Paramedic Papers Daily — 29 October 2026

Ten new papers today — here are the top four. Paper one — a systematic review finds prehospital trauma analgesia safe and effective across all four drug classes Australian crews carry. Paper two — trauma patients who aren't taken to a major trauma centre have a nineteen per cent higher risk of dying in hospital. Paper three — calcium derangements are common in trauma patients on arrival, and prehospital blood may be part of the picture. Paper four — a prehospital blood pressure of one hundred and eighty or higher is linked to worse recovery after severe stroke.

Paper one — Emergency Medicine Australasia. A systematic review of seventeen studies covering more than seventeen thousand injured adults. The question — are the drugs given for pain on the way to hospital actually safe and effective? Four agent classes — opioids, ketamine, methoxyflurane and paracetamol. All four showed effectiveness to varying degrees. Apart from one opioid study, there were no drug-attributed serious adverse events anywhere. Nausea, dizziness and drowsiness were common, but nothing serious. All four are standard kit across Australian services, so this is directly reassuring for practice in Australia. The caveat — only six of the seventeen studies were randomised trials; most of the evidence is retrospective or observational. Bottom line — it supports what crews already do.

Paper two — Surgery. A retrospective cohort study from Pennsylvania — just under fifty-nine thousand injured adults from a statewide discharge database. Undertriage here means patients who met field triage criteria for a major trauma centre but were taken somewhere else first. That happened to fifty-three per cent of them. After adjusting for injury severity and other factors, undertriage came with a nineteen per cent higher relative risk of dying in hospital. Patients over sixty were also less likely to be discharged home. The number that jumps out at me is that undertriage rate — more than half. The caveat — this is administrative claims data with coded criteria, which can misclassify both triage status and injury severity. Still, it's the same destination question Australian crews weigh up on every major trauma.

Paper three — The American Journal of Emergency Medicine. A preplanned subanalysis of a prospective multicentre study — one thousand and forty-seven trauma patients brought in by ambulance to three US trauma centres. On arrival, two hundred and thirty-five were hypocalcaemic and thirty-nine were hypercalcaemic — and both groups had lower survival. Of the hundred and thirty-six patients who received prehospital blood, roughly fifty-seven per cent were hypocalcaemic on arrival. And five of the hypercalcaemic patients had been given calcium before hospital — a hint of possible iatrogenic harm. Prehospital blood is still limited to a few Australian services, and calcium isn't something Australian ambulances carry, so this informs the debate more than day-to-day practice. The caveat — the sickest patients were the ones given blood, which confounds the comparison.

Paper four — the Journal of Stroke and Cerebrovascular Diseases. A retrospective Japanese cohort — one thousand one hundred and six stroke patients with large vessel occlusion, all transported by ambulance, average age seventy-nine, sixty per cent treated with thrombectomy. A prehospital systolic of one hundred and eighty or higher, compared with under one hundred and twenty, nearly halved the odds of a good functional outcome at ninety days — adjusted odds ratio zero point four three. The link held in the thrombectomy patients but not in the others. Bleeding complications were similar across the blood pressure groups. The caveat — it's retrospective, and no prehospital blood pressure treatment was actually tested, so management implications are unproven. What it does suggest — that scene blood pressure reading matters more than it might seem.

Quick recap. One — prehospital trauma analgesia looks safe and effective across all four drug classes. Two — field undertriage in major trauma carries a nineteen per cent higher risk of in-hospital death. Three — calcium derangements on arrival are common in trauma and linked to lower survival, with prehospital blood part of the picture. Four — a prehospital systolic of one hundred and eighty or more predicts worse recovery after large vessel occlusion stroke.

Six more on the dashboard today, including central venous access during cardiac arrest, a CT stroke unit model, and fatigue among helicopter air ambulance pilots. That's the roundup for Thursday the twenty-ninth of October. Back tomorrow.