Prehospital Research Articles

Frequent callers contacting the Norwegian national emergency medical number 113: a retrospective study

BackgroundCalling for help is the first link in the chain of survival; however, few studies have investigated the challenges faced by frequent callers (FCs) to emergency medical communication centres (EMCCs). This study aimed to explore the characteristics of FCs and the nature of their calls to the Bergen EMCC, Norway.MethodsThis was a retrospective analysis of all emergency calls to the Bergen EMCC over three consecutive years (2019–2021). Bergen is the second-largest city in Norway, and the Bergen EMCC and ambulance services are part of the specialist medical service, covering a population of 460,000. The Bergen EMCC receives approximately 60,000 emergency calls per year. The study population comprised all adults identified during emergency medical calls. FCs were defined as individuals who registered five or more calls over 12 consecutive months during the three-year period.ResultsThe analysis included approximately 50,000 individuals, who made > 90,000 calls during the study period. Of those, 1,594 (3.2%) were FCs, accounting for approximately one in four (21,339 of 90,085, 23.7%) calls. The FCs included more men (882 of 1,594 (55.3%) vs. 24,204 of 47,564 (50.9%)) and registered a lower proportion of calls with an acute degree of urgency (6,051 of 21,339 calls (28.4%) vs. 30,276 of 68,746 calls (44.0%)). Calls from FCs showed an even occurrence throughout the week, peaking between 19:00 h and 20:00 h. Compared with calls from non-FCs, calls from FCs had a higher proportion of ‘no response/verbal referral to local emergency medical department’ and involved a lower proportion of hospital transfers. The EMCC most frequently used the medical criterion ‘Mental health problems/suicide’ for calls from FCs.ConclusionsFCs were common, and more often men. The EMCC dispatched ambulances or admitted patients to hospitals less frequently following these calls. Many of these situations could be handled in other parts of the healthcare system, reducing the burden on EMCCs, and providing more suitable services for FCs. Thus, EMCCs should identify and adjust patient management to match their actual needs.

Efetividade e segurança do uso do ar ambiente em comparação ao oxigênio a 100% em prematuros em parada cardiorrespiratória: protocolo de revisão sistemática

Introduction: Cardiorespiratory arrest is a clinical situation characterized by the interruption of blood circulation. It is estimated that 11.1% of all live births in the world are premature, generating short and long-term repercussions. One of the main challenges during cardiacarrest in premature infants is providing sufficient, but not excessive, oxygen during assisted ventilation. Objective: To compare the effectiveness and safety of using room air in relation to 100% oxygen in the resuscitation of premature infants in cardiorespiratory arrest. Methods: To this end, we will carry out a systematic review of randomized clinical trials (RCTs). The study protocol was registered on the Prospero Platform (CRD42024519724). We will include preterm infants with gestational age <37 weeks with CA. The searches were carried out in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Excerpta Médica dataBASE (Embase) via Elsevier, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Latin American Literature and the Caribbean Doctor in Health Sciences (LILACS) through the Virtual Health Library Portal, without restrictions on language or year of publication. The selection of studies, transmission of data, assessment of the bias of included studies and assessment of the certainty of the evidence will be carried out by two independent investigators. Expected results: Clarify the transit and safety of using room air compared to 100% oxygen, provide useful information for clinical decision-making, and support future high-quality randomized clinical trials on the topic. Conclusion: This study aims to compile existing research to analyze the effectiveness and safety of application of 100% oxygen in the resuscitation of premature infants. Keywords: Heart arrest; infant premature; systematic review.

Ureteroscopy and lasertripsy for lower pole stones

To investigate the outcomes of ureteroscopy and lasertripsy in lower pole renal stones <2 cm when treated in situ compared to displacement to the upper pole. Using the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, the Excerpta Medica dataBASE (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov we identified adult population, English language, studies published until March 2023 comparing surgical outcomes and stone-free rates (SFRs) in relation to lower pole stones <2 cm managed in situ vs those displaced (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42023432750). Analysis was performed using R with the 'meta' package. Bias analysis was performed using the Cochrane Risk of Bias 2 tool for randomised trials and the Newcastle-Ottawa scale for observational studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to ascertain the certainty of evidence. A total of five studies were included, comprising two retrospective cohort studies, three randomised trials, with a total of 408 patients. Meta-analysis demonstrated SFRs are significantly higher in those patients undergoing displacement vs those managed in situ (risk ratio 1.21, 95% confidence interval [CI] 1.10-1.34, P < 0.001). There was no significant difference in complication rates. Operative time was significantly longer in the displacement group (mean difference 5.62 min, 95% CI 0.40-10.83 min; P = 0.03). Overall risk of bias was moderate. Certainty of evidence was moderate for stone-free status, and very low for all other outcomes. This systematic review and meta-analysis demonstrates that for lower pole stones <2 cm displacement strategies have significantly higher SFRs than treatment in situ, with no significant difference in complications. There is significantly increased operative time in the displaced group, but an additional 6 min is unlikely to be clinically significant.

Frequent contacts to Emergency Medical Services (EMS): more than frequent callers

BackgroundA frequent caller is defined by The Frequent Caller National Network (FreCaNN) as an adult who makes five or more emergency calls in a month or twelve or more in three months, related to individual episodes of care. However, we believe that when limiting the definition to those who call themselves, one underestimates the impact frequent contacts have on the Emergency Medical Communication Center (EMCC) and the Emergency Medical Services (EMS).MethodWe conducted a descriptive retrospective cross-sectional database review of frequent contacts; defined as persons who have ≥ 5 contacts in a month or ≥ 12 contacts in three months. Data were provided from Oslo EMCC, between 1. January 2017 and 31. December 2022. Contrary to the FreCaNN definition, we included all types of contacts and callers, both emergent and non-emergent, regarding patients of all ages.ResultsDuring the study period, 2.149.400 contacts were registered. Of these 129.700 were contacts from frequent callers, where the patients called themselves. When including contacts frequently made on behalf of a patient, we found that 268.723 fit the definition of frequent emergency contacts. When also taking non-emergent contacts into account, a total of 437.361 contacts fit the definition of frequent contacts.ConclusionWhen limiting the criteria to only frequent callers, one underestimates the impact persons who have frequent contacts, have on the EMCC and the EMS. We were able to distinguish between three categories—contacts from frequent callers, frequent emergency contacts, and frequent contacts. We believe broadening the definition can benefit both research and audits, when accessing the use of emergency resources to patients with frequent requests for help to the EMCCs.

Predictors of emergency medical transport refusal following opioid overdose in Washington, DC.

Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care. In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model. Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023. Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses. Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined. The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1year (-36%), had a variable association with transport. Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research.

Rhythm conversion in out-of-hospital cardiac arrest and influence on the return of spontaneous circulation at the hospital arrival: a 10-year retrospective study in Croatia

BackgroundWhile initial non-shockable (NS) rhythms are often associated with poor prognosis, the conversion to shockable rhythms during cardiopulmonary resuscitation (CPR) can significantly influence survival rates. This retrospective cohort study investigated the impact of rhythm conversion on the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients.MethodsThe study analyzed data recorded from January 2012 to August 2022 obtained from the Utstein Templates from The Institute of Emergency Medicine of the City of Zagreb. Statistical analysis, including logistic regression, was performed to assess the likelihood of achieving maintained ROSC.ResultsStudy included 2791 cases of OHCA with emergency medical service attempts at resuscitation. A total of 74.92% of patients had an initial NS rhythm with a total conversion rate of 18.27%. Factors significantly associated with rhythm conversion were younger age, male sex (74.13%), public place (32.35%) of and witnessed collapse (75.98%), higher adrenaline dose, use of a mechanical compression machine (41.68%), and shorter response interval. There was no significant difference in the occurrence of conversion between the cases with initial asystole and pulseless electrical activity (PEA). However, cases with converted asystole (33.48%) compared to the ones with converted PEA (20.65%) had significantly greater ROSC maintenance (p = 0.006), as well as when compared to cases with sustained PEA (20.93%, p < 0.001). Logistic regression revealed that women with rhythm conversion, lower adrenaline doses, and provided bystander CPR were significantly more likely to achieve ROSC at hospital admission (P < 0.001).ConclusionsThis comprehensive study sheds light on the importance of rhythm conversion in patients with OHCA, with greater ROSC achievement, especially in patients with initial asystole, than in patients with initial PEA.

Ethiopian Emergency Medical services: Bridging up the Gaps in Prehospital Services

Abstract This review identified the critical gaps in pre-hospital emergency medical services (EMS) in Ethiopia, highlighting their detrimental impact on health outcomes, particularly among vulnerable populations. There are significant barriers to timely access to care, contributing to elevated morbidity and mortality rates from preventable conditions. Establishment of a structured pre-hospital care framework, emphasizing the need for trained emergency medical technicians, national EMS guidelines, and an effective emergency communication system is recommended. These findings advocate for enhanced community awareness and collaboration among stakeholders to address logistical challenges. As result, there is urgency of implementing systemic improvements in pre-hospital care to mitigate health disparities and foster economic development in Ethiopia.

Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market

BackgroundThe opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of...

Transient Ischaemic attack Emergency Referral (TIER): randomised feasibility trial results

BackgroundEarly assessment of patients with suspected transient ischaemic attack (TIA) is crucial to provision of effective care, including initiation of preventive therapies and identification of stroke mimics. Many patients with...

Ambulance Transports from NCAA Division 1 Football Games.

There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings. Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR. Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS. This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.

Best clinical practice experience at University of Gondar Comprehensive specialized Hospital Emergency and critical care Medicine department, A Case Study Under a resource limited set up

Abstract Background The emergency department (ED) is unique unstable environment where someone faces unscheduled and undifferentiated diseased patients, stressed families, unsettled staffs and unequitable resources.UoGCSH is the oldest in the Ethiopia and the only referral hospital for more than 13 million people from the five-zone north-west Ethiopia with 950 beds capacity. During the 2020 G.C a proposal paper was submitted to the administration bodies of the college and the hospital. The proposal was suggesting short term, mid-term and long-term quality improvement segments implemented in institutionally convenient manner. Objective To describe the transformation of emergency and critical care medical services at University of Gondar Comprehensive specialized hospital from scratch to the current status. Method A descriptive case study design was applied to narrate critical care service transformation at UoG Comprehensive Specialized Hospital. Since this case study is a data review from gathered secondary data, desk reviews of the emergency department, quality directorate data review, and the annual audit report review, there was no need for IRB approval. Result and recommendation After a year of renovation, we were able to organize a newly refurbished emergency room having a triage area with adequate reception space, Red resuscitation area with 10 beds (considering patient overflow), Orange with 18 beds, Yellow with 10 beds and floater area, isolation room, decontamination room, ED laboratory, main store, disaster store and piped oxygen system to all beds. we have gone a long journey in bringing those promised practices into demonstrable practice and finally replicable prototypic best practice. Even though we paced extra miles in achieving this status. Standard emergency room work flow implementation enable us to control the day-to-day patient and attendant crowding that impedes the anticipated medical treatment outcome and result in a significant dissatisfaction.Despite this achievement the trauma center establishment and high-quality patient care is recommended.

Establishing Outcome Parameters for Helicopter Emergency Medical Services Research in The Netherlands: Results of a Mixed-Methods Delphi Consensus Study

Objectives Physician staffed Helicopter Emergency Medical Services (P-HEMS) care in the Netherlands has transitioned from predominantly trauma management to handling a variety of medical conditions. Relevant outcome parameters for Dutch P-HEMS research have not been previously defined. National consensus was sought to identify relevant long term patient outcome parameters, process outcome parameters and performance outcome parameters for Dutch P-HEMS care. Methods This was a mixed methods Delphi consensus study. A list of potentially relevant outcome parameters was identified using a systematic literature review. These parameters were subsequently surveyed in a Delphi consensus study. Helicopter Emergency Medical Services physicians and relevant stakeholders were invited to participate in this Delphi survey, where they were allowed to suggest additional outcome parameters. Descriptive analysis was performed on all data sets. Results Forty-nine potential outcome parameters for Dutch P-HEMS care were surveyed. Of 71 invited participants, 53 (75%), 40 (56%), and 20 (28%) participated in the first, second, and third round of the Delphi study, respectively. Consensus was reached on 25 (51%) of 49 outcome parameters as being important. These consisted of seven long term patient related outcome parameters, four short term patient related outcome parameters, five process outcome parameters and nine performance outcome parameters. Conclusions In conclusion, this study identified 25 outcome parameters relevant for Dutch physician staffed HEMS care. These parameters should be considered when designing future studies and should be routinely collected for each dispatch if possible.

What causes Emergency Medical Services (EMS) delay? Unravel high-risk buildings using citywide ambulance trajectory data

Emergency Medical Services (EMS) delay poses a challenge to public health, especially in ultra-dense cities and aging societies. The potential relationship between the built environment and the ambulance response time (ART) has not been thoroughly investigated at the building-level. This impedes the unraveling of high-risk buildings for EMS delay, and thus the precise optimization of urban EMS systems. Our study develops a quantitative-qualitative approach to construct a building-level ART prediction model and then validated it with ambulance drivers' experiences. A comprehensive theoretical framework is tailored for ART prediction incorporating neglected built environment factors of land use and development intensity. Based on 73,129 ambulance trajectories, a machine learning model is constructed and then employed to predict the ART for each of the 253,475 buildings in central Shanghai under multiple combinations of traffic periods and weather conditions. The results show that the accuracy of high-risk buildings for EMS delay achieves 91%. Moreover, three of the neglected built environment factors, medical POIs density, business POIs density and floor area ratio, rank high in the factor importance. The ambulance drivers’ experiences validate the importance of these built environment factors and emphasize the value of bus priority lanes for ambulance to borrow for swift access. In addition, to illustrate potential applications, we simulated the effects of built environment interventions in case areas predicted to concentrate high-risk buildings. This work provides a new computer-based tool to pinpoint the service blind spots of such urban emergency systems and to develop built environment interventions.

Knowledge of Acute Coronary Syndrome Symptoms and the Intention to Call Emergency Medical Services in Culturally and Linguistically Diverse Australians

Prompt recognition of symptoms and response to acute coronary syndrome (ACS) are crucial for reducing pre-hospital delay. This study compares culturally and linguistically diverse (CALD) and non-CALD Australian populations in terms of their (i) ACS symptom knowledge and (ii) intention to call emergency medical services (EMS) for ACS. This cross-sectional study used data from HeartWatch, an online survey collected by the National Heart Foundation of Australia between 2018 and 2020 for Australian adults aged ≥18 years. CALD respondents were defined as non-Indigenous individuals who reported speaking a language other than English at home. Characteristics associated with ACS symptom knowledge and EMS calling intentions were analysed using multivariable logistic regression. Of 31,919 respondents, 16.3% were from CALD backgrounds (n=5,212). Compared with non-CALD, CALD respondents were less likely to name any ACS symptom (63.0% vs 76.0%; adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.61-0.70) and were less likely to state that they would call an ambulance for ACS (50.2% vs 72.1%; AOR 0.53; 95% CI 0.50-0.57). Almost one-quarter (23.0%) of CALD respondents reported not knowing what they would do. In both groups, males, individuals aged ≤60 years, and those with diabetes were less likely to name an ACS symptom and had lower intention to call an ambulance. Those unable to list a single ACS symptom also had a lower intention to call an ambulance. Knowledge of ACS symptoms and intention to call an ambulance were lower among CALD respondents. The demographics of those with low ACS symptom knowledge and EMS calling intention were similar in the two groups. Future education efforts in Australia should focus on promoting ACS symptom knowledge and EMS use and should target these groups.

Individualized decision making in on-scene resuscitation time for out-of-hospital cardiac arrest using reinforcement learning

On-scene resuscitation time is associated with out-of-hospital cardiac arrest (OHCA) outcomes. We developed and validated reinforcement learning models for individualized on-scene resuscitation times, leveraging nationwide Korean data. Adult OHCA patients with a medical cause of arrest were included (N = 73,905). The optimal policy was derived from conservative Q-learning to maximize survival. The on-scene return of spontaneous circulation hazard rates estimated from the Random Survival Forest were used as intermediate rewards to handle sparse rewards, while patients’ historical survival was reflected in the terminal rewards. The optimal policy increased the survival to hospital discharge rate from 9.6% to 12.5% (95% CI: 12.2–12.8) and the good neurological recovery rate from 5.4% to 7.5% (95% CI: 7.3–7.7). The recommended maximum on-scene resuscitation times for patients demonstrated a bimodal distribution, varying with patient, emergency medical services, and OHCA characteristics. Our survival analysis-based approach generates explainable rewards, reducing subjectivity in reinforcement learning.

ECPR-the evolving role in cardiac arrest.

Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to restore blood circulation in patients during refractory cardiac arrest. So far, ECPR is not the standard of care but has become part of clinical routine for select patients in many places. As ECPR is ahighly invasive support option associated with considerable risks for fatal complications, premature use in patients who may have return of spontaneous circulation should be avoided. However, the selection criteria for ECPR are still evolving, as the search for evidence is ongoing. Recent randomized controlled trials of different ECPR strategies support its use within integrated systems built around highly specialized ECPR centers. The ECPR caseload is an important predictor of patient survival, and continuous training is key for evidence-based quality of care. Typical complications after ECPR include vascular injury or malposition of cannulas, thrombotic complications, hemolysis, and bleeding events that require early detection and interdisciplinary management. When provided by highly specialized and well-trained expert teams in dedicated ECPR centers within integrated pre-hospital and intra-hospital emergency care systems, ECPR may improve survival in select patients with refractory cardiac arrest. This article is freely available.

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p&lt;0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

Caring for Transgender and Gender Diverse Prehospital Patients: a NAEMSP Position Statement and Resource Document

ABSTRACT Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care–especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient’s identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals’ right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers. NAEMSP Recommends: EMS clinicians should maintain basic cultural competency regarding TGD populations, including familiarity with TGD-related health and health care disparities, consideration of TGD populations as underserved, and understanding the centrality of stigma and transphobia in creating disparities and other challenges which complicate daily life for TGD people. EMS clinicians should demonstrate cultural humility towards the TGD community, which includes self-assessment of knowledge gaps, as well as openness to new or unfamiliar ideas, information, and advice from those with different lived experiences. EMS clinicians should understand basic TGD-specific terminology and use appropriate language–including patient-identified name and pronouns–during direct patient care, in handoffs, and in documentation. EMS clinicians should treat a patient’s TGD status as sensitive health information and take care not to inadvertently disclose this information without the patient’s express permission. EMS clinicians should have a basic understanding of social transitioning and of gender-affirming medical and surgical treatments. EMS clinicians should employ a trauma-informed approach when caring for TGD patients. EMS education and training should incorporate learning domains that address comprehensive care for TGD patients, with educational content providing the specific knowledge and skills required to promote equitable care. EMS workplaces should implement policies to improve recruitment and retention of TGD personnel, covering harassment protection, non-discrimination practices, inclusive working environments, equal advancement opportunity and tailored employee benefits. Future EMS research should focus on elucidating the disparities in and barriers to prehospital care of the TGD patient population with emphasis on patient experience and education of prehospital clinicians.

Differences in Accuracy Between Paramedics and Emergency Medical Technicians (EMTs) When Identifying Low-Acuity Pediatric Patients

Background Alternative emergency medical services (EMS) disposition programs have been developed for adults with low-acuity complaints. One barrier to including children in such programs is a lack of evidence regarding whether paramedics and emergency medical technicians (EMTs) can accurately identify children with low-acuity complaints. Our primary objective was to compare the accuracy of EMTs to that of paramedics in identifying low-acuity pediatric encounters. Our secondary objective was to determine whether support for alternative EMS dispositions differed between paramedics and EMTs. Methods This was a planned secondary analysis of a cross-sectional study of children transported by EMS to an emergency department (ED). Acuity was defined using a composite measure that included physiological patient assessments, resources used (including laboratory tests and radiographs), and patient disposition. EMS clinicians rated on a Likert scale their level of agreement that a patient had a low-acuity problem and could have been transported by private vehicle, seen in clinic, or not transported. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for paramedic and EMT acuity assessments were calculated. Results EMS surveys were completed for 84.0% of 996 participants (76.4% by EMTs, 22.6% by paramedics). 35.1% of participants were classified as having a low-acuity complaint. The sensitivity for identifying a child as low-acuity was 24% (95% CI 20%, 38%) for paramedics and 50% (46%, 54%) for EMTs. The PPV for identifying a child as low-acuity was 0.44 (0.28, 0.60) for paramedics and 0.62 (0.55, 0.68) for EMTs. Only 20.5% of paramedics and 22.5% of EMTs supported non-transport for children with low-acuity complaints. Conclusions Relying on EMS assessments of pediatric patient acuity may lead to under-triage, regardless of whether a paramedic or EMT makes this determination. Additional training and triage tools may be required before children can be safely included in alternative EMS disposition programs.

The performance of screening tools and use of blood analyses in prehospital identification of sepsis patients and patients suitable for non-conveyance - an observational study.

Early recognition of sepsis by the EMS (Emergency Medical Services), along with communicating this concern to the emergency department, could improve patient prognosis and outcome. Knowledge is limited about the performance of sepsis identification screening tools in the EMS setting. Research is also limited on the effectiveness of prehospital use of blood tests for sepsis identification. Integrating blood analyses with screening tools could improve sepsis identification, leading to prompt interventions and improved patient outcomes. The aim of the present study is firstly to evaluate the performance of various screening tools for sepsis identification in the EMS setting and secondly to assess the potential improvement in accuracy by incorporating blood analyses. This is a retrospective observational cohort study. The data were collected from prehospital and hospital medical records in Region Halland. Data on demographics, vital signs, blood tests, treatment, and outcomes were collected from patients suspected by EMS personnel of having infection. The data were analysed using Student's t-test. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were used to indicate accuracy and predictive value. In total, 5,405 EMS missions concerning 3,225 unique patients were included. The incidence of sepsis was 9.8%. None of the eleven tools included had both high sensitivity and specificity for sepsis identification. White blood cell (WBC) count was the blood analysis with the highest sensitivity but the lowest specificity for identifying sepsis. Adding WBC, C-reactive protein (CRP) or lactate to the National Early Warning Score (NEWS) increased the specificity to > 80% but substantially lowered the sensitivity. Identifying sepsis in EMS settings remains challenging, with existing screening tools offering limited accuracy. CRP, WBC, and lactate blood tests add minimal predictive value in distinguishing sepsis or determining non-conveyance eligibility.