Paramedic Papers Daily — 22 October 2026

Fifteen new papers today — here are the top four. Paper one — dispatcher training and a volunteer responder app lifted bystander CPR in France. Paper two — real-time feedback tightens bag-valve-mask ventilation during arrest. Paper three — fatigue is the stand-out symptom a year after cardiac arrest. Paper four — pulse checks under five seconds roughly double the odds of ROSC.

Paper one — The Lancet Public Health. A stepped-wedge cluster-randomised trial across twelve French EMS agencies, sixteen hundred and eighty-four adults with non-traumatic out-of-hospital cardiac arrest. The intervention bundled dispatcher training in early arrest recognition, telephone-assisted compressions, and a smartphone app that dispatched trained volunteers to nearby arrests. Bystander CPR before EMS arrival rose from sixty-one per cent to seventy-one per cent. The catch — survival to discharge and neurological outcome didn't move, and the CPR effect wasn't significant once the researchers adjusted for underlying trends over time. Everything in that bundle — dispatcher training, telephone CPR, community responder apps — is live territory for Australian services, so the mechanism is worth watching, but more hands on chests hasn't yet bought more survivors.

Paper two — Resuscitation. A before-and-after study with the Paris Fire Brigade — four thousand three hundred ventilations across one hundred and sixty-three arrests. Basic life support teams bagging during thirty-to-two CPR got a display showing insufflated volume in real time. With feedback, sixty-eight per cent of breaths landed in the guideline four hundred to six hundred millilitre range, against forty-two per cent without. Volume variability dropped by about a third, and leak fell twelve per cent. Expired tidal volume — what actually reaches the lungs — barely changed, which is the honest caveat, and it's a single-system before-and-after design with no patient outcomes. The message for crews is that even experienced baggers over- and under-ventilate more than they think, and feedback fixes the visible part of that.

Paper three — Resuscitation, and this one's homegrown. A Victorian population-based cohort — seven hundred and twenty-eight survivors of out-of-hospital cardiac arrest interviewed twelve months down the track. Fatigue in thirty-six per cent, anxiety in twenty-three, depression in eighteen. Fatigue was the stand-out, sitting well above population norms. Heavier symptom burden tracked with worse quality of life, worse function and lower return-to-work rates. Younger survivors, those with pre-existing anxiety or depression, diabetes, and non-shockable initial rhythms fared worse. Symptoms were self-reported and roughly a third of eligible survivors were lost to follow-up. For Australian crews it's a reminder the job doesn't end at ROSC — fatigue may be the under-recognised part of survivorship.

Paper four — Resuscitation again. A two-hundred-and-fifty-two-patient multicentre study from Türkiye compared pulse checks finished inside five seconds with those running six to ten. Shorter checks came with roughly double the ROSC rate — thirty-six versus twenty per cent — plus healthier capnography: less end-tidal drop during the pause, and faster recovery afterwards. Big caveat — patients were categorised rather than truly randomised, so quick checks may partly just mark arrests that were going well anyway. Still, it lines up with what guidelines already push — keep the pause under five seconds, and watch the capnograph through every check.

Quick recap. One — dispatcher training plus a volunteer app lifted bystander CPR in France, without a survival gain yet. Two — real-time feedback tightens bagging volumes during arrest, though expired volumes didn't move. Three — a year on, over a third of Victorian arrest survivors report fatigue above population norms. Four — pulse checks under five seconds doubled ROSC odds in the Turkish data.

Eleven more on the dashboard today, including the AED pad application bottleneck, prehospital whole blood's first two years, and point-of-care troponin cutting ED visits.

That's the roundup for Thursday the twenty-second of October. Papers on the dashboard. Back tomorrow.