This study examined whether intolerance of uncertainty and decision-making styles were associated with theoretical START triage knowledge among paramedic students. Secondary exploratory analyses assessed psychosocial differences according to self-rated decision-making under stress, perceived coping with uncertainty, professional motivation, and challenges in prehospital emergency care.

In this cross-sectional study, 121 students from a First and Emergency Aid Program completed a self-administered paper-based questionnaire including a sociodemographic form, the Decision-Making Styles Scale, the Intolerance of Uncertainty Scale-12, and the START Triage Knowledge Test. Data were collected in classroom settings under researcher supervision between May and June 2025 and analyzed using descriptive statistics, group comparisons, and correlation analyses.

The mean theoretical START triage knowledge score was 69.99 ± 14.76. START knowledge was not significantly associated with intolerance of uncertainty or decision-making style subscale scores. Exploratory analyses identified associations between psychosocial scores and self-rated decision-making under stress, coping with uncertainty, professional motivation, and perceived challenges.

Theoretical START triage knowledge was not associated with intolerance of uncertainty or decision-making styles. Secondary findings were limited to self-reported psychosocial associations. The study assessed declarative knowledge and did not evaluate START application in simulated or field settings. Future studies should use simulation-based, scenario-based, or observational outcomes.

Heat stroke and heat exhaustion (HS/HE) are life-threatening conditions requiring immediate intervention. Cooling devices play a critical role in emergency and prehospital care, yet their effectiveness and field readiness are inconsistently reported. This systematic review evaluates commercially available cooling devices for the treatment of HS/HE with an emphasis on device feasibility, performance, and suitability for prehospital and remote deployment.

A comprehensive literature search was conducted in August/October 2025 across academic databases (PubMed, Scopus, Cochrane Library, Compendex, Engineering Village, and IEEE Xplore) and gray literature via Google Advanced Search. Academic records were screened using Rayyan, while gray literature was organized in Excel with the aid of a custom HTML scraper. Devices were included if they met the United States Food and Drug Administration (FDA) definition of a medical device, were designed for adult human use, and specifically addressed HS/HE. Parameters extracted included working principle, cooling rate, weight, dimensions, volume, power requirements, external resource demands, and reusability. Cooling performance was benchmarked using thresholds reported by McDermott, et al, and portability was assessed using the MIL-STD-1472H single-person carriage limit of ≤16kg.

A total of 18 devices were identified and evaluated. Only three met the ideal cooling rate threshold (≥0.155°C/minute), and two others achieved acceptable performance (0.078-0.154°C/minute). Approximately 61% of devices did not report cooling rate data. Five devices met field portability criteria (≤16kg), though most were limited by reliance on water, power, or disposable components. Only one device demonstrated feasibility for remote use; this device, however, lacked full reusability.

No device meets the combined criteria of effectiveness, portability, field readiness, and reusability for HS/HE treatment. Current FDA pathways do not require reporting of key performance metrics, highlighting a regulatory gap. There is a need for development of field-appropriate solutions and revised evaluation standards that prioritize cooling performance, resource independence, and usability in austere environments.

Emergency Medical Services (EMS) demand varies across circadian, weekly, and seasonal timescales. This study is among the first such integrated analyses in the Turkish 112 EMS context.

The primary objective of this study was to characterize circadian patterns in overall EMS case-record volume and across seven clinical groups, as well as hourly, weekly, and seasonal variation in diagnostic composition across eight categories. Secondary objectives were to estimate adjusted temporal associations and evaluate frozen transfer of aggregate daily forecasts from 2024 to the immediately subsequent 2025 holdout.

This retrospective study analyzed 60,811 routinely collected EMS case-record rows from Karaman Province, Türkiye over 731 days in 2024-2025. Interaction, cosinor, and negative binomial (NB) models characterized temporal patterns; aggregate daily case-record volume was forecast using weekly Fourier terms with autoregressive integrated moving average (ARIMA) errors trained on 2024 and frozen for 2025. The data represented provincial case-record workload, an operational proxy for population demand rather than a census of all inbound calls or unique patients.

Case-record volume peaked at 21:00 and was lowest at 06:00; adjusted volume at 21:00 was 3.53-times that at 06:00 (95% CI, 3.28–3.81). Hourly diagnostic composition differed modestly (Cramér V = 0.061). Rhythmicity was detected in all seven clinical groups (all joint-test P values < 0.001), but low full-cell R2 values indicated substantial unexplained hour-date variation; acrophases ranged from 14:41 to 19:14 and relative amplitudes from 28.6% (Respiratory) to 67.9% (Trauma). Standardized Trauma share was higher in summer than winter (25.7% versus 18.1%), whereas Respiratory share was higher in winter than summer (9.7% versus 3.6%). Adjusted volume was higher on Monday than Saturday and higher in August than November (IRRs 1.11 and 1.23, respectively). In the frozen 2025 holdout, the selected model achieved mean absolute scaled error (MASE) = 0.722 and 95% prediction-interval coverage of 96.2%.

Clinical-group rhythms and seasonal composition differences were observed. The frozen evaluation quantified aggregate daily forecast transfer only from 2024 to the immediately subsequent 2025 within one provincial series. Findings support local monitoring of recorded evening workload and seasonal diagnostic composition, particularly the higher Trauma share in summer and the higher Respiratory share in winter.

Neonatal intensive care unit (NICU) evacuation poses distinct operational and ethical challenges because neonates often depend on continuous life-sustaining technologies and specialized care. Although several neonatal or pediatric disaster triage systems have been proposed, actual NICU evacuation cannot be ethically or practically tested under controlled disaster conditions. A reproducible framework comparing evacuation-order strategies is therefore needed.

This study aimed to develop and apply a reproducible simulation framework for NICU evacuation-order evaluation and, within that framework, to compare structured triage with evacuation without triage and quantitative with categorical neonatal triage approaches.

A retrospective simulation study was conducted using routinely recorded clinical triage assessments from a tertiary NICU, comprising 1,079 patient evaluations in 162 neonates across 49 triage days. During clinical practice, clinical severity and triage status had been recorded using the Neonatal Therapeutic Intervention Scoring System (NTISS), Neonatal Extrication Triage (NEXT), and Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R); NEXT was a quantitative six-domain resource-dependency score ranging from zero to 12, whereas START-Neo-R was a five-level categorical neonatal triage system. Three evacuation strategies were evaluated: descending-order evacuation using NEXT, descending-order evacuation using START-Neo-R, and evacuation without triage. Evacuation-order performance was quantified using the Total Evacuation Score (TES), defined as the time integral of cumulative NTISS scores among patients remaining in the NICU across sequential evacuation steps. The TES distributions were compared descriptively across strategies rather than inferentially.

Within the 49 observed triage days, both structured triage strategies generated TES distributions shifted lower than those from evacuation without triage. In the direct comparison between NEXT and START-Neo-R, the worst-case TES under NEXT was lower than more than one-half of the START-Neo-R TES distribution on 34 of the 49 observed triage days (69.4%).

In this simulation study using real-world NICU data, TES provided a reproducible framework for comparing neonatal evacuation-order strategies under explicit assumptions. Within this TES-based framework, structured triage generated TES distributions shifted lower than those from evacuation without triage, and NEXT showed a more favorable distribution-based pattern than START-Neo-R on most observed days. These findings suggest that TES-based evaluation may help identify triage strategies that support more transparent and testable NICU evacuation planning.

This study aimed to describe the epidemiological, clinical, and operational characteristics of violence-related emergency medical services (EMS) encounters recorded on the Anatolian side of Istanbul from 2019 to 2023, to conduct secondary descriptive comparisons by sex, and to identify factors associated with confirmed prehospital death status.

We conducted a retrospective observational registry-based analysis of records coded as “Violence & Assault.” Clinical, operational, and demographic variables were analyzed. Comparisons by sex and confirmed death status were conducted using nonparametric and categorical-data tests. In a secondary exploratory analysis, Firth-penalized multivariable logistic regression was used to estimate adjusted associations with confirmed prehospital death status.

The sample comprised 29,335 violence-related EMS encounters; most involved young adult males and occurred in urban districts. Most recorded clinical findings were normal or preserved, although a small subgroup showed physiological instability. Several sex-based differences were statistically significant, but their effect sizes were generally small. Confirmed prehospital death was recorded in 132 encounters (0.45%). In the exploratory Firth model, severe respiratory status (aOR 56.02, 95% CI 8.62-364.05), altered consciousness (aOR 10.71, 95% CI 1.67-68.67), and cyanotic skin (aOR 4.24, 95% CI 2.67-6.73) were associated with the highest adjusted odds ratios for confirmed prehospital death.

Violence-related EMS encounters were concentrated among young adult males, and most did not meet the confirmed-death definition. Nevertheless, a clinically important subgroup presented with physiological instability. In the exploratory analysis, confirmed prehospital death was most strongly associated with acute physiological compromise; operational intervals should be interpreted cautiously as potential markers of case complexity and EMS workflow rather than as causal determinants.

To describe nursing workforce arrangements, training exposure, educational needs, and support needs for nuclear emergency medical care among Nuclear Emergency Core Hospitals (NECHs) in Japan.

This facility-level cross-sectional survey targeted all 51 NECHs. Questionnaire items were developed and reviewed for content validity through internal consensus by 3 study-team nurses or public health nurses; no pilot testing or recruitment reminders were conducted. Facility proportions included exact Clopper-Pearson 95% confidence intervals, and free-text responses underwent qualitative content analysis.

Twenty-two facilities responded (43.1%; exact 95% CI, 29.3-57.8%). Emergency departments (19/22, 86.4%) and DMAT membership (20/22, 90.9%) were common, while certified nurse specialists in radiation nursing were reported by 5 facilities (22.7%). Radiation basics and PPE donning/doffing practice were each selected by 21 facilities (95.5%). Free-text responses yielded 43 meaning units across 5 categories emphasizing recurrent training, workforce maintenance, organizational and financial support, and clearer staffing standards.

Among responding NECHs, nuclear emergency nursing preparedness relied heavily on emergency/disaster nursing infrastructure, while radiation-specific advanced nursing expertise was reported less frequently. Sustainable preparedness may benefit from recurrent practical training, broader access to radiation nursing expertise, organizational support, and policy-level staffing discussion.

This study aims to determine the agility level of the prehospital emergency medical services (EMS) organization and to examine the impact of organizational agility (OA) on prehospital emergency health care professionals’ perception of disaster preparedness using a structural equation model (SEM).

This study employed a quantitative correlational research design and was carried out with 468 health care professionals serving in various roles within the 112 Ambulance Service, a public prehospital emergency health care institution operating in Istanbul, in the Marmara region of Türkiye.

Among personnel working in prehospital EMS, the average OA score was 3.65 ± 0.83 and the average disaster preparedness perception score was 4.00 ± 0.71, indicating a high level. According to the results of the SEM analysis, it was determined that OA (competence, flexibility, responsiveness, and speed) has a significant and positive effect on the perceptions of disaster preparedness among personnel working in prehospital EMS, and that the explained variance (R2) is 0.582.

The study offers a set of recommendations intended to enrich the existing literature and to enhance OA and disaster preparedness within prehospital emergency health care institutions.

Hemorrhagic shock represents a major cause of preventable mortality following trauma. Identifying shock early on the scene is critical for survival, particularly within resource-limited settings like Thailand, where prehospital blood products are unavailable. Although several scoring tools exist, uncertainty remains regarding which tool offers the optimal diagnostic accuracy for predicting massive transfusion (MT) and early death in this specific setting.

This research aimed to compare the predictive performance of five prehospital scoring tools – Shock Index (SI), Reverse Shock Index multiplied by Glasgow Coma Scale (rSIG), National Early Warning Score (NEWS), Assessment of Blood Consumption (ABC), and Revised Assessment of Bleeding and Transfusion (RABT) – for predicting MT and 24-hour mortality.

This retrospective prognostic accuracy study included adult trauma patients transported by Emergency Medical Services (EMS) to a university-affiliated Level 1 Trauma Center in Bangkok from January 2019 through December 2024. The primary endpoint was MT; the secondary endpoint was 24-hour mortality. Area Under the Receiver Operating Characteristics (AUROCs) assessed discrimination and the DeLong test compared performance among scores.

A total of 584 eligible patients were included, of whom 63 (10.8%) required MT. The NEWS demonstrated the highest discriminatory power for MT (AUROC 0.84; 95% CI, 0.79–0.90), followed by rSIG (AUROC 0.83; 95% CI, 0.76–0.90) and SI (AUROC 0.78; 95% CI, 0.72–0.86). In contrast, trauma-specific scores showed lower performance, with AUROCs of 0.69 for ABC and 0.74 for RABT. For 24-hour mortality, NEWS and rSIG demonstrated excellent discrimination (AUROCs of 0.93 and 0.91, respectively). At a cut-off of four or higher, NEWS showed a sensitivity of 81.0% for MT, while rSIG ≤ 16 provided a balanced sensitivity of 74.6% and specificity of 88.5%.

Both NEWS and rSIG predicted MT and 24-hour mortality more accurately than ABC and RABT. These tools may support early pre-arrival notification and blood bank preparation without delaying rapid transport.

Dispatcher-guided cardiopulmonary resuscitation (CPR) via video calls represents an important shift from purely verbal instruction to real-time visual modeling for untrained bystanders during out-of-hospital cardiac arrest. This approach may improve compression depth, rhythm, overall CPR quality, and reduce interruptions.

Its implementation remains challenging because voice calls may be faster, whereas video guidance requires stable connectivity, smartphone access, digital literacy, appropriate camera positioning, and trained dispatchers. Moreover, simulation findings among young university students may not reflect real emergency conditions.

Video-assisted CPR should be developed as a hybrid, equitable, low-bandwidth intervention and tested pragmatically across diverse emergency systems.

The provision of instant telephone pre-arrival instructions (PAI) on first aid to laypeople by emergency services’ telecommunicators for conditions beyond cardiac arrest, such as trauma or acute coronary syndrome, is practiced by emergency services around the world and is recognized by some prehospital systems as a standard of care. However, to the best of the authors’ knowledge, no attempts have been made to date to systematically summarize the related research evidence.

The aim of this study was to systematically map and analyze published quantitative research on telecommunicator-assisted first aid (TAFA) for medical emergencies other than cardiac arrest.

Peer-reviewed journal papers reporting original quantitative data on experimental or real-world applications of TAFA were identified through PubMed, Scopus, and Google Scholar. Studies focusing solely on cardiac arrest management (cardiopulmonary resuscitation [CPR] or automated external defibrillation) were excluded. A scoping review of eligible papers was conducted in accordance with the PRISMA-ScR guidance.

Twenty-two studies published from 2000 through 2024 met inclusion criteria. First authors represented nine high-income countries. The studies investigated hypothetical or actual application of TAFA for anaphylaxis, chest pain or myocardial infarction, stroke, trauma, bleeding, childbirth, foreign body airway obstruction, opioid overdose, and respiratory arrest; four studies did not specify the type of emergency. Eight studies (36.4%) analyzed real Emergency Medical Services (EMS) call data, another eight (36.4%) were simulation-based, five (22.7%) used surveys, and one (4.5%) represented a cost-effectiveness analysis. The studies described existing TAFA practices, evaluated expectations and perceptions of the service by the public, demonstrated the feasibility of experimental techniques, including video communication, and identified areas for future investigations and interventions. Along with some beneficial effects of TAFA, several studies have demonstrated downsides of the practice, including suboptimal dispatcher adherence to pre-arrival protocols. The relationships between the real-world application of TAFA and patient outcomes are unclear.

According to the review of quantitative research, non-resuscitative TAFA remains an under-explored area of prehospital medicine. Considering the paucity and the inconclusiveness of available evidence, significantly more research is required to better understand its effects and practical implications. The evidence map generated by this scoping review may assist the professional community in advancing the development of non-resuscitative TAFA.

Prehospital electrocardiogram teletransmission (E-ECG) enables early cardiac diagnosis and triage in the field. This study assessed its diagnostic and operational impact in a real-world Emergency Medical Service (EMS) in Marseille, France.

A retrospective, single-center observational study including adults ≥18 years who underwent E-ECG acquisition by Marseille first responders from January 1 through September 15, 2023 was conducted. Electronically transmitted prehospital ECGs were transmitted via Schiller devices to medical regulators. Patients with trauma, pediatric age, pregnancy, training cases, uninterpretable ECGs, or incomplete files were excluded. The main outcome was the proportion of acute ECG abnormalities (signs of ischemia, rhythm, or conduction disorders).

Secondary outcomes included reinforcement requests, patient orientation, and transport mode.

Among 425 included patients (Median age: 56 years [IQR 40–72]; 61% male), 21.9 % (n = 93) presented abnormal ECGs, including 2.1% with ST-elevation myocardial infarction (STEMI). Transmission results led to management changes in 11.5% of cases (n = 49): 8.2% required additional medical reinforcement and 3.3% underwent direct cardiology triage without medical reinforcement. Technical issues occurred in 15.8% of transmissions (n = 67).

Prehospital ECG teletransmission allowed early detection of cardiac abnormalities and was associated with changes in patient management in a subset of cases. Its integration in emergency workflows could enhance triage, optimize cardiology routing, and strengthen coordination between field teams and regulation centers.

The Emergency Paramedic Act (EPA; Notfallsanitätergesetz), implemented in 2014, expanded the legal authority of German paramedics to independently perform defined invasive and pharmacological interventions under specific conditions. However, real-world implementation of these competencies within the physician-based German Emergency Medical Services (EMS) system remains insufficiently described.

The aim of this study was to evaluate the frequency, type, temporal development, and regional variation of invasive and pharmacological/therapeutic interventions performed independently by paramedics over a six-year period.

A retrospective, descriptive multicenter analysis of digital EMS documentation was conducted across three districts in Saxony, Germany, from January 1, 2019 through December 31, 2024. All missions were screened (n = 197,842). Paramedic-led missions without physician presence were included; physician-attended missions and non-emergency interfacility transports were excluded. Interventions were classified according to the 2024 Federal Association of Medical Directors of EMS competency catalogue. Frequencies were analyzed by year and district. Temporal trends were assessed using the Mann–Kendall test, and regional differences were explored using one-way ANOVA with Tukey HSD post hoc testing. All inferential analyses were exploratory.

Of 197,842 missions, 156,417 (79.1%) were paramedic-led without physician presence. Invasive procedures occurred in 7.6% of missions and were predominantly peripheral intravenous (IV) access (5.7%). Advanced airway management and intraosseous (IO) access were rare (<0.1%). Pharmacological/therapeutic administrations occurred in 11.3% of missions and increased from 9.4% in 2019 to 12.1% in 2024 (Mann–Kendall test), whereas overall invasive procedure rates remained stable.

Ten years after implementation of the EPA, invasive and pharmacological interventions performed independently by German paramedics remain relatively infrequent and largely confined to basic measures. Advanced procedures are rarely applied, reflecting continued structural characteristics of the physician-based EMS model.

Appropriate, evidence-based care of traumatically injured patients in the prehospital setting is essential to saving lives and yielding better outcomes. There exists mixed evidence on the outcome differences between ambulance and helicopter prehospital transport, and on the effects of transport time on outcomes. The purpose of this paper is to examine these in patients presenting to an urban Level-1 trauma center.

A retrospective analysis was conducted with three years of patient information from a trauma registry maintained by a Level-1 trauma center in St. Louis, Missouri (USA). Propensity matching was used to compare helicopter versus ground ambulance outcomes, while regression analysis was used to investigate transport time.

After propensity matching to injury severity, helicopter transport was associated with improved prehospital survival (OR = 4.1; [95% CI, 1.2-21]; P = 0.02), though no difference in in-hospital survival (OR = 0.9; [95% CI, 0.4-1.8]; P = 0.71), intensive care unit (ICU) stay (difference = 0.8 days; [95% CI, -0.9-2.5]; P = 0.36), or hospital length-of-stay (difference = 51 hours; [95% CI, -7-109]; P = 0.08). Decreased transport time was not associated with increased survival (P = 0.31), but when transport times were less than 30 minutes, further reductions were significantly associated with shorter hospital stays (r2 = 0.02; P = 0.05) and fewer ICU days (r2 = 0.02; P = 0.05).

Decreased injury to hospital arrival time and increased use of helicopter transport in specific situations may improve patient outcomes; this indicates the need for prospective studies.

Hazardous materials (HazMat) incidents pose significant risks to public health, safety, and the environment. This study aimed to characterize the temporal trends, geographic distribution, operational settings, and incident types of HazMat events reported in Oman.

This retrospective descriptive study analyzed data from the national HazMat incident records maintained by the Civil Defence and Ambulance Authority (CDAA). All reported chemical, biological, or radiological incidents between June 1, 2019, and November 30, 2024, were included.

A total of 55 HazMat incidents were recorded during the study period. Reported incidents increased over time, with the highest annual counts observed in 2023 (14 incidents) and 2024 (17 incidents). Muscat Governorate accounted for 39 incidents (71%). Residential neighborhoods were the most common operational setting (26/55, 47%), followed by other public areas (9/55, 16%), while airports, educational institutions, industrial areas, and transportation corridors each accounted for 5 incidents (9%). Gas leaks were the most frequently reported incident type, involved in 28 incidents (51%).

HazMat incidents in Oman increased over the study period and were concentrated in Muscat Governorate. Incidents occurred across diverse operational settings, particularly residential and public environments, while gas leaks represented the most frequently reported incident type.

Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality world-wide. Early bystander cardiopulmonary resuscitation (CPR) is a critical determinant of survival; however, many witnessed arrests are managed by untrained laypersons. Dispatcher-assisted CPR (DA-CPR) increases bystander intervention rates, but telephone-based guidance limits real-time assessment of compression quality. Video-assisted CPR (V-CPR) may overcome these limitations by enabling visual feedback and demonstration-based guidance.

The aim of this study was to evaluate whether video call-assisted dispatcher guidance incorporating simultaneous real-time demonstration improves CPR performance quality compared with voice call-assisted guidance in untrained laypersons during a simulated adult OHCA scenario.

This prospective, randomized, single-blind, manikin-based trial included 85 university students without prior CPR training. Participants were randomized to telephone-assisted CPR (T-CPR; n = 40) or video-assisted CPR (V-CPR; n = 45). All participants performed standardized hands-only CPR for five minutes following dispatcher instructions. In the V-CPR group, the dispatcher simultaneously demonstrated CPR on a manikin during the video call. The primary outcome was the composite CPR Quality Score generated by the manikin feedback system. Secondary exploratory outcomes included compression depth, compression rate, interruption time, and Emergency Medical Services (EMS)-related time intervals. Robust regression analysis adjusted for age, sex, dominant hand, height, and weight was performed.

The mean age of participants was 20.13 (SD = 1.81) years, and 54.1% were female. The CPR Quality Score was significantly higher in the V-CPR group than in the T-CPR group (median difference −47; 95% CI, −60 to −36; P < .001). The V-CPR group demonstrated greater mean compression depth, higher proportions of compressions within recommended rate and depth ranges, and shorter interruption times between compressions. The T-CPR group showed shorter time from case recognition to EMS call, while the interval from dispatcher contact to CPR initiation was similar between groups. In multivariable robust regression analysis, allocation to the V-CPR group remained independently associated with higher CPR Quality Score and improved compression performance metrics.

Video call-assisted dispatcher guidance incorporating simultaneous real-time visual demonstration significantly improves CPR quality in untrained lay rescuers compared with voice-only guidance. These findings suggest that structured visual modeling integrated into DA-CPR systems may enhance bystander resuscitation performance and help bridge gaps in community CPR training.

Mass gathering events represent complex operational environments that challenge emergency preparedness and prehospital medical response systems. Milano Pride, Italy’s largest LGBTQIA+ event, attracts over 300,000 attendees annually and combines a dynamic parade with a high-density static concert. This study reports a 3-year experience (2022-2024) of prehospital organization, operational deployment, and patient presentation patterns during the event.

A retrospective observational study was conducted using data from medical action plans, mission reports, and patient records collected during the final day of Milano Pride from 2022 to 2024. The integrated response system included 6 Basic Life Support ambulances, one Advanced Life Support unit, foot and bicycle rescue teams, a field hospital, and a centralized command center.

A total of 165 missions were recorded across the 3 editions. Most cases were minor and managed on site; 8-20% required field hospital care and ≤7% hospital transport. Substance- and alcohol-related presentations accounted for approximately one quarter of cases annually. Trauma-related cases decreased over time. The mean patient age was 32 years, and the medical incident rate (0.17-0.20 per 1,000 participants) was lower than rates reported for comparable international events.

A structured, multidisciplinary prehospital system ensured effective on-site care while minimizing hospital impact, highlighting the importance of proactive planning and coordinated response in large urban mass gatherings.