Paramedic Papers Daily — 16 October 2026

Nine new papers today — here are the top four. Paper one — in traumatic cardiac arrest, electrical activity at the scene is the sign of life that matters most. Paper two — prehospital pain gets assessed and documented in fewer than half of patients. Paper three — a ten-year review of paediatric trauma retrievals in New South Wales found helicopter launch times have slipped. Paper four — one in five patients crews transport spend six hours or less in hospital and get no intervention at all.

Paper one — The Journal of Emergency Medicine. A retrospective analysis of a Japanese cardiac arrest registry, four hundred and sixty-two adults in traumatic arrest with no pulse when paramedics arrived. Overall, just four point eight per cent survived beyond the emergency department. But where cardiac activity and spontaneous breathing were both present at the scene, a quarter survived — twenty-five per cent. With cardiac activity alone, eight and a half per cent. And among the three hundred and eighteen patients — nearly seventy per cent of the cohort — with no signs of life at all, nobody survived. The caveat: it's a descriptive retrospective analysis, and survival beyond the ED is a low bar — no discharge or neurological outcomes here. Still, for crews weighing how long to work a traumatic arrest, scene electrical activity is the number doing the talking.

Paper two — a systematic review in the Medical Journal of the Islamic Republic of Iran. Eight observational studies of prehospital pain assessment, and the headline is blunt: pain was assessed and documented in only twenty-two and a half to forty-seven per cent of patients. Where pain management did happen, pain scores came down — but the studies were too different to pool the numbers. The obvious limitation is eight heterogeneous studies with no quantitative synthesis. But the picture should feel familiar here in Australia — pain scales and documentation are standard across Australian services, so this gap is a practice gap, not a kit gap.

Paper three — Air Medical Journal, and this one's home grown. A ten-year review of paediatric trauma retrievals by the New South Wales specialist paediatric transport service, helicopter missions from twenty-ten to twenty-nineteen. Teams left base in a median of ten minutes by day and seventeen at night. But the time between the team leaving base and the helicopter launching got worse after operational changes in twenty-seventeen — from a median of seventeen minutes to thirty. And once the patient was stabilised at the referring hospital, teams took more than ten minutes to depart in eighty per cent of missions. It's single-service retrospective data ending in twenty-nineteen with no patient outcomes, so read it as systems feedback rather than a safety signal.

Paper four — BMJ Open, a population-based cohort from Denmark. Nearly ninety thousand emergency calls over two years. Fifteen per cent of patients weren't conveyed at all. Of the eighty-five per cent who were transported, about one in five spent six hours or less in hospital with no documented procedure, medication or imaging — and their short-term mortality was just zero point four per cent, versus one point three per cent for longer stays. The caveats matter: three-day mortality only, one Danish region, and a short stay doesn't mean the transport was unnecessary — reassurance and a safe discharge count for something too.

Quick recap. One — scene cardiac electrical activity is the sign of life that predicts survival in traumatic arrest. Two — prehospital pain assessment still happens in fewer than half of patients. Three — paediatric retrieval launch times in New South Wales have drifted slower since twenty-seventeen. Four — one in five transported patients leave hospital within six hours with no intervention.

That's the roundup for Friday the sixteenth of October. Five more on the dashboard today, including self-presenting STEMI patients faring worse, mobile stroke units, and helicopter overtriage in burns. Back tomorrow.