Paramedic Papers Daily — 17 October 2026

Ten new papers today — here are the top four. Paper one — a point-of-care blood test detected brain haemorrhage in comatose patients with ninety-seven percent sensitivity. Paper two — bystander CPR started within three minutes of collapse carried triple the odds of a good outcome versus a ten-minute delay. Paper three — school cardiac arrests from chest impacts did strikingly well when an AED arrived fast. Paper four — the prehospital qSOFA score flags sicker sepsis patients, but adds almost nothing to what the hospital already measures.

Paper one — JAMA Network Open. A diagnostic accuracy study from a UK doctor–paramedic helicopter service tested a point-of-care blood test for intracranial haemorrhage in comatose patients. Sixty-five adults with a Glasgow Coma Scale score of twelve or less, all with suspected bleeding on the brain and already undergoing rapid sequence induction by the crew. The GFAP test picked up ninety-seven percent of the haemorrhages confirmed later on CT, with an area under the curve of zero point nine four — strong for a bedside test. Half the patients had a bleed, thirteen went to neurosurgery, and thirty-day survival was forty-six percent. The catch: this is a small, highly selected cohort from a doctor-staffed helicopter service. Point-of-care brain biomarkers aren't something Australian ambulances carry, and adoption here would need a guideline change and a very different crew model. Promising, but early days.

Paper two — Resuscitation Plus. A time-to-event analysis of Japan's national out-of-hospital cardiac arrest registry — fifty-six thousand and eighty-two witnessed, non-traumatic arrests. During the pandemic, the overall bystander CPR rate barely moved, sitting at about fifty-nine percent before and after. But the timing slipped — people took longer to start compressions. And timing matters enormously. CPR started within three minutes of collapse carried more than three times the odds of a favourable neurological outcome at one month compared with CPR started after ten minutes. Start between four and seven minutes and the odds were still well over double. It's an associative, pandemic-era comparison, so confounding can't be ruled out — but with data this size, the message lands for Australian communities: every minute of delay costs brain.

Paper three — Acute Medicine and Surgery. A nationwide Japanese database of cardiac arrests in schools, reconstructed over fifteen years, found thirty sports-related arrests from external causes. Commotio cordis — the chest impact rhythm — led the list with fifteen cases. In those, AED pads went on in ninety-three percent of cases, shocks were delivered in eighty-seven percent, and eighty percent survived with good brain function. Among the other fifteen cases, mostly drownings, shocks were rare — seven percent — and just seven percent had good outcomes. Thirty cases in fifteen years, so it's descriptive and can't prove the defibrillator programmes caused the gap. But it's a clean illustration that a fast public-access AED turns a usually fatal rhythm into a survivable one — the exact landscape Australian crews work within on school ovals and sporting grounds.

Paper four — Journal of Clinical Medicine. A Turkish retrospective cohort of one thousand and seventy-seven adults transported by ambulance with suspected infection asked a simple question: does the qSOFA the crew already calculate add anything for the receiving hospital? Within every emergency department triage group, a prehospital qSOFA of two or more roughly doubled the odds of death within thirty days. So there's real prognostic signal in the field score. But added to the hospital's own arrival vitals and labs, it shifted the discrimination measure by just zero point zero zero seven — essentially nothing. And it was a single centre that excluded nearly sixty percent of eligible patients, so selection bias is a serious risk. Useful as a flag on the handover, not a practice-changer.

Quick recap. One — a point-of-care GFAP blood test detected brain haemorrhage in comatose patients with ninety-seven percent sensitivity. Two — bystander CPR started within three minutes tripled the odds of a good neurological outcome versus a ten-minute delay. Three — school commotio cordis cases reached eighty percent good outcomes when AEDs shocked early. Four — prehospital qSOFA predicts death in suspected infection but adds little beyond hospital vitals.

Six more on the dashboard today, including a review of prehospital chest pain risk tools and a study finding teamwork training showed no measurable gain.

That's the roundup for Saturday the seventeenth of October. Papers on the dashboard. Back tomorrow.