prehospital amiodarone administration in patients with myocardial infarction significantly reduced the incidence of malignant arrhythmia and the average number of defibrillations, while improving the success rate of rescue. Furthermore, it lowered the incidence of adverse reactions, the recurrence rate of myocardial infarction, and shortened the length of hospital stay. These findings support the clinical promotion of amiodarone in prehospital emergency care for myocardial infarction.

Background: Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide. Among them, acute coronary syndrome (ACS) stands out as an acute event requiring early diagnosis and intervention, which are decisive factors in the prognosis of these patients. Telehealth, through telediagnosis and cardiology teleconsultation, has emerged as a valuable tool for supporting early diagnosis and appropriate management of ACS cases in a country of continental dimensions and health care access disparities. Methods: A cardiological best-practices program implemented in partnership with the Brazilian Ministry of Health and a private tertiary hospital provided 24/7 tele-electrocardiogram (ECG) interpretation and cardiology teleconsultation support. The program included more than 300 public prehospital emergency care units distributed in 26 Brazilian states. Data from 13,311 eligible patients were analyzed between January 2021 and December 2023. Outcomes such as discharge, hospital transfer, antiplatelet therapy use, and mortality were compared between patients who did and did not receive teleconsultation using both mean differences and Propensity Score Matching models. Results: Among 13,311 patients eligible for teleconsultation with an ECG performed between January 1, 2021, and December 31, 2023, 7,184 had complex arrhythmias (3,854 with success teleconsultation and 3,330 failure), and 6,127 had ST-segment elevation myocardial infarction (STEMI) cases (2,907 with success teleconsultation and 3,220 failure). Analysis indicates that teleconsulting was associated with a reduction in the mortality rate for STEMI in patients with contact when compared with those without contact (X% vs. Y%; p = 0.019). There is also evidence of a lower mortality rate for complex arrhythmias and total eligible patients (STEMI plus complex arrhythmias). Conclusions: Integration of tele-electrocardiography and remote cardiology teleconsultation in prehospital emergency care significantly improves key clinical outcomes for ACS and arrhythmias. This model demonstrates the value of telemedicine to enhance access to specialist care and reduce geographic disparities in cardiovascular emergency treatment.

Nurses' perspectives on providing analgesia in the Italian prehospital emergency setting: A phenomenological study.

Road traffic deaths are a leading global concern, especially for those aged 5-29. Brain damage can occur within five minutes without first aid, yet ambulances often take longer to arrive. In Rwanda, delays may be worse, motorcyclists and bicyclists who are often the first witnesses to road traffic crashes, often lack the knowledge and confidence to provide immediate assistance. To assess the effect of first aid training on motorcyclists and cyclists' knowledge, skills, attitudes, and self-efficacy in Rwanda. A quasi-experimental study involved 95 motorcyclists and cyclists, conveniently selected from two Rwandan districts. A self-administered questionnaire and observational checklists were used in a one-group pre-post test design. Participants had a mean age of 33 years (SD = 7.45) and 6.56 years of driving experience (SD = 4.50). Cyclists made up 52.08%, and 38.30% had secondary or tertiary education. While 52.38% had witnessed accidents, 75.00% had no prior first aid training. Post-training, significant improvements were seen in knowledge (6.11 to 11.29), attitude (28.50 to 37.59), self-efficacy (113.25 to 157.08), and skills (22.03 to 31.78) (all p < 0.001). First aid training may significantly improve motorcyclists' and cyclists' capacity to respond to road traffic accidents while waiting formal prehospital emergency care services to arrive on the scene of accident.

BackgroundParamedics play a vital role in pre-hospital emergency care, and their university education is critical to ensure professional competence. This study aimed to evaluate the adequacy and effectiveness of university-level education received by paramedics working in Emergency Health Services in Türkiye.MethodsA cross-sectional descriptive study was conducted with 156 paramedics employed in 112 Emergency Health Services stations across Antalya. Data were collected via a structured questionnaire developed by the researchers. The survey was administered either in-person or online. Participants’ views on curriculum content, infrastructure, and self-perceived professional competence were analyzed using descriptive and inferential statistics.ResultsNo statistically significant association was found between self-efficacy levels and core curriculum exposure (p = 0.247), simulation training (p = 0.174), written materials (p = 0.716), practice rooms (p = 0.665), or access to a training ambulance (p = 0.449). Nevertheless, many participants emphasized the need for more comprehensive and hands-on training, particularly in emergency scenarios, highlighting a gap between theoretical knowledge and real-world readiness.ConclusionsAlthough theoretical instruction was generally considered sufficient, practical skill development was reported as inadequate by many paramedics. These findings suggest a need to enhance university paramedic programs by expanding simulation-based education and clinical internships to better align with field demands.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08268-3.

ABSTRACTBackgroundCritical emergency medicine (CrEM) is one of four subspecialty pillars within anesthesiology and intensive care medicine, as defined by the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). Despite its recognized clinical relevance, a comprehensive definition of CrEM has until now been lacking. The aim of this study was to establish a consensus‐based definition of CrEM and delineate its core components, competencies, and operational domains.MethodsA modified Delphi study was conducted among experts from the SSAI‐CrEM education program. The process involved two iterative rounds followed by external validation with alumni from previous CrEM programs. Statements for evaluation were generated from participant essays and refined by a steering committee of experienced consultants. Consensus was defined as ≥ 90% agreement.ResultsOf 44 initial statements, 37 reached consensus and were organized into six thematic domains: (1) Core Function and Scope, (2) Competence and Training, (3) Work Environment and Challenges, (4) Interdisciplinary and Teamwork Approach, (5) Ethical and Decision‐Making Responsibilities, and (6) Need for Research and Continuous Development. CrEM was defined as a physician‐led, context‐adapted subspecialty focusing on rapid stabilization, life‐saving interventions, and high‐acuity care across diverse clinical, and prehospital environments. The results emphasize the need for structured training, ethical competence, leadership in multidisciplinary teams, and ongoing scientific development.ConclusionCrEM constitutes a distinct and essential subspecialty within anesthesiology and intensive care medicine, bridging advanced emergency care across institutional boundaries. This study provides a structured definition and framework that may support curriculum development, clinical governance, and research initiatives within the field. Future work should aim to further validate these findings and guide the evolution of CrEM in both clinical and academic contexts.Editorial CommentThis Delphi process report presents the practice and training concepts for critical emergency medicine as a subspecialty of Anesthesia and Intensive Care Medicine in the Nordic country medical context. Perhaps particular for the Nordic countries, which combine medical specialty expertise and practice areas for perioperative medicine, intensive care medicine, pain medicine, and emergency (critical) prehospital care, this document describes current goals in susbpecialty education for the Nordic practice tradition for critical emergency medicine.

ObjectiveAcute Type A Aortic Dissection (ATAAD) is a highly lethal cardiovascular emergency characterized by persistently high postoperative in-hospital mortality (POIM), which necessitates effective preoperative risk assessment tools. This study aimed to investigate the predictive value of the preoperative CRP-albumin-lymphocyte (CALLY) index for POIM in ATAAD patients and to construct a corresponding nomogram model.MethodsThis retrospective study enrolled 522 surgically treated ATAAD patients admitted to Fujian Medical University Union Hospital between October 2015 and July 2024, with POIM designated as the study endpoint. Univariate and multivariate logistic regression analyses were performed to identify predictors of POIM,and LASSO regression was subsequently used to develop a predictive model.ResultsThis study included a total of 522 patients. The results demonstrated that the preoperative CALLY index was an independent protective factor for POIM (OR=0.131, 95% CI:0.110–0.199), and its predictive performance (AUC=0.820) was superior to that of individual parameters such as lymphocyte count, albumin, and CRP. Patients with lower CALLY index had significantly higher incidences of postoperative gastrointestinal hemorrhage, acute kidney injury, and POIM (P<0.05). The nomogram model integrating pre-hospital emergency care, prothrombin time, urea, creatine kinase, troponin I, lactate, and CALLY index showed good predictive performance (AUC=0.843). Internal and external validations yielded robust AUCs of 0.849 and 0.869, respectively, with Hosmer-Lemeshow tests confirming good fit (P>0.05).Subgroup analysis revealed that the predictive value of the CALLY index was consistent across different clinical subgroups.ConclusionThe preoperative CALLY index demonstrates significant predictive efficacy for POIM in ATAAD patients. The developed nomogram model, incorporating the CALLY index, provides a practical tool for optimizing perioperative decision-making.

Modernising prehospital emergency care in low-to middle-income countries

IntroductionPrehospital emergency care (PEC) requires rapid evidence-based decisions to maximise the effectiveness of care and to improve clinical outcomes. There are multiple challenges related to clinical research performed in the PEC setting. The aim of our study is to systematically review and assess the characteristics, quality of reporting, risk of bias and pragmatism in recent PEC trials, thereby identifying potential gaps and strengths that can guide the design of future prehospital studies.Methods and analysisWe will systematically search databases MEDLINE, Embase and Cochrane CENTRAL to identify all randomised controlled trials conducted in the field of PEC and published in English language between 2010 and 2024. No restrictions will be made to the participants, interventions and outcomes. Risk of bias will be evaluated using the Cochrane Risk of Bias 2 tool. The level of pragmatism will be assessed using the Pragmatic-Explanatory Continuum Indicator Summary-2 score. Exploratory data analysis will be used to investigate and summarise main patterns. Differences in characteristics between PEC fields, study designs, publication year and associations between pragmatism levels, risk of bias and quality of reporting will be the primary focus.Ethics and disseminationThere are no ethical concerns directly relevant to this review. This study has been previously registered with the Open Science Framework (osf.io/rzn9j). The manuscript will be submitted for publication to a relevant, peer-reviewed journal.