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Daily scan
Paramedic research, 22 September 2026
19 new paramedic and prehospital papers from the 22 September 2026 scan.
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Prehospital antibiotics earlier in sepsis
Thai observational cohort of 364 adults with suspected sepsis testing prehospital antibiotics — prehospital administration was associated with lower adjusted 28-day mortality (ARR 8.9%, 95% CI 0.8–17.1; aOR 0.51) and antibiotics ~125 minutes sooner, but scene times ran 8.5 minutes longer.
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Traumatic arrest in older adults
French national registry study of 5,595 traumatic cardiac arrests comparing older (≥65) with younger adults — older patients achieved ROSC more often (22.5% vs 18.6%) but 30-day survival was lower (0.5% vs 1.2%), leading the authors to argue age alone shouldn't preclude resuscitation though a concurrent medical cause should be sought
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Smartphone CPR app: ROSC up, survival not
Before–after study of 615 OHCA patients after the MySOS smartphone bystander-CPR app launched in Bangkok — post-implementation ROSC probability rose ~6 percentage points, but 24-hour and discharge survival showed no significant improvement
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Bystander CPR benefits greatest in deprived areas
Analysis of 184,727 Korean OHCA cases found bystander CPR rates were lowest in the most deprived regions, yet its association with good neurological outcome was strongest there (aOR 1.56 vs 1.31–1.34 in better-off regions)
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In-hospital arrests in resource-limited Somalia
Prospective study of 240 in-hospital arrests in a Mogadishu ED — ROSC 5.8%, survival past 24 hours 1.3%, with CPR initiation documented in only 15% of cases, underlining system gaps rather than treatment questions
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Causal model for prehospital blood trials
Methodology paper building an expert-refined causal model for prehospital blood transfusion trials in traumatic haemorrhagic shock — maps confounders (system times, training, units available) and mediators so future studies can actually isolate a treatment effect against crystalloid
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Whole blood during prolonged entrapment rescue
Case report of an entrapped trauma patient after a motor vehicle collision receiving advanced airway management, finger thoracostomies and multiple units of low-titre O-positive whole blood during a prolonged multi-agency extrication — the blood came via the regional prehospital program supporting a physician response team
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Paediatric air medical intubation performance
US national cohort of 1,040 paediatric air medical intubations — 86.5% first-pass success overall but only 69.1% in infants under 1, with ketamine the commonest induction agent and substantial site-to-site variation
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VAPOX preoxygenation in ED intubation
Australian retrospective cohort of 116 patients intubated with ventilator-assisted preoxygenation (VAPOX) in two EDs — 78% achieved first-pass success without hypoxaemia, but half had at least one complication and 36% became hypotensive after intubation
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Post-arrest biomarker platforms don't agree
Platform-comparison study of post-arrest HIBI biomarkers (GFAP, Nf-L, tau, UCH-L1) — lab-grade analyser results correlated highly with each other, but the point-of-care i-STAT agreed poorly, so prognostication thresholds can't be shared across devices
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SGLT-2 inhibitor hypoglycaemic ketoacidosis
Case report of severe hypoglycaemic ketoacidosis in an SGLT2 inhibitor user requiring insulin — a reminder these agents can produce ketosis with atypical glucose readings that muddle the diabetic-emergencies picture
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Aortic emergencies: HR/BP drugs in transport
Cohort of 1,530 aortic emergencies in US critical care transport — esmolol, labetalol and nicardipine strategies hit HR/BP targets at similar rates, with esmolol alone showing the highest hypotension incidence (9.3%) and labetalol alone the lowest (2.1%)
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Medetomidine withdrawal transfers on dexmedetomidine
Cohort of 100 interfacility transfers on dexmedetomidine infusions for medetomidine withdrawal — transports were largely uncomplicated but profound hypertension was common (39%), reflecting the growing US opioid-supply adulterant problem
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Intranasal dexmedetomidine paediatric sedation
Townsville cohort of 114 children given intranasal dexmedetomidine for ED procedural sedation — effective as a sole agent in 78%, adverse events in 13% (mostly mild bradycardia), but ED stays ran long at a median 395 minutes
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IMPACC paramedic model cuts ED transport
Evaluation of 7,382 encounters under Toronto's IMPACC model, which lets specially trained paramedics redirect lower-acuity 911 callers — activated encounters had transport rates of 36% vs 82% for others (still 43% vs 79% after matching) but added roughly 24 minutes on scene, with 4% re-contact at 72 hours
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US border counties: more trauma, more delays
Comparison of 421,877 EMS encounters in US border versus matched non-border counties — border areas carried more severe trauma and environmental exposures (25.5% vs 8.2%) alongside larger response and scene delays
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How to write medicolegal statements
Practical guide on the statement types Australian emergency clinicians may be asked to provide for police, coroners and criminal proceedings — they're statements of fact rather than opinion, and structure and clarity matter
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48-hour AF cardioversion threshold abandoned
EMA commentary arguing the once-conventional 48-hour elective cardioversion threshold for recent-onset atrial fibrillation is no longer supported
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Guideline updates changed prehospital birth care
A 13-year French registry of 3,473 unplanned out-of-hospital births attended by 79 EMS centres found guideline dissemination drove practice change — more prophylactic oxytocin, less routine suctioning — but response times lengthened and neonatal thermal protection worsened.